Rosacea

What is rosacea?

Rosacea is an inflammatory and vascular condition. Two processes underlie most of what is seen: blood vessels in the face dilate too readily and too often, producing flushing and then fixed redness; and an inflammatory response produces the papules, pustules and, over time in some people, tissue thickening.

Its origins are multifactorial and not fully understood. Recognised contributors include genetic susceptibility, an altered skin microbiome with increased density of Demodex mites, dysregulation of the immune response, and neurovascular mechanisms that make the facial vessels unusually reactive.

A change in how rosacea is approached

Rosacea used to be sorted into four fixed subtypes. Current international consensus has moved to a phenotype-based approach — assessing each feature a person actually has and treating accordingly — because in practice features overlap and most patients have more than one at once. This matters clinically: the agents that calm background redness are not the same as those that clear inflammatory bumps, and combination treatment is often appropriate.

Rosacea in deeper skin tones

Rosacea is widely described as a condition of fair, Northern European skin. It is more common in that group — but it occurs across all skin tones, and is recognised to be under-diagnosed in skin of colour.

The reason is largely one of visibility. The redness that clinicians are taught to look for is simply much harder to see against a deeper background tone, so the condition may be attributed to adult acne, sensitivity, or nothing at all. By the time it is recognised, visible vessels or thickening may be established.

Features that remain informative regardless of skin tone include persistent facial warmth or burning, skin that stings with ordinary skincare, inflammatory bumps without blackheads or whiteheads, and eye symptoms. A history of easy flushing is also useful.

Singapore's climate adds its own difficulty. Heat, sun exposure and sudden movement between hot outdoors and cold air-conditioning are among the most frequently reported triggers, and all three are hard to avoid here — which makes consistent sun protection and a settled skincare routine more important, not less.

How rosacea is treated

Treatment is matched to the features present. Because most people have more than one, combination treatment is common.

The foundation

Gentle skin care and daily broad-spectrum sun protection underpin everything else — sun exposure is the single most frequently reported trigger. Simplifying an overloaded routine, and identifying and reducing personal triggers, does a great deal of the work.

For inflammatory papules and pustules

Topical options include ivermectin, metronidazole and azelaic acid. Where disease is more extensive or resistant, a low-dose oral tetracycline may be used — at this dose it acts as an anti-inflammatory rather than as an antibiotic, which limits concerns about resistance.

For redness and visible vessels

Persistent background erythema may be helped by a topical vasoconstrictor. Fixed telangiectasia responds poorly to creams, and vascular laser or intense pulsed light is the recognised approach — with device and settings chosen for your skin type. Our laser and cosmetic dermatology page explains that assessment in more detail.

For thickening and eye involvement

Established phymatous change is addressed with surgical or laser techniques. Ocular rosacea is managed with lid hygiene, warm compresses and, where needed, oral treatment — and may warrant ophthalmology input.

When to see a dermatologist

Consider a specialist assessment if:

• Facial redness is persistent rather than coming and going
• You have inflammatory bumps that have not responded to acne treatment
• Your skin stings or burns with ordinary skincare products
• You have dry, gritty or irritated eyes alongside facial redness
• Visible blood vessels are appearing
• The nose or another area is beginning to thicken
• The appearance is affecting your confidence or daily life

Rosacea is diagnosed clinically. There is no specific test, and the diagnosis rests on the pattern of features, their distribution, and the history of flushing and triggers.