A closeup of a woman's face with red and inflamed skin in New York on Dec. 14, 2025. Scientists arenÕt entirely sure what causes rosacea, or why it intensifies as you get older, but they have some theories. (Eric Helgas/The New York Times)
Rosacea symptoms often intensify for many individuals as they reach their 40s and 50s, leading to increased flushing, acne-like breakouts, and visible blood vessels. This condition affects millions globally, particularly women and those with fair skin. According to Dr. Julie C. Harper, a dermatologist based in Birmingham, Alabama, while rosacea can be diagnosed at any age, many individuals experience their first symptoms after turning 30.
The precise cause of rosacea remains unclear, but it is believed to result from an overactive immune response to various environmental triggers. These triggers can include sun exposure, spicy foods, alcohol, temperature extremes, stress, and physical exertion. Dr. Marie Leger, a dermatologist in New York City, notes that the symptoms can also manifest as skin dryness, tightness, and burning sensations.
Understanding Rosacea and Its Progression
Rosacea symptoms typically “wax and wane” throughout a person’s life. In particular, if rosacea develops in one’s 20s or earlier, it often worsens between the ages of 30 and 50. Chronic inflammation resulting from repeated exposure to triggers may weaken the tissue surrounding blood vessels, leading to chronic redness and persistent flushing, according to Dr. Harper.
Over time, the skin undergoes natural aging processes and damage from sun exposure, which can thin collagen fibers and reduce elasticity. This can result in blood vessels becoming visibly dilated and contribute to chronic redness. Dr. Dina Elrashidy, a dermatologist at Northwestern Medicine in Chicago, emphasizes that skin thinning and drying with age can exacerbate these symptoms.
Many patients in perimenopause and menopause report worsened rosacea symptoms. While hormonal factors might play a role, Dr. Harper points out that a clear hormonal connection has not yet been established.
Strategies for Managing Rosacea
Effectively managing rosacea usually requires a combination of approaches tailored to individual needs. These strategies include:
– **Avoiding Triggers**: Identifying personal triggers is essential. Dr. Harper suggests steering clear of known triggers to minimize flare-ups, although some, like cold weather, may be unavoidable.
– **Using Gentle Products**: Opting for moisturizing cleansers containing ingredients like glycerin or dimethicone can help soothe the skin. Dr. Elrashidy recommends using sulfur-based products for their anti-inflammatory properties, while avoiding scrubs and fragrant products that may irritate the skin.
– **Wearing Sunscreen**: Sun exposure is a common trigger for rosacea. It is advisable to apply a broad-spectrum sunscreen with an SPF of 30 or higher daily, reapplying it every couple of hours when outdoors. Mineral-based sunscreens with zinc oxide or titanium dioxide are often better tolerated than their chemical counterparts.
– **Prescription Medications**: Treatments such as brimonidine gel and oxymetazoline cream can help narrow blood vessels and reduce persistent redness. Other topical options include azelaic acid, ivermectin cream, and metronidazole, which can decrease inflammation and improve symptoms. Oral antibiotics may also be prescribed for longer periods or during flare-ups.
– **Laser Treatment**: Laser therapy can effectively reduce redness by shrinking dilated blood vessels. Initial treatments typically involve one to three sessions, spaced about a month apart, with maintenance sessions every six months to a year.
Seeking guidance from a dermatologist is crucial for those experiencing worsening or new symptoms of rosacea. Dr. Harper encourages patients to consult a specialist, as they can help identify triggers and develop personalized management strategies. “Having a strategy can make patients feel much more in control,” Dr. Leger notes.
Understanding the complexities of rosacea is vital for those affected. Although there is currently no cure, effective management strategies exist to help individuals maintain skin health and confidence.
