Rosacea causes flushing, persistent redness, visible vessels and spots on the central face. Treatment works, and which treatment works depends on which of those four you have. Redness and vessels respond differently from spots. A 30 minute consultation is £150.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Rosacea is a long term inflammatory condition of the central face. It runs through four features, flushing that comes and goes, redness that stays, visible small vessels, and inflammatory spots. Most people have some combination rather than all four.New England Journal of Medicine van Zuuren, 2017
It is not acne, although the spots look similar. There are no blackheads in rosacea, and treatments that work for acne can make rosacea worse. That distinction is the whole reason the diagnosis matters.NICE NG198, 2021
Triggers are individual and reproducible. Heat, sun, alcohol, spiced food, exercise, hot drinks and stress are the common ones. The mechanism involves the blood vessels of the face and the skin’s own immune response rather than an infection.British Journal of Dermatology Schaller, 2020
Around half of people with rosacea have eye involvement, which shows up as gritty, dry, sore eyelids and is often treated as something else for years. Anybody with facial rosacea is asked about their eyes.New England Journal of Medicine van Zuuren, 2017
Adult women with spots along the jaw and chin are often treated for acne for a year before rosacea is considered. The two are told apart by the absence of blackheads and the presence of flushing, on examination rather than by test.Journal of the American Academy of Dermatology AAD guideline, 2024
Send us what you are seeing and we will tell you what it is likely to be.
The diagnosis is made on examination and history. The appointment establishes which features you have, which triggers set yours off, whether the eyes are involved, and what has been used on the skin so far.British Journal of Dermatology Schaller, 2020
No test confirms rosacea. Tests are done to exclude the conditions it can be confused with, which is a small list and includes lupus, and that is decided on the pattern rather than ordered routinely.New England Journal of Medicine van Zuuren, 2017
Flushing that comes with palpitations, diarrhoea or drenching sweats is investigated rather than treated as rosacea. It is rare and it is the one pattern that changes the appointment entirely.NICE NG12, 2015
What treatment can and cannot reach is set out before you choose. Creams settle spots, light treats vessels, and neither stops flushing, and knowing that in advance is what makes the choice yours.General Medical Council GMC guidance, 2020
Trigger control and sun protection
The part that costs nothing and is skipped most often. Daily broad spectrum sunscreen and avoiding your own identified triggers reduce flare frequency more than any single prescription.British Journal of Dermatology Schaller, 2020
Topical treatment for the spots
Several topical preparations have good evidence for the inflammatory spots of rosacea. They do little for fixed redness and nothing for visible vessels, which is why matching the treatment to the feature matters.Cochrane Database of Systematic Reviews van Zuuren, 2015
Topical treatment for redness
Preparations that constrict the vessels reduce redness for several hours at a time. The effect is temporary and some people get rebound redness as it wears off.Cochrane Database of Systematic Reviews van Zuuren, 2015
Oral treatment
Used for moderate to severe inflammatory rosacea and for eye involvement, usually alongside a topical rather than instead of it.New England Journal of Medicine van Zuuren, 2017
Laser and light
The only thing that treats visible vessels and fixed background redness. It does not stop the disease and flushing can continue, so it is a treatment for what is already there rather than a cure.British Journal of Dermatology Schaller, 2020
Inflammatory spots respond within 8 to 12 weeks. Fixed redness and visible vessels do not respond to creams at all and need light based treatment, so a course of topical treatment that clears the spots and leaves the redness has worked rather than failed.Cochrane Database of Systematic Reviews van Zuuren, 2015
Rosacea is long term. Treatment controls it and does not cure it, relapse after stopping is usual, and maintenance is the normal state rather than a sign that something has gone wrong.New England Journal of Medicine van Zuuren, 2017
Keep a 4 week trigger diary. Date, what you ate and drank, the temperature, exercise, and a flushing score out of 10 that evening. Most people find 2 or 3 triggers account for the majority of their flares, and identifying them is free and permanent.British Journal of Dermatology Schaller, 2020
Cut the routine back to three products for 2 weeks before the appointment. A non foaming wash, a bland moisturiser, and a mineral sunscreen with zinc or titanium. Rosacea skin is irritable, and a lot of what people call a flare is a reaction to something they are putting on it.Cochrane Database of Systematic Reviews van Zuuren, 2015
Check your own eyes with two questions. Do your eyelids feel gritty in the morning, and do your eyes water in the wind. Around half of people with rosacea have eye involvement, and it is the part most often missed for years.New England Journal of Medicine van Zuuren, 2017
Do not buy acne treatments for rosacea. Scrubs, strong exfoliants and high strength benzoyl peroxide inflame rosacea skin, and people arrive having spent months making it worse with products bought for the wrong diagnosis.Cochrane Database of Systematic Reviews Yang, 2020
Do not buy a course of laser while inflammatory spots are active. Settle the inflammation first, then treat the vessels, or you pay for a course that treats the wrong feature and irritates the rest.British Journal of Dermatology Schaller, 2020
Step 1
Flushing, fixed redness, vessels or spots, and the two or three things that reliably set yours off.
Step 2
A prescription aimed at the feature you actually have, with the routine cut back to three products so the skin stops being irritated by what is on it.
Step 3
Once the inflammation is settled, light based treatment is considered for the redness and vessels that creams cannot reach.
Ask before you book if you are not sure this is the right appointment.
No, and treating one as the other makes it worse. Rosacea has no blackheads, sits on the central face, and comes with flushing and visible vessels that acne does not have. Scrubs and strong acne products inflame rosacea skin.
No. It is a long term condition that is controlled rather than cured. Treatment settles the spots, light based treatment reduces the redness and vessels, and maintenance is the normal state rather than a sign that something has failed.
Heat, sun, alcohol, spiced food, exercise, hot drinks and stress are the common ones, and yours are individual and reproducible. A 4 week diary usually identifies 2 or 3 that account for most flares, which is the cheapest treatment available.
Not the fixed redness or the visible vessels. Topical treatment works on the inflammatory spots and some preparations narrow the vessels for a few hours at a time. Permanent redness and vessels need light based treatment, which is a different appointment.
Ask yourself whether your eyelids feel gritty in the morning and whether your eyes water in the wind. Around half of people with facial rosacea have eye involvement and it is commonly treated as dry eye for years before anyone connects the two.
The consultation is £150 for 30 minutes and the telephone review 12 weeks later is £59. A clinician skin consultation is also £150. An in person laser assessment, which is what fixed redness and vessels need, is £350. Prescriptions are dispensed and priced by the pharmacy.
A mineral sunscreen with zinc oxide or titanium dioxide, used daily including in winter. Chemical filters sting irritable skin more often. Sun is one of the most consistent triggers there is, so this is the one product worth buying before the appointment.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
British Journal of Dermatology
Recommendations for rosacea diagnosis, classification and management, update from the global ROSacea COnsensus panelSchaller, 2020
Cochrane Database of Systematic Reviews
Interventions for rosaceavan Zuuren, 2015
Cochrane Database of Systematic Reviews
Topical benzoyl peroxide for acneYang, 2020
General Medical Council
Decision making and consentGMC guidance, 2020
Journal of the American Academy of Dermatology
Guidelines of care for the management of acne vulgarisAAD guideline, 2024
New England Journal of Medicine
Rosaceavan Zuuren, 2017
NICE
NICE
Acne vulgaris, managementNG198, 2021
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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