If you’re looking to get rid of rosacea permanently, I don’t have great news for you: this skin condition is lifelong.
‘Rosacea is complex and frustrating, for both the patient and me, because there is no cure, so management of the condition focuses primarily on trying to control the symptoms,' Cosmetic Physician Dr Bibi Ghalaie says.
However, it’s not all doom and gloom. There is a lot you can do to improve rosacea in 2025. I should know, I’ve finally calmed my perennially flushed and hot complexion after a decade of suffering – and it wasn’t as obvious a route as you might think.
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It's about time we started shining a light on rosacea, because new studies carried out in December 2024 show that around 5% of the global population suffer with it. They also discovered that the highest prevalence of rosacea isn't in older people, as previously suspected, but within the 25-39 age demographic. Clearly, there's still a lot to learn about this ailment.
The problem with rosacea treatment is that it’s all hidden behind closed doors – and there’s a lot of off-license solutions out there – which is why industry insiders have a head start. Doctors class rosacea as a medical condition, so a lot of beauty brands are bound by law not to make any claims regarding the condition; this is why you’ll see skincare mentioning ‘redness’ not rosacea. This can make it very hard to find the right treatment and tackle the problem head on.
What is rosacea?
'Rosacea is a chronic inflammatory skin condition that typically affects the central third of the face, particularly the cheeks, nose, chin and forehead. The most common symptoms are erythema (facial redness), flushing, sensitivity, telangiectasia (visible blood vessels), pimples and pustules,' says Dr Bibi.
What are the symptoms of rosacea?
'Symptoms range from visible blood vessels and thread veins, to facial redness and flushing which can come and go. You can also have bumps that resemble acne, sensitive skin, thickening of the skin including on the nose which can cause it to appear larger than it originally was,' Dr Leah Totton tells ELLE UK. 'Rosacea can be painful for some people, and may result in burning and tingling sensations.'
What are different types of rosacea?
'Getting a diagnosis is the first step to improving rosacea,' says leading dermatologist Dr Emma Craythorne. 'So many people with rosacea actually treat it as if it’s acne.' In fact, the four subcategories within this skin condition look very different:
- Erythematotelangiectatic rosacea (ETR) which is mainly characterised by redness and visible vessels.
- Papulopustular rosacea is characterised by redness with acne like bumps.
- Phymatous rosacea is characterised mainly by thickened skin, particularly on the nose.
- Ocular rosacea affects the eyes with symptoms of irritation and dryness. This affects a quarter of rosacea sufferers.
What causes rosacea?
The root cause of rosacea is unknown but it is linked to inflammation. Therefore you need to focus on healing what’s inside as well as what’s outside when tackling redness head on.
If you suddenly developed rosacea after an illness or Covid-19, remember that everything from a bug, to food poisoning, or a round of antibiotics, can cause gut dysbiosis thus a new skin condition or food intolerance; some temporary and some long-term.
Rosacea can also be linked to the immune system – so if you have a health condition already like diabetes, celiac disease, multiple sclerosis, or rheumatoid arthritis, there could be a link thanks to the inflammation in your body.
There is also mounting evidence, according to The National Rosacea Society, to show that an overabundance of demodex (a natural community of microorganisms that live within the skin), may trigger an immune response in people with rosacea, or that the inflammation may be caused by certain bacteria associated with the mites.
Rosacea is also thought to be hereditary, so even without all of the above, you might be pre-disposed to this skin condition.
What triggers rosacea?
It can vary from person to person. For me, there’s a long list of potential rosacea triggers that gets shorter when my condition is under control.
A lot of people talk about the 'bucket theory', whereby a little of something won't cause a reaction but once that bucket of irritants is overflowing you will start to flare up. For instance, it might be that you can tolerate aged cheese or red wine alone, but in tandem they may trigger your rosacea.
Here's a list of common irritants for rosacea (but remember your triggers are individual to you, why is why it's worth keeping a diary to help manage this):
- Emotional stress.
- Wind, the sun, UV rays and heat.
- High intensity exercise.
- Certain skincare products or medication.
- High histamine foods like egg white, strawberries, tomatoes, aged, smoked or processed meats and cheese.
- Alcohol, particularly red wine and champagne.
- Spicy foods is one people mention often, but it won't typically be a fresh chilli that triggers your rosacea, but high histamine elements within a spicy dish – tinned tomatoes, paprika or spice in an aged powder form.
How to treat different types of rosacea:
A lot of advice out there generalises rosacea but, 'all kinds can develop independently. They don’t all merge into one another, they behave as separate entities most of the time,' explains Dr Craythorne. 'You can just present with the big nose without having had background steps beforehand. Or you might just have the very bad flushing and flaring,'
We asked the Klira founder to roughly summarise which rosacea subgroup works best with which treatment, so that you can skip straight to the part of this guide that's most relevant to you:
- 'For people who just have a kind of background redness, but no pustules (rythematotelangiectatic rosacea), hormones tend be at play. Laser treatment can be brilliant for those patients.'
- 'For those who have the spots (papulopustular rosacea), lasers are further down the list of benefits, it’s better to try a topical treatment first to get your skin under control.'
- 'The use of an IPL is very good for ocular rosacea'
- The only real treatment for phymatous rosacea is a combination of medicine (either Roaccutane or Isotretinoin) and carbon dioxide laser.
How to treat rosacea from the outside
If you've landed on this page because you suffer from rosacea, no doubt you'll have read countless articles that advise being gentle on the skin, using a barrier-protecting moisturiser, avoiding retinoids and slathering on various soothing creams as well as your non-negotiable SPF. We've done a deep dive on how best to approach skincare regimes for rosacea here, but in this piece we're assuming you know the basics and skipping straight to the hardcore treatment.
The best rosacea creams
As someone who has tried a slew of creams, nothing has helped me like Klira, the prescription skincare brand created Dr Emma Craythorne (read our review here). The prescribing team don't just treat rosacea, they size up your skin based on the pictures and details you share, then send you a night cream with precise doses of active ingredients.
'For some people, all they need is some mild azelaic acid and that will be enough to get their rosacea under control,' says Dr Craythorne of her Klira formulations.
'The next step up is adding in ivermectin, which works as an anti inflammatory parasitic so it kills the little demodex mites that live under our skin'.
'Tretinoin (a prescription-strength retinoid) is the other ingredient we add, as it's particularly good for people with rosacea trigger by inflammation. The three together are a gold standard treatment for this condition.'
If you are one of lucky few that only needs a mild azelaic acid, there are affordable alternatives on the market that are less personalised but still very effective: Beauty Pie's Happy Face,10% Azelaic Acid Skin-Clearing Gel-Cream and Skin + Me's Azelaic Acid-powered night cream.
Azelaic Acid night cream
Happy Face Cream
Rosacea and laser
If you need results fast, such as in the lead-up to a wedding or big event, look to laser. Within the first session you will marked improvements. Before turning to Dr Leah, I had tried laser at high street clinics but found the treatment caused lots of swelling and irritation, that I needed more of them, and the effects didn't last.
Dr. Leah Clinics use advanced medical-grade laser technology, specifically the Harmony Laser, to target rosacea. 'When a vascular lesion (like a visible blood vessel under the skin) is exposed to short bursts of visible light, the light heats up the area where there’s a lot of haemoglobin (the part of blood that carries oxygen). This heat damages the walls of the blood vessel, causing it to break down. The body then naturally absorbs the damaged vessel, which makes it less visible.'
Generally three treatments are advised, around four to six weeks apart to allow the skin to heal. If your rosacea is severe, it might take up to six.
Within three treatments my rosacea was 99% dormant and most of my broken capillaries gone. Having tried other clinics, I found the cooling tip on the Harmony laser a lifesaver – it meant minimal downtime, no swelling and I could go about my business as usual straight after a session. Dr Leah recommends you back up laser with the appropriate skincare and revisit for follow up treatment after around nine months to address any new veins that have formed.
Rosacea and polynucleotides
Any skincare buff or Kardashian fan will have heard this buzzword. Or perhaps the phrase 'salmon sperm facial'. But did you know the power of polynucleotides?
'Polynucleotides (PNs) – especially polydeoxyribonucleotides (PDRN) like Plinest – are known to have bioregenerative, anti-inflammatory, and hydrating effects on the skin.' says Dr Bibi. 'They modulate inflammatory cytokines, helping calm the skin and reduce persistent redness and irritation. They also support support skin repair and restore the epidermal barrier, reducing reactivity to environmental triggers. They help retain water in the skin, reducing dryness and the rough texture that are common in rosacea.'
Dr Bibi is the first to admit this isn't a quick-fix, but more of a tool in your long-term journey to getting rid of rosacea as best as you can. 'Although they do not target vascularity directly, by improving the resilience of the skin and decreasing inflammation over time, they can help reduce redness which tends to be one of the main bothersome symptoms of rosacea. Finally, polynucleotides are often used after vascular laser treatments in rosacea patients to support the healing process and reduce downtime.'
How to treat rosacea from the inside
There are three big factors to consider when tackling rosacea from the inside out: gut health, hormones and histamines. They are all interlinked and can all be impacted directly by stress.
While a GP or dermatologist might recommend topical or oral antibiotics for rosacea, since antibiotics – while life saving and essential – strip the gut of good bacteria, so it would be wise to try other methods before resorting to this.
Rosacea and hormones
I had never heard of oestrogen dominance until I worked with nutritionist and author Hannah Alderson – and yet it was one of the key drivers of my rosacea.
Women can have a disproportionate amount of oestrogen in their system (compared with progestrone) for several reasons. Some as simple as stress and constipation, other due to underlying conditions such as endometriosis and PCOS, or a sluggish liver. One of the main causes is perimenopause and menopause.
I got to work immediately trying to balance my hormones with diet and lifestyle, but mainly to clear the oestrogen from my system. This involved eating more flaxseeds and cruciferous vegetables to support liver detoxification. I also started taking some incredible supplements with which I saw a direct impact to my rosacea flare ups – as soon as I stopped taking them, they crept up again.
Invivo Bio.Clear Oestro
Deep Detox
Rosacea and gut health
The gut-skin axis is becoming more and more apparent: our gut health is essential to the control of inflammation, which can manifest as rosacea. The advice out there is conflicting because some of the 'gut health' foods like fermented veg, kombucha and kefir, not to mention some leading probiotics, can actually exacerbate rosacea symptoms. If this is the case, you can still nourish your gut by getting the ZOE app-recommended 30 plants per week (herbs, seeds and spices count!) and fuelling your body with prebiotic fibre, as well as avoiding processed foods and too much alcohol and sugar.
A good probiotic will help populate your gut with good bacteria and decrease inflammation. Out of the non-fermented options, I've personally found Emily English’s Epetome to work wonders, but Optibac also comes highly recommended.
Rosacea and histamine intolerance
If you find that certain foods produce bizarre symptoms – facial flushing (ETR), hives, nasal congestions, headaches and heart palpations – your GP doesn't recognise as an allergy, you could be suffering with a histamine intolerance. This is a deficiency of the gastrointestinal enzyme diamine oxidase (DAO) that breaks down the histamines in your food. It's a growing phenomenon, that's more widely recognised in private medicine and the US, that might well be exacerbating your rosacea.
Histamine intolerance makes improving your gut health a real head-scratcher, because fermented foods. However, Hannah Alderson says, 'don't go too hard Googling a low-histamine diet, or all you'll be eating is dust.' Not to mention, everyone has completely different triggers. A safe place to start is avoiding smoked and overly processed foods, as well as aged cheese and red wine, to give your skin a break. From there you can see what your rosacea tolerates and what it doesn't.
The good news is if you are looking to balance your hormones and support your liver, this supports your system and helps to flush out excess histamines.
Rosacea and stress
Have you ever had a conflict at work or felt embarrassed and found your skin betray you with a bout of flushing, red-hot rosacea across your cheeks? Cruelly, this condition is triggered by emotional distress.
Avoiding inevitable daily micro-aggressions is easier said than done, but if you work holistically to reduce your general stress levels, you'll find your rosacea is dampened. Standard advice for this tends to be 'eat well', 'take up yoga' 'get enough sleep', which can feel both reductive and too generalised at the same time.
Mindset Coach Izzy Utterson is all about adding in easy and very specific daily habits to positively impact your day, such as dry body brushing for lymphatic drainage, waking up half an hour early to have a slower morning (but setting your alarm with a soothing tone to prevent your cortisol spiking), eating a protein-rich breakfast before coffee, gratitude journaling and putting your phone on aeroplane mode.
The list goes on – but even adopting just a few of these habits could sooth your nervous system, balance your hormones, and begin to improve your body's reactivity, thus preventing rosacea flare-ups.
Meet the experts ELLE turns to:
- Dr Bibi Maryam Ghalaie (MBBS BSc MRCGP DRCOG DCD DipAesMed) is a leading practitioner of modern aesthetics. When she's not in her cosmetic clinic, she is working at A&E for the NHS.
- Dr Leah Totton MBBS (DIST), DIP DERMATOLOGY MBCAM is a medical doctor and an award-winning cosmetic doctor. She was the winner of The Apprentice 2013.
- Dr Emma Craythorne MBChB FRCP is a consultant dermatologist and dermatological surgeon who has her own TV show, Bad Skin Clinic, broadcast in over 100 countries and is the founder of successful skincare brand Klira.
- Hannah Alderson is a BANT registered nutritionist, hormone health specialist, published author and a functional medicine practitioner
- Izzy Utterson is a TikTok wellness influencer and mindset coach.
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Abigail Southan is our Senior Fashion Ecommerce Editor and has five years' experience as a writer and editor in the industry. Abigail has a BA in History from the University of Bristol and an MA in Fashion Journalism from Central Saint Martins. Abigail currently covers all things style and shopping across titles including Harper’s Bazaar, ELLE, Esquire and Red. On a daily basis, she helps readers buy better with how-to-wear guides, first-person product reviews and deep dives into the latest trends. Previously, Abigail has worked for The Sunday Times’ Style and Fabulous magazine as their first ecommerce writer and was a founding editor of Sun Selects. She has also written for Net-a-Porter, I-D, Man About Town, Wonderland and 1 Granary, and has interviewed the likes of Paris Hilton, Dua Lipa and Christopher Bailey. You can follow Abigail on Instagram at @abigailsouthan.
