Facial Flushing and Rosacea: Symptoms, Causes & Treatment
Facial redness that flares and won't settle may be rosacea, not simple flushing. A Seoul dermatologist covers symptoms, triggers, diagnosis and treatment.
This is an English adaptation of a clinical article Dr. SangYoul Yun — board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul — originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers; all references are the author's own.
Do you have facial redness that flushes even more in certain situations, and do you often feel under stress? According to a 2021 paper, 19.6% of rosacea patients experience depression and 15.6% experience anxiety — at least twice the rate in the general population.1 This is a condition that can genuinely wear people down. Today, let's look at rosacea.
What is rosacea?
When I tell a patient they have "rosacea" (in Korean, jusa), many are taken aback — "but I hardly drink!" The Korean term uses characters meaning a nose that reddens as if from drinking. In reality, rosacea may or may not be related to alcohol.
Rosacea is a chronic, inflammatory skin disease. Its characteristic features are:
- Flushing — persistent (not merely transient) erythema
- Papules and pustules
- Telangiectasia — visible dilated vessels
- Rhinophyma — phymatous (thickening) change of the nose
It may also be accompanied by itching and a burning or stinging sensation.
Causes and aggravating factors
The cause and pathophysiology of rosacea are not fully understood, but abnormal vascular regulation, immune imbalance, Demodex (mite) infestation and sun exposure are thought to be aggravating factors. It is also associated with genetic factors, endocrine abnormalities, local infection, vitamin deficiency, caffeinated drinks and alcohol.
Diagnosis
Rosacea is diagnosed using the features defined by the ROSacea COnsensus expert panel (ROSCO) and the National Rosacea Society (NRS).2 A phymatous change of the nose or persistent centrofacial erythema is a primary diagnostic feature. If these are absent, a diagnosis can be made when two or more major features are present. Major features include flushing / transient erythema, papules and pustules concentrated in the central face, and conspicuous telangiectasia on the nasal ala and central face.
The four clinical types
Rosacea has four clinical forms:
| No. | Type |
|---|---|
| 1 | Erythematotelangiectatic type |
| 2 | Papulopustular type |
| 3 | Phymatous type |
| 4 | Ocular rosacea |
It can occur in both men and women from the teenage years onward, is common in the 30s–50s, and tends to be more severe in men. In the erythematotelangiectatic type, only intermittent flushing appears early on, sometimes with stinging or a burning sensation lasting from hours to days. For a deeper look at how the types differ and how each is treated, see our fuller guide: Rosacea's four types — accurate diagnosis and evidence-based treatment.
Trigger factors
The number-one trigger for rosacea is sun exposure. Other major triggers are emotional changes, hot weather, alcohol, and spicy or hot food. For this reason, rosacea patients need lifestyle adjustments to avoid these conditions as much as possible.
Treatment
Medications
- Topical agents: metronidazole (Metrogel, Rozex gel); pimecrolimus (Elidel); and, for papulopustular rosacea, ivermectin (Soolantra) — applied once daily.
- Systemic therapy: oral antibiotics and isotretinoin.
Laser treatment
For dilated capillaries, pulsed dye laser and IPL are used. In clinic we treat this with the Vbeam pulsed dye laser, and Laser Genesis can help with background redness in sensitive skin.
Rosacea is a chronic condition that can bring on depression and anxiety. Treatment requires identifying the patient's skin type and, based on that, taking a combined and repeated approach — oral medication and topical agents alongside repeated laser treatment. Lifestyle correction is essential: avoid heat, excessive sun, alcohol, and hot or spicy food.
References
- Dermatol Ther. 2021 Dec;11(6):2089–2105.
- Rosacea: An Update in Diagnosis, Classification and Management.
Medical disclaimer. This article is general information and does not replace individual consultation. Rosacea is a chronic condition where differential diagnosis matters, so diagnosis and treatment should be decided after an in-person consultation with a dermatologist. Prescription medicines (antibiotics, ivermectin, isotretinoin, etc.) require a doctor's care.
Notice: The information in this article is for general educational purposes only and does not constitute medical advice. Individual treatment plans are determined through personal consultation with a board-certified dermatologist. Results may vary.
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