Rosacea is a chronic skin disorder that affects the skin, showing up in different ways depending on the person. It’s a tricky mix of nerve issues (like pain and itching), immune responses (like inflammation), and blood vessel changes (like redness and swelling).

What Does Rosacea Look Like?

If you’re dealing with Rosacea, your skin might seem red, irritated, and extra sensitive. Or, you might notice tiny blood vessels close to the surface, giving your skin that flushed appearance. Or, you can feel thickened reddish patches of the skin.

Common Signs of Rosacea

• Persistent redness
• Swelling
• Thickened skin
• Raised bumps or pus-filled spots
• Burning or stinging sensation
• Skin that feels hotter than usual
• In some cases, the skin on the nose may thicken (rhinophyma)

Rosacea vs. Acne: What's the Difference?

Acne is very commonly mistaken for Rosacea. Here are the main differences:

• Acne comes from clogged hair follicles, while Rosacea is tied to nerve and blood vessel issues.
• Acne can show up on your face, chest, and back, but Rosacea presents only on the face and the eyes.  
• Acne presents with blackheads and whiteheads, but Rosacea doesn’t have blackheads.
• Acne flares up in teens to 30s, while Rosacea typically appears after 30.
• Acne can affect anyone, while Rosacea tends to show up more in people with Northern European backgrounds.

Key Difference: Acne leaves dark marks (post inflammatory pigmentation) or dehydrated patches, while Rosacea often causes prolonged blushing and flushing.

Key Similarity: Both Acne and Rosacea can present with pustules and papules. This is why Rosacea is commonly mistaken for Acne. Also, there is no such thing as “Acne Rosacea”. It is either Acne or Rosacea and they can be present simultaneously.

Rosacea Subtypes (Now Called Phenotypes)

• Facial Redness: Constant redness, flushing, and burning.
• Bumps and Pimples: Often mistaken for Acne, these show up as pustules and papules.
• Thickened Skin: Commonly seen on the nose, chin, forehead, cheeks, or ears.
• Eye Irritation (Ocular Rosacea): Causes redness, burning, and discomfort in the eyes.

In people with darker skin tones, Rosacea can be very hard to spot. Instead of bright redness, it may appear dark red or purple with thicker, bumpier skin and enlarged pores. A special technique called diascopy (pressing a glass slide against the skin) may be needed to diagnose Rosacea.

Why Does Rosacea Happen?

Experts believe these three factors play a big role:

1. Vascular Endothelial Growth Factor 2 (VEGF-2): Rosacea patients often have higher levels of VEGF-2.
2. Microbes: Demodex mites and bacteria like Staphylococcus aureus or Bacillus oleronius can contribute by producing enzymes that irritate the skin.
3. Lipase Enzyme: Found in all Rosacea patients, this enzyme breaks down skin oils. It becomes active when skin heats up to 99°F or higher — another reason why heat can trigger Rosacea.
4. HCL - Hydrochloric Acid- when weakened, undigested food disturbs gut microbiome and this might cause skin eruptions 

Managing Rosacea

To keep Rosacea calm, focus on:

• Reducing redness - cooling, hydrating ingredients and modalities such as skin icing
• Repairing and protecting your skin barrier 
• Avoiding triggers like stress, intense workouts, sun exposure, spicy foods, alcohol, hot baths, HEV/Blue lights from Electronic devices, and harsh skincare products

Skincare ingredients that might trigger rosacea:

Camphor, Capsaicin, Hydrogen Peroxide, Hydrocortisone, Methyl Salicylate, Organic sunscreens, Retinoids, Salicylic Acid, AHAs, DMAE, Fragrance, Fruit enzymes - bromelain, papain, Niacinamide, Sesame oil, Vitamin . Vitamin D ( cholecalciferol ) increases anti microbial peptide LL-37 and when skin is exposed to sunlight it may contribute to rosacea flareups.

Foods that might trigger Rosacea:

Coffee, tea, spicy foods and alcohol can cause blood vessels to dilate, these should also be avoided, and also: aged cheese, all peppers, chocolate, cinnamon, curry, fatty foods, ginger, hot drinks, niacin containing foods (salmon, peanuts, tuna, chicken breast), Oysters, peppermint, vinegar, yogurt, soy sauce, Saurkraut, yeast-containing food (beer, fermented products).

Medical Treatment Options

• Topical Therapies: Epsolay, azelaic acid (15%), metronidazole, and brimonidine can help.
• Oral Therapies: Doxycycline is commonly used.
• Laser & Light Therapies: Helpful for redness and visible blood vessels.
• Micro-Botox Injections: Can reduce redness and calm flushing.

Esthetic Treatment options and ingredients:

• Peels with Mandelic and Azelaic Acids
• Cryotherapy
• Oxygen therapy

      Ingredients:

• Mandelic Acid - if well tolerated, antimicrobial
• Benzoyl Peroxide - for pustules
• Green and white tea extract
• Hops extract
• Transexamic Acid
• Azelaic Acid
• Beta Glucans
• Zinc Oxide
• Borage
• Bisabolol
• Oats
• Licorice extract

The Gut Connection

Some people that suffer from Rosacea also suffer from indigestion, especially after they have eaten fatty foods. These people may be deficient in a pancreatic enzyme called lipase, which helps to digest fat. Supplements of this enzyme improve both the indigestion and the Rosacea. Other research shows that a deficiency in stomach acids and enzymes is common in rosacea patients. A HCL supplement, available at the health food stores, often does the trick.

Psychological Impact

Living with Rosacea can be frustrating, and it’s common for people to feel anxious, worried, or self-conscious. Managing stress and building confidence are key parts of controlling rosacea flare-ups.

What can you do to help your Rosacea

Something to think about: In one study, 40% of participants have triggered Rosacea by their skin care, and out of that number, 82% when using exfoliants, soap or toners. Start eliminating suspects from your daily routine and see how your skin reacts.

Key Tip: Your Skin Barrier Matters!

Rosacea-prone skin is often more vulnerable. Until your barrier is repaired and strengthened, managing rosacea symptoms can be tough. Focus on gentle, hydrating products that restore balance. Try this routine: 

• The Mandelic Cleansing Gel: Provides a gentle cleanse with anti-inflammatory and antioxidant properties to reduce redness and calm sensitive skin.
• The Zinc Mask: Calms inflammation, purifies pores, and supports the skin microbiome to reduce redness and irritation common in rosacea.
• The Glycolic Lactic Toner: Gently exfoliates and restores moisture balance, leaving skin smoother and less prone to irritation.  
• The Acne Gel: Helps minimize breakouts, reduce pore congestion, and control surface oil, which can soothe inflammation & pustules associated with rosacea.
• The Daily Moisturizer: Hydrates and protects the skin barrier while minimizing dullness, ideal for soothing rosacea-prone skin. 

With patience, the right care, and some smart lifestyle choices, rosacea can be managed effectively!

What does Biba think about Rosacea?

Biba believes that Rosacea mostly comes from gut disbalance. Before undergoing radical and time consuming actions and treatments, it doesn’t hurt to first eliminate triggering skincare products and spicy foods, then try Lipase enzyme and HCL supplements and test your vitamin D3 levels. If your Rosacea symptoms start to feel alleviated, there is your answer.