There are some skin conditions we’re very familiar with: spots during adolescence, allergic rashes, sunburn. But others are less easy to diagnose, and could be quite a surprise, particularly if they suddenly pop up in your thirties or beyond.
Take rosacea, for example, which has symptoms that can mimic those of more familiar skin problems. ‘Rosacea is probably the most misdiagnosed skin condition I see,’ says Dr Emma Cunningham, founder of Dr Emma Clinics. ‘People often come in thinking they have acne or just sensitive skin. However, rosacea is a distinct condition with its own set of triggers and requires a very different approach to treatment.’
Emily West, an aesthetic nurse practitioner at Creo Clinic agrees, saying that people often think they have acne or eczema rather than rosacea. However, while it can cause bumps and spots, ‘unlike acne, it causes persistent redness, flushing and sensitivity – without blackheads,’ she explains. And it’s different from eczema because ‘it lacks intense itching and dryness but can still cause irritation.’ A key sign to look out for, she says, is ‘broken capillaries, especially around the nose and cheeks, which aren’t typical in acne or eczema.’
For the full lowdown on this common skin condition, we spoke to dermatologist Dr Mazin Al-Khafaji of dermatology-m.com.
Dermatologist Dr Mazin Al-Khafaji has shared his tips for dealing with rosacea
What are the symptoms of rosacea?
Rosacea is a chronic skin condition that always affects the face (specifically the forehead, cheeks, nose and chin and very occasionally the neck), causing redness, visible blood vessels commonly called spider veins telangiectasia), and sometimes small, red, pus-filled bumps (papules).
It often begins with episodes of flushing, where the skin temporarily turns red. This can happen when drinking hot drinks or food, after consuming alcohol, or going from a hot room to cold environment or visa-versa. It can also occur when the skin is exposed to sunlight or you’re embarrassed. Over time, the redness may become more persistent, and the blood vessels can become more noticeable. In rare cases, and almost exclusively in males, the skin may thicken, especially around the nose, leading to a condition called rhinophyma.
Rosacea can also cause a burning or stinging sensation, dryness, and sensitivity to skincare products. Some people experience eye symptoms, including redness, irritation, and swollen eyelids, known as ocular rosacea.
What causes rosacea?
While the exact cause is unknown, factors such as genetics, immune system response, and environmental triggers like sun exposure, poor diet. spicy foods, and stress can contribute to flare-ups.
Why is rosacea often misdiagnosed?
Rosacea is often misdiagnosed because its symptoms can resemble other common skin conditions such as acne, eczema, allergic reactions, or the auto-immune condition lupus.
The redness, pustular lesions and bumps, and inflammation associated with rosacea can be mistaken for acne (in fact rosacea used to be known as acne rosacea), leading to inappropriate treatments like harsh acne medications that may worsen the condition.
Papulopustular rosacea could be mistaken for acne.
Another reason for misdiagnosis is that rosacea presents in different ways. Some people experience persistent redness, while others have visible blood vessels, acne-like breakouts, or thickened skin. As symptoms vary, it can be difficult for inexperienced clinicians to recognise rosacea in its early stages.
Ocular rosacea, which affects the eyes, is sometimes mistaken for dry eye syndrome, conjunctivitis, or allergic conjunctivitis delaying the correct diagnosis.
Who is most prone to rosacea?
Rosacea can affect anyone, but certain factors make some individuals more prone to developing the condition.
People with fair skin, especially those of Northern or Eastern European descent, are at a higher risk. It is more commonly diagnosed in individuals with light skin that easily flushes or blushes. However, rosacea can also occur in darker skin tones, though it may be underdiagnosed due to less noticeable redness.
Genetics play a role, as rosacea tends to run in families. If a close relative has the condition, there is a greater chance of developing it.
Age is another factor, with rosacea most commonly appearing in adults between 30 and 50 years old (unlike acne, which is most often seen in younger age groups).
Women are more likely to develop rosacea than men, but men often experience more severe symptoms, especially when it leads to thickened skin around the nose (rhinophyma).
Certain lifestyle and environmental factors can also increase the risk. People who are frequently exposed to sun, extreme temperatures, or high levels of stress are more prone to flare-ups. Alcohol consumption, spicy foods, hot beverages, and certain skincare products can also contribute to worsening symptoms in those who are already predisposed.
Rosacea most commonly develops between the ages of 30 and 50
Can rosacea appear at any time in a person’s life?
Rosacea can develop at any time in a person’s life, but it most commonly appears between the ages of 30 and 50. While it is less common in children and teenagers, it is not impossible for it to appear then. Some people may have mild, undiagnosed symptoms for years before experiencing noticeable flare-ups.
Certain factors can prompt or trigger the onset of rosacea, even in someone who has never had skin issues before. These triggers include:
• Genetics: If there is a family history of rosacea, a person may develop it at some point, especially when exposed to common triggers.
• Sun exposure: UV rays are a major trigger, and prolonged sun exposure can cause rosacea to appear for the first time or worsen existing symptoms.
• Hormonal changes: Pregnancy, menopause, or hormonal fluctuations can trigger rosacea in some individuals.
• Stress and emotional factors: Chronic stress, anxiety, or frequent blushing due to nervousness can contribute to rosacea development.
• Dietary factors: Junk food, spicy foods, alcohol (especially red wine), hot drinks, and certain histamine-rich foods can prompt symptoms.
• Extreme temperatures: Hot weather, cold weather, wind, and humidity can all irritate sensitive skin and trigger rosacea.
• Skincare and cosmetic products: Harsh skincare products, heavy makeup, or irritating ingredients like fragrances, and exfoliants can cause flare-ups.
• Medical conditions and medications: High blood pressure, gut health issues (such as H. pylori bacteria), and certain medications, including steroids and vasodilators, can contribute to rosacea symptoms.
How should you treat rosacea?
Treating rosacea requires a combination of skincare products, medicated treatments (I advise herbal treatment rather than the standard conventional treatment of antibiotics that can severely disrupt the gut microbiome), and lifestyle adjustments to manage symptoms and prevent flare-ups.
Stick to a simple routine with gentle cleansers, moisturizers, and sunscreen to avoid overloading your skin with potentially irritating products.
Skincare routine
- Avoid soap, scrubs, and exfoliating cleansers and use gentle hydrating cleansers that are mild, and non-foaming. I suggest using a cleanser that is gentle and helps restore the microbiome of the skin, an essential element of creating an equilibrium to the skin.
- Choose lightweight, non-comedogenic, and fragrance-free moisturizers.
- Use targeted medicated treatments such as Redness Reducing Tincture before applying moisturiser as it significantly reduces the presence of demodex mites. Demodex mites are microscopic parasites that naturally live on human skin, particularly in hair follicles and sebaceous (oil) glands. While they are present on almost everyone, research has shown that they are much more common in rosacea skin and play a role in triggering or worsening rosacea.
- Apply a broad-spectrum SPF 30 or higher sunscreen daily. Mineral-based sunscreens containing zinc oxide or titanium dioxide are preferred, as chemical sunscreens may cause irritation. Wearing a wide-brimmed hat and avoiding direct sun exposure can also help.
- Less is more when it comes to skincare. Stick to a simple routine with gentle cleansers, moisturizers, and sunscreen to avoid overloading your skin with potentially irritating products.
- Lukewarm water is best when washing your face. Hot water can increase redness and sensitivity, while cold water may cause irritation.
- Pat your skin dry instead of rubbing it with a towel. Use a soft, clean cloth to avoid friction and irritation.
- Be mindful of hair and shaving products. Some shampoos, conditioners, and shaving creams contain harsh ingredients that can trigger flare-ups if they come into contact with the face. Look for gentle, sulphate-free formulas.
- Test new products gradually. Introduce one new skincare or makeup product at a time to see how your skin reacts before using it regularly.
Lifestyle changes
- Identify and avoid triggers by keeping a rosacea diary to track flare-ups. Common triggers include spicy foods, alcohol (especially red wine), caffeine, hot drinks, stress, extreme temperatures, and sun exposure.
- Adjust your diet by reducing or eliminating junk food, foods high in histamines, such as aged cheese, and processed meats. Eating anti-inflammatory foods like leafy greens, oily fish, berries, and whole grains help support gut health, which is strongly linked to rosacea in Chinese medicine.
- Manage stress through meditation, yoga, deep breathing, or regular exercise to prevent stress-related flare-ups. Prioritising good sleep and relaxation techniques can also be beneficial.
- Be mindful of temperature control by avoiding hot showers, saunas, and steam rooms, which can trigger flushing. Using a humidifier in cold weather may help keep the skin from drying out.
Common rosacea triggers include caffeine and hot drinks.
Any advice for those who want to disguise rosacea with make-up?
For those who want to disguise rosacea with makeup, the key is to use gentle, non-irritating products that provide good coverage without making symptoms worse. Since rosacea-prone skin is sensitive, choosing the right formulas and application techniques is essential.
What to look for
- A green-tinted primer can help neutralise redness before applying foundation. Look for lightweight, fragrance-free products.
- Choose a gentle, hydrating foundation with ingredients like hyaluronic acid or ceramides. Liquid or cream foundations provide better coverage without emphasizing dryness.
- A full-coverage, lightweight concealer with a yellow undertone can help further cover redness.
- If setting powder is needed, opt for a finely milled, translucent powder that won’t settle into dry patches. Avoid heavy powders that can make skin look cakey.
- When using blush, choose soft peach or neutral shades instead of pink or red, which can enhance redness. Cream blushes tend to blend more seamlessly into rosacea-prone skin compared to powder blushes.
Application tips
• Apply makeup with a light hand to avoid making the skin look heavy and emphasizing texture.
• Dab rather than rub, using a damp beauty sponge to gently press foundation and concealer into the skin rather than rubbing with fingers or a brush.
• Use only as much product as needed, focusing on red areas rather than applying thick layers all over.
Things to avoid
• Makeup products containing alcohol, fragrance, or menthol, as these can trigger irritation and flare-ups.
• Matte or drying foundations, which can cling to dry patches and make redness more noticeable.
• Heavy powder application, as it can settle into fine lines and make skin look dull.
• Shimmery or glittery products on red areas, since they reflect light and can highlight redness.
• Makeup wipes, which can be too harsh for sensitive skin; instead, use a gentle, hydrating cleanser.
For best results, always apply makeup over a well-moisturised and sunscreen-protected base to keep skin hydrated and prevent irritation. Removing makeup gently at the end of the day with a mild cleanser and soft cloth is just as important for maintaining skin health.
