The best way to treat rosacea, by those who know first-hand

Rosacea is one of those skin conditions that can drive you to despair. It’s not properly understood, prone to flaring up unprovoked and capable of making sufferers feel awful about their skin. Those with rosacea often spend their lives trying to manage the red flushes, dilated veins, an uncomfortably hot and prickly face and upsetting acne-like bumps.

What is rosacea?

A chronic and incurable condition, it’s more common than you think (up to one in ten people are thought to have it, although for many, it’s low-level and not all that noticeable), and often exacerbated by age (women over 40 are particularly prone to it). It’s influenced by both genetic and environmental factors, such as stress and diet. “I don’t believe you just wake up with rosacea one day,” says consultant dermatologist Justine Hextall. “I find that it is very often a skin manifestation of a systemic issue – a confluence of events that eventually presents in the skin.”

That sounds fiendishly tricky to unpick but there is hope. You can definitely minimise rosacea by adopting the right habits and strategies - none of them particularly complicated, nor necessarily expensive. Here, three rosacea sufferers reveal how they keep their skin under control and Dr Hextall tells us what she’s learned from treating her rosacea patients.

The makeup artist: “Stress is a real trigger for me, and my emotional wellbeing (or lack thereof!) can quite literally be written all over my face"

Rose Gallagher, 33, is a beauty content creator and journalist who’s been sharing the trials and tribulations of dealing with her rosacea on Instagram for years – her page has become a go-to for sufferers (and for fans of her make-up artistry).

My rosacea history

“I’ve been rosy for as long as I can remember, as evidenced by the red cheeks you can see in my childhood photos. I used to wear a full-coverage concealer to secondary school, so I was always aware of it. But the issues with my skin's texture got worse when I moved to London in 2018. That’s when I was diagnosed.

“My rosacea shows up in two ways: one, a permanent flushing of my cheeks and nose in a typical butterfly shape across the centre of my face. It becomes more noticeable if I’m hot or cold. And two, red texture that could be mistaken for acne. This tends to be the most aggressive on my upper cheeks and can flare up if I don’t stick to my regular habits. I tend to be able to minimise this for the most part with prescription creams.

The things that make my rosacea worse

“Stress is a real trigger for me, and my emotional well-being (or lack thereof!) can quite literally be written all over my face. Certain foods can have an impact, and sugary things will often bring out a flare-up. Temperature is also something my skin is very sensitive to, and a room that is slightly warmer or colder than normal will instantly cause my skin to flush. More often than not, I do everything right and then I wake up one day and it has flared up with no rhyme or reason. I can have a weekend of partying and have completely clear skin, and then the weeks that I’ve exercised, eaten well, slept like a baby and rested, I have the battle of Hastings happening on my face!

My lightbulb moment in understanding my rosacea

“The first time I saw a dermatologist (I now see the exceptional Dr Emma Wedgeworth). She completely overhauled my skincare routine. Back then, it was filled with harsh exfoliants in a bid to try and smooth the texture. Now I know that they were simply hammering my already-compromised skin barrier. Once I kept things super simple - cream cleanser, rich moisturiser, daily SPF - and removed all oils (another previous favourite), I saw a big reduction in redness.

“My next revelation, having tried metronidazole [an antibiotic] initially as my prescription cream, was introducing azelaic acid instead. To this day, this is the single most effective ingredient I’ve found in managing my own skin. It drastically reduces my red texture and is the key to calming down a bad flare-up.

My lifestyle adjustments to manage rosacea

“I never take a hot shower or go for a long walk without applying a thick layer of moisturiser beforehand. It makes all the difference between ending up with a slight flush or a completely overpowering redness.

“I generally avoid harsh exfoliants, oils and retinol, and try to opt for fragrance-free things where possible. This said, sometimes the fragrance-free police are perhaps a bit too frightened of scent. Some of my favourites do have a hint of it!

The skincare that helps manage my rosacea

“Prescription azelaic acid is my number one favourite thing. I’ve used the at-home skin treatment for rosacea by online dermatological prescription service Skin&Me for over a year, and it is fantastic.

But there are many cosmetic products that make a real difference. The French pharmacy brands, such as La Roche Posay, are go-tos – many of these have specialised redness franchises. But a good tip is to check out their barrier repair franchises as well – quite often, I see better results from them than from the anti-redness products.

Cleansers for rosacea

• La Roche Posay Toleriane Dermocleanser, £15, and Sensitive Micellar Water, £14
• Avene Gentle Eye Makeup Remover, £12.75
• Elemis Pro Collagen Naked Cleansing Balm, £48. I know balms are seen as the devil for rosacea as they are so oil-rich but this one is very comfortable.
• Soft, microfibre flannels. I go very, very gently with them but it means I can remove my full-coverage makeup quickly and without too much distress.

Serums for rosacea

• Vichy Mineral 89 Hyaluronic Acid Hydrating Serum, £26
• The Inkey List Super Solutions Azelaic Acid Serum, £15.99. It’s the best one I’ve found that you can buy without a prescription.

Moisturisers for rosacea

• SkinCeuticals Epidermal Repair, £80 - an investment but very good to speed up the calming of a bad flare
• Avene Tolerance Hydra10 Hydrating Cream, £18
• La Roche Posay Toleriane Dermallergo Night Cream, £21
• CeraVe AM Facial Moisturiser SPF50, £16.50 - for dry skin days
• La Roche Posay Anthelios UVmune 400 Invisible Fluid SPF50, £19

Makeup for rosacea

• IT Cosmetics CC+ Cream SPF50+, £36.50. It’s been my favourite everyday base for years.
• L’Oreal Paris Infallible Foundation, £11.99, - a more affordable option
• Dr. Jart Cicapair Tiger Grass Colour Correcting Treatment, £38, - great for no makeup days
• IT Cosmetics Bye Bye Pores Loose Powder Translucent, £30 - helps keep makeup in place when my skin gets hot to the touch.

The self-taught skin expert: "I just thought I just had rosy cheeks"

Lucy Partington, 32, is a beauty journalist and influencer whose passion for skincare was driven by her desire to sort out her ruddy cheeks. The more she learned, the better her skin got.

My rosacea history

“My rosacea definitely isn’t as severe as some types although I flush quite easily, especially during facials, and I have certain triggers (mostly wine and champagne). I’ve always had it, but for ages I just thought I just had rosy cheeks – people would forever comment on them when I was growing up. Then, when I started working in beauty, a few people mentioned I might have rosacea but it was consultant dermatologist Dr Justine Kluk who finally diagnosed it in around 2018.

My lightbulb moments in understanding the condition

“The visit to Dr Justine opened my eyes. Before that, I was half-heartedly using anti-redness serums which didn’t really do a lot. But she prescribed me Skinoren (a 20% azelaic acid cream) that made a world of difference. Since then, I’ve taken a gentler approach to my skincare routine and the treatments that I have, and I try not to let the redness stress me out as much as it used to do. It’s just a part of me, and although it has dramatically improved over the last few years, it’s probably something I’ll always have.

My lifestyle adjustments and skincare tricks to manage rosacea

“I now always have a tube or two of Skinoren in my stash, I buy it online from The Independent Pharmacy. I’ve switched from AHAs to PHAs(polyhydroxy acids) because they’re much gentler and don’t trigger my skin as much as alpha-hydroxy acids do.

I’ve also been having regular laser facials at the D Thomas Clinic - I’ve seen such a big improvement after seven or eight sessions. It’s important to get just the right laser and light treatments for your skin concern; if not, things will get worse. Laser therapist Debbie Thomas uses yellow laser and light wavelengths (which are attracted to red pigment in the skin) on me: IPL with yellow filters and the Fotona SP Dynamis laser to zap dilated veins, calm the redness and inflammation, and destroy the parasites that are thought to set off rosacea.”

The gut and emotional health doctor: "Healing took me ten months but my rosacea never came back"

Dr Radka Toms, 48, of mysugarstop.com, specialises in integrative nutrition, functional medicine and ophthalmology. Her energy, metabolic health and gut health-boosting programmes have helped numerous people, including herself, control their rosacea.

My rosacea history

“When my mum died young, I vowed to become a doctor to help others and make her and my dad proud – and worked so hard to achieve my goals that I ended up physically, mentally and emotionally exhausted. My metabolic and gut health collapsed and, in my thirties, my face exploded with rosacea - the serious kind, with angry veins and pustules disfiguring my face. I had been ignoring warnings my body had been giving me and my system had had enough, with my skin suffering the visible consequences. For about two years, I could not look in the mirror and went down a negative spiral, with my self-confidence taking a bad hit. Healing took me ten months but my rosacea never came back.

My lightbulb moment in understanding my problem

“Around 2012 I learned about functional medicine and realised there must be a way to heal myself, without just subduing my symptoms with medication. I focused instead on the root causes of my issues. I studied everything I could find on the gut microbiome, nutrition, inflammation, autophagy (the body’s ability to upcycle old and damaged cells), the power of mindset, meditation, and so on. And it was an article by Professor Robert Lustig linking sugar directly to inflammation that flicked a switch. Most of the biochemical pathways that control homeostasis (physiological equilibrium) are controlled by nutrition. Many chronic diseases can be stopped and often even reversed through nutrition and achieving balance in the body, and that includes rosacea. I decided to heal it from the inside out.

The lifestyle adjustments that made my rosacea disappear

“I switched to an anti-inflammatory and gut-optimising diet. I cut out all refined sugar (including refined carbs and alcohol), limited my dairy intake, and piled my plate with a rainbow of vegetables, nuts, seeds, beans and pulses full of healing polyphenols and omega 3 and 6 fatty acids. To optimise my digestion and to create balance overall, started practicing daily yoga, meditation, and breathing techniques, and I do intermittent fasting. Hot and cold therapy – think ice baths – is great too, as it strengthens the system and the body’s ability to heal.

“At the same time, I realised I had to work on a healing mindset, practise self-love and focus on gratitude, as thoughts and stress can be as inflammatory as physical damage and toxins. I told myself I could do this, but also to be happy with what was. Gradually, my rosacea disappeared.

“Today, I encourage everyone to see rosacea as a gift – it gives us an opportunity to explore what is out of balance in our bodies and what needs our attention. The power of mind, food as medicine, and a healing lifestyle are what subdued my rosacea, and I believe they can help anyone.”

The dermatologist’s view: 'It is not uncommon to see rosacea mistaken for acne"

Consultant dermatologist Dr Justine Hextall specialises in skin cancer surgery, acne and rosacea, and takes a holistic approach to skin diseases, treating many rosacea sufferers. She is a spokesperson for La Roche Posay.

The skin-brain-gut axis is the key to treating rosacea

“My lightbulb moment when it comes to rosacea came at a dermatology lecture in 2016. A physician talked about the gut microbiome and its link with skin and the brain, and how inflammation affects this connected system. I could immediately see the relevance to rosacea, and it inspired me to write a holistic treatment plan for my rosacea patients.”

Antibiotics are not the best option for rosacea

“I will take a very careful history and look at common triggers: gut issues, stress levels, history of antibiotic use and day-to-day skincare. Depending on the presentation of rosacea I will vary my prescription medications, but I almost never prescribe antibiotics.  What I will frequently do is start the patient on probiotic supplements and encourage a prebiotic diet to feed a healthy gut.

Stress must be addressed

“If stress is a trigger, this should ideally be tackled to give a sustainable solution. I work with an amazing therapist who helps to support individuals with stress and other mental health issues.

Some procedures can be a great help for rosacea

“LED light therapy will calm and strengthen skin over time. Intense Pulsed Light (IPL) and vascular lasers [those with wavelengths attracted to redness] will tackle the telangiectatic [spider veins] element of this condition, reducing flushing and persistent redness. Mesotherapy and skin boosters [such as Profhilo] increase hyaluronic acid in the skin to help support hydration.”

Skincare underpins skin health for those with rosacea

“Protection against UV and pollution is vital, and I will manage this with the most effective SPFs in combination with anti-oxidants. It is not uncommon to see rosacea mistaken for acne but the topical treatments for acne will usually exacerbate rosacea. The right skincare in rosacea must hydrate and soothe the skin and help to build a more robust skin barrier. Ingredients to look for include azelaic acid – it helps to reduce inflammation and support a healthy skin barrier. Niacinamide is anti-inflammatory and reduces post- flare skin marks and pigmentation. Ceramides help to seal in hydration, making the skin robust and less prone to sensitivity. Humectants such as hyaluronic acid and glycerin help to draw moisture to the skin - perfect for rosacea-prone skin when used under or as part of a light, effective moisturiser.”

Dr Justine Hextall’s skincare picks for rosacea-prone skin

Cleansers

I recommend only the gentlest cleansers – La Roche Posay Toleriane Dermocleanser, £22, is a favourite. Others include CeraVe Hydrating Cleanser with Hyaluronic Acid, £11.50, and Cetaphil Gentle Skin Cleanser Wash, £9.99.

Hydration

A humectant serum helps trap moisture in the skin before applying a moisturiser. I am very interested in new La Roche Posay Cicaplast B5 Serum for Dehydrated Skin, £39: it has 10% soothing panthenol (vitamin B5), which is intensely hydrating and has been shown in studies to help to support the skin barrier and reduce moisture loss.

I recommend applying La Roche Posay Toleriane Dermallergo Soothing Cream, £19.50, over this to seal in the moisture. It has a neurosensine peptide that helps reduce the burning and stinging that those with a weakened skin barrier can suffer from.

SPFs

I cannot over-emphasise the importance of good-quality, high-factor broad-spectrum SPF. I love La Roche Posay UVmune 400 as it protects even against longer UVA wavelengths. I also like SkinCeuticals Mineral Radiance UV Defense 50, £45 - highly effective and has a light-reflective tint that helps hide redness. I also recommend Heliocare 360 Mineral Tolerance Fluid SPF50, £31, for its broad-spectrum cover and Colorescience Sunforgettable Total Protection Brush-On Shield SPF50, £48.83 for great protection while concealing redness.

Troubleshooters

To tackle a flare up, I like soothing botanicals-packed SkinCeuticals Phyto Corrective Essence Mist, £55, directly from the fridge. If the skin is very red and sensitive, applying La Roche Posay Cicaplast Soothing Face and Body Balm, £15, before showering is a great idea. It’ll shield skin from shampoos and shower gels to effectively reduce that common post-shower flare.