How to Recognize Rosacea

Rhinophyma, a.k.a “W.C. Fields nose”

The big red bulbous nose of W.C. Fields is the extreme example of rosacea and certainly not how this condition appears in most people.  I mention this for 2 reasons: 1.) If you have rosacea don’t freak out that this is going to happen to your nose (you can get this condition under control long before it develops into rhinophyma) and 2.) You can learn to recognize rosacea in its early stages so you can start managing it right away.

The biomedical cause of rosacea is still unknown.  Rosacea typically affects people between the ages of 20 and 50 and is seen most often in those with fair complexion.  Women are affected more often than men, although the condition tends to be more severe in men (is this because they tend to wait longer to seek medical intervention?  Who knows.)  Rosacea is a chronic inflammatory condition of the skin that affects the face (mostly the cheeks, nose and forehead) and sometimes the eyes.   I have rosacea and I will describe my experience because it is rather typical and gives a good idea of what the early stages look like.

Mild Rosacea (I’m not wearing any makeup here). Note the difference between my neck and my face.

I wish I would have recognized the signs 20 years ago when they first began to show up in my late teens.  It began with flushing.  I would blush rather easily if embarrassed and especially if angry or upset.  Even with light aerobic activity my face would look like a tomato immediately – I am pretty sure everyone in the spinning class thought my head was going to explode but I was barely breaking a sweat.  I looked like I had sunburn (on my whole face) whenever I was out in the sun or wind for even a short period (even though it wasn’t actually a burn).  This easy flushing went on for many years but it always disappeared in a reasonable amount of time, so I never gave it much concern.  It wasn’t until last year (at the age of 37) that the flushing appeared and then no longer disappeared.  Oh sure, my friends were jealous because I looked like I was wearing blush even when I had no makeup on.  But when I examined my face closely I could see tiny little purple capillaries on my cheeks that looked like spider veins.  Within a few months of discovering the telangiectasia (dilated capillaries), the skin on my face began to sting a little; nothing major, but it felt a bit like mild sunburn all the time (I assure you, it was not sunburn).  My face is easily irritated and gets bright red whenever I rub it – no matter how gently I apply a minimal amount of pressure – when I wash it, when I apply moisturizer, when I towel dry it.  I like beer and wine, but I don’t drink very much or very often.  But now even a few sips of alcohol will instantly (within minutes) make my rosy cheeks flush even rosier.  Spicy foods, hot tea and coffee do it, too (it is the heat, not the caffeine that triggers this).  For a while I was developing small zits on my cheeks but I eventually cleared those up with an herbal toner that I made (more on that in the next post).  Most recently I began to notice some eye symptoms – slightly puffy and itchy eyelids with the sensation that a grain of sand or a little piece of fuzz is in my eye.  Now, I really shouldn’t jump to the conclusion that this is the ocular aspect of rosacea.  It could just as easily be seasonal allergies, as those have started very early this year in northern Colorado.  But I am being vigilant about it.

Rosacea can resemble acne

I am doing several things to manage my condition and I hope to have it fully under control before long.  But if I were to let it go on, it could easily get much more severe.  As rosacea progresses, the flushing becomes permanent (nontransient erythema), more papules and pustules (zits) develop, more telangiectasia occurs (permanently dilated blood vessels), and the skin (esp. of the nose) can thicken and hypertrophy (called rhinophyma, which is irreversible).  Eye symptoms can also develop.

When there is just flushing and redness on the cheeks, rosacea can be mistaken for lupus erythematosus.  The papules and pustules of rosacea are easily mistaken for acne in adults.  It is really important to determine which condition you may have because the treatments and prognosis will differ quite a bit.  So be sure to see your dermatologist if you have significant facial flushing/redness or you start developing what you think may be acne after age 20.

In our next posts we will cover the TCM diagnoses of rosacea and we will discuss the most common triggers and what you can do to avoid them.  Here’s your first tip: do a better job of avoiding alcohol than I have been doing lately.  I just now took a sip of beer as I get ready to publish this post and I can already feel the heat building in my face!  Dang it!

Tags: acne, dermatitis, dermatology, lupus, red cheeks, rosacea, rosy cheeks, skin care

Topics: Acne, Beauty, Facial Care, Rashes, Rosacea

Publish Date: April 1, 2011     *Articles may include updates since original publishing.

About the Author ()

Diana Hermann is a licensed acupuncturist and board certified in Chinese Herbal Medicine. She received her Master Degree in Acupuncture and Oriental Medicine from the Oregon College of Oriental Medicine in Portland, OR and trained in China at the Nanjing University of Traditional Chinese Medicine. Diana treats patients in her Fort Collins, Colorado clinic and hand crafts herbal skin care products for her company Zi Zai Dermatology. In 2015, she completed the Diploma In Chinese Medicine Dermatology program from Avicenna in London, UK. She completed the program for a second time in 2019 in Chicago.

Comments (30)

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  1. aimeejensen says:

    This is great information! Thank you!

  2. Mike says:

    I can’t think of a more annoying skin condition than rosacea.
    What would you recommend a 20 year old guy to use for both acne and rosacea? Now I’m not 100% sure that I have it, but I remember my skin becoming temporarily lighter when my old dermatologist put me on antibiotics and differin, which helped A LOT, but I’m far from clear. I guess I should also add that my skin type is oily.


    • It is frustrating, isn’t it? Without knowing more about your health history, I can still recommend a few things for you to try (I will write a blog post about tips for rosacea, but this will give you a head start). First, make sure your facial cleanser is not too drying (i.e. not too much alcohol in it). Alcohol and other ingredients that are drying to the skin can actually aggravate rosacea or aggravate the redness that accompanies acne. Secondly, I would recommend you use a toner after each time you wash your face (which should be twice daily – once in the morning, and once before bed). As an extra treatment, I would use a facial mask once or twice per week (even though you are a guy and this step might seem girly, it really can make a big difference). Clay facial masks help draw out “toxins”, dirt and impurities from the pores. For a great cleanser, use honey. That’s right – just plain ol’ honey. It has antibacterial properties and won’t over-dry. Be sure to apply it to damp skin or it will just be a sticky mess. For a toner to use after cleansing, mix apple cider vinegar with distilled water (50% vinegar, 50% water). Apply this toner to a cotton ball or round cotton pad and apply it to a clean, dry face (it will dry quickly). For a facial mask, you can buy French green clay (a.k.a. sea clay) in health food stores. Mix it with a little water to form a paste and spread it on your dry face. Allow it to dry completely (20 to 30 min.) before gently washing it off. If you don’t want to mix up your own stuff, we have great products made with Chinese herbs: (You would like the Honey & Herb Scrub and either the RosaceaHerbal 2 facial mask or the AcneHerbal facial mask). Check back for that next blog entry about Tips to Improve Rosacea.

  3. Mike says:

    Thanks for the reply.

    I think you hit the nail on the head when mentioned alcohol, because I just washed my face with Spectro Jel and I did notice my face becoming more red. Couldn’t ask for a better time to replace it with something else, seeing as how you recommended using honey and apple cider vinegar. One question though, wouldn’t ACV mess with my skin’s pH balance? Thanks.

    Looking forward to your next blog post.

    • benita says:


      Before you listen to the acupuncturist–see a dermatologist!!!! The things that she is suggesting are very irritating to skin that may already be irritated. Don’t use a clay mask for God’s sake!!! Your dermatologist will recommend what your skin-cleaning regimen should be as well. Most people don’t need to wash their faces twice a day, once is enough. Sometimes, these “all natural” food products are too harsh for the skin and actually make it worse. Also, you may want to see a doctor about using a laser to get the redness under control. I don’t know what Spectro Jel is–but Cetaphil puts out a very gentle cleanser that is excellent and non-irritating.

      • Benita, you bring up some excellent points and I appreciate this discussion. It is entirely true that some “natural” products can be overly harsh on the skin and can make the skin less healthy. Just because a product claims to be natural does not mean it is beneficial. But clay masks are absolutely fine for skin with rosacea or acne…in fact they can be very beneficial. They should only be weekly treatments (not daily – that would be too drying). Our clay & herb facial masks are balanced to have just the right percentage of herbs and clay so as to help draw toxins out of the skin, reduce inflammation and not be overly drying. You mention that Cetaphil’s cleanser is not-irritating, however Cetaphil’s Gentle Daily Skin Cleanser contains the following ingredients: Water, cetyl alcohol, propylene glycol, sodium lauryl sulfate, stearyl alcohol, methylparaben, propylparaben, butylparaben. The parabens used for the preservative are known endocrine disruptors; the sodium lauryl sulfate (SLS) is a harsh surfactant that is known to cause skin irritation; and propylene glycol has been associated with irritant and allergic contact dermatitis as well as contact urticaria. Although this is definitely not my idea of “gentle”, the fact is, this product works great for many people without causing any negative skin reactions. So it seems that for ANY products, each individual has to find what works for them because even the most gentle of ingredients may not react well on a certain individual’s skin. You are correct – not everyone needs to wash their face twice daily. For some folks, once per day IS enough (that is true for me SOME days) but most often for people with oily skin, washing (gently!) twice per day gives them clearer skin. (And anyone who wears makeup should be washing that off their face every night – sleeping with makeup on your face is a terrible habit for your skin.) I often recommend patients see a dermatologist if they do not have a clear diagnosis of what is going on with their skin. Some dermatologists can offer a lot of help. And others prescribe skincare regiments that are far more harsh than anything I would ever recommend. Lasers will not address the general erythema of rosacea, but they can be helpful to reduce the appearance of the dilated capillaries or acne scars.

  4. Excellent question! Apple cider vinegar actually does lower the pH of your skin and on the outer layer (called the acid mantle) this is exactly what you want because it helps form a barrier against bacteria.

  5. A. says:

    glad i found your blog. i also have a question if you don’t mind. what shampoo do you use?

    • I haven’t found a shampoo that I love enough to stick with. I rotate and try news ones all the time. I have to avoid ones that contain jojoba oil since I am sensitive to that ingredient. I plan to make my own herbal shampoo (eventually).

      • So eventually I will make my own herbal shampoo (hopefully available for sale one of these days)…but for now I have found Wen Hair Care. Yes, the stuff from the infomercial. I really love their shampoo – it is shampoo and conditioner all-in-one without any harsh cleansers (no sodium lauryl/lauryth sulfate).

  6. Sally says:

    This information is so helpful. I have some of the symptoms – I blush when I’m embarrassed, when it’s hot and when I exercise (only in these cases, it’s not a on-going). I don’t really drink any alcohol, so I’m not sure what reaction it would cause. I saw a doctor once, and she laughed at my fear saying that my blushing is normal (blood vessels being close to skin or smth like that). But that’s the thing with doctors in my country, she didn’t take my “red cheeks problem” seriously, she didn’t even examine me. Is there any way I could know for sure if I have rosacea? I always thought I just had a very sensitive skin. (By the way, it’s just my cheeks that turn red, not chin or forehead or nose).
    Thanks again on your amazing post.

    • Did you see an actual dermatologist or just your primary care provider? Dermatologist can help you determine if it is truly rosacea or just a normal blushing response (often people with fair complexions blush more easily or more intensely than others but this is not rosacea). A dermatologist usually will do a much better job of diagnosing skin conditions than a regular M.D. who may not be familiar with the condition or who (like in your case) deflects it as not being an important concern.

      • Sally says:

        Thanks for a reply !
        I didn’t see the actual dermatologist, but I see now that I should. This blushing was always annoying (I’m 20 and it seems like I’ve always had it, always blushed in particular situations), but I never thought it could be serious. I just started covering it with a light make-up. I’ll see dermatologist as soon as I can. But just to calm myself down before that, is there any way I MYSELF could “guess” if it’s just blushing or rosacea? I don’t have any other symptoms, and I do have very pale skin. (I spent 2 hours googling rosacea and trying to figure out if I have it) Sorry, I turn into a big baby when it comes to health issues.
        I so appreciate you taking your time to reply.

  7. Sally says:

    Thanks again. I don’t live in USA, so I couldn’t really use that website. But I’ll see a local dermatologist soon (I hope they’ve at least heard of rasocea). I saw the tips and I’ll be more careful about what I eat now. I don’t smoke or drink alcohol, and I treat my skin quite carefully. As for vitamins and other stuff, I hope the dermatologist will himself tell what to start taking. One last question, I just joined rowing team in my college and their work-outs are pretty intense. I really don’t want to give that up. Could it worse my condition? I already did rowing 3years ago, and sure I used to blush during practices, but apart from that I haven’t noticed any changes.

  8. Jenifer Sutherland says:

    Hi. I have been diagnosed with rosacea and contact dermatitis and perioral dermatitis- by the same and different dermatologists. My naturopath is trying to help me with my digestive health. I have been eating very clean for almost 2 years, and I was eating healthy vegetarian/ vegan prior to that. I am a stressor…..but have been working on that. I would love to know how to treat this, as it just keeps getting worse. I don’t get flushing in my cheeks often, it is more of a rash that is red all the way around my mouth like a circle (except the middle of my chin), around my eyes and unfortunately, despite all of my efforts with diet, i now have it under my eyes, between my eyebrows and a patch or two above my brow.
    Thank you for any insight you could give me. I will do anything
    Much appreciated,

  9. Keri says:

    I think I have ocular rosacea. I am awaiting an eye doctor visit. My eyes are dry, and look inflamed. They have veins that are visible in them, and my eyes feel very sore trying to open them in the morning. Like sandpaper rubbing across my eyes. This began with a facial like rash or redness with papules. That has cleared up, but my skin is very dry on my face and i often flush at night. Not so much in the day. Have you had success with healing ocular rosacea with Chinese Herbs? I am currently taking Zhi Bai Di Huang wan, as my flushing at night seems to coincide with yin deficiency. My face feels hot a lot. What would you do to help ocular rosacea?

    • To date, I have not treated ocular rosacea in my private practice – sorry. I like the Zhi Bai Di Huang Wan, but for eye symptoms I recommend a variation of that formula: Qi Ju Di Huang Wan (it contains herbs to reduce redness and dryness of eyes). Did you purchase it over the counter or are you under the care of a TCM practitioner? I recommend seeing a TCM practitioner bc they can customize a formula for you and make sure you are taking the proper dose of herbs. Let us know what the ophthalmologist says.

  10. Eula says:

    I have long suspected that I may have rosacea because of my red cheeks, but brushed it off as due to genes/my country’s hot and humid weather. My cheeks look like your photo on mild rosacea. Knowing how the condition can get worse with age, I’ll have to have it checked. Thanks for the information!

    • I find that rosacea is more common in people whose parents also have it. Almost all the adults in my family have rosacea. Joy! Hopefully you can keep your condition in check. Good luck to you. Thanks for writing.

  11. Lili says:

    Hi Diana! I just wanted to know if it qas ocular rosacea or not, I just was diagnosed with rosacea but I’m suspecting that I may have the ocular one too!
    Pls let me know, I’m terrified

  12. Mariana says:

    Can you post an updated photo of your skin now? I’m looking into therapy and would like to see an example of results. Would be so helpful, thank you!

  13. Natosha says:

    I have been newly diagnosed with rosacea and my dermatologist wanted to put me on antibiotics and steroid creams which was not going to happen, so I did some research and decided to give Dermalmd Rosacea Serum a try and I and super happy with the purchase and would highly recommend Rosacea Relief!

  14. Donna says:

    Hi my nose is constantly on fire and I have red marks on the skin and I feel my nose is a little swollen.
    The gp has said it’s nothing to be concerned about but I’m terrified of getting a massive bulbous nose and am actually having very bad anxiety about it.

  15. Claudia says:

    I’ve never been diagnosed with rosacea, but my face has a lot of redness. Almost instantly after applying Dermalmd rosacea serum, the redness almost completely disappeared. It’s so cooling and soothing on the skin with a matte–not greasy nor oily–finish.

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