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Rosacea: What is it and What can be done?

Rosacea: What is it and What can be done?

posted: Feb. 04, 2026
Dr. Toula Berti

What Is Rosacea and What Are the Symptoms?

Rosacea primarily affects the central face—cheeks, nose, forehead, and chin—and often begins in adulthood, between ages 30 and 50. It's more common in people with fair skin but can impact anyone. The condition isn't contagious and isn't caused by poor hygiene. Common symptoms include:

Persistent facial redness or flushing that may come and go.
Visible small blood vessels (telangiectasia or "spider veins") on the face.
Small red bumps or pimples (papules and pustules), sometimes resembling acne.
A burning, stinging, or tight sensation on the skin.
Dry, irritated, or sensitive skin.
In some cases, thickened skin (especially on the nose, known as rhinophyma) or eye irritation (ocular rosacea, causing watery, red, or gritty eyes).

Symptoms can flare up due to triggers like sun exposure, hot drinks, spicy foods, alcohol, stress, extreme temperatures, or certain skincare products. Early recognition and treatment can prevent worsening and improve quality of life.

What Causes Rosacea?

The exact cause of rosacea remains unclear, but it's thought to involve a combination of factors:

Demodex mites (tiny skin residents), microbiome changes is involved
Genetic predisposition — It often runs in families.
Overactive immune response — The skin's innate immune system overreacts, leading to inflammation. Key pathways include activation of toll-like receptor 2 (TLR2), which increases antimicrobial peptides like cathelicidin (LL-37) and promotes inflammation.
Neurovascular dysregulation — Abnormal blood vessel function causes flushing and visible vessels, influenced by nerves and triggers that dilate blood vessels.
Skin barrier issues — A weakened barrier allows irritants to penetrate more easily, worsening sensitivity
Oxidative stress, stress, lack of sleep and environmental factors also play a role.

Rosacea is a spectrum of issues (phenotypes like erythematotelangiectatic for redness/flushing, papulopustular for bumps, etc.), which is why personalized treatment is key.

How Is Rosacea Treated?

There's no cure, but treatments effectively control symptoms, reduce flares, and improve appearance. A combination approach often works best.

1. Lifestyle and Trigger ManagementStart by identifying and avoiding personal triggers (e.g., use gentle, fragrance-free skincare; avoid foods that exacerbate symptoms and manage stress).

2. Topical MedicationsThese target inflammation, redness, and bumps directly on the skin:

Ivermectin — Targets Demodex mites and has anti-inflammatory effects, clearing bumps effectively.
Metronidazole or azelaic acid — Reduce inflammation and papules/pustules by calming immune overactivity.
Brimonidine or oxymetazoline — Alpha-adrenergic agonists that constrict blood vessels for quick redness reduction (great for flushing).

3. Oral MedicationsFor moderate to severe cases:

Low-dose doxycycline or minocycline — These work mainly as anti-inflammatories (not at level for antibiotic resistance), reducing bumps and overall redness by targeting pathways like matrix metalloproteinases and LL-37.
They help control flares with fewer side effects at sub-antimicrobial doses.

4. Laser for Redness for persistent redness and visible blood vessels.

Lasers provide excellent cosmetic improvement by targeting dilated vessels and stimulating collagen. The Cutera Laser Genesis (a gentle 1064 nm Nd:YAG non-ablative laser) is particularly effective for rosacea. It works by:

Gently heating the skin's deeper layers to reduce redness and diffuse erythema.
Targeting dilated blood vessels and calming inflammation without damaging the surface.
Stimulating collagen production for smoother texture, reduced pores, and an overall healthier glow.

Treatments tend to be 30 minutes, comfortable (often described as a warming sensation), with virtually no downtime.. Multiple sessions (typically 4–6) yield cumulative results, significantly alleviating redness and improving skin tone.

At Nashville Dermatology Physicians, Dr. Toula Berti and Dr. Jeffrey Berti are experts in using Laser Genesis alongside medical therapies for comprehensive care, addressing both the underlying inflammation and visible cosmetic concerns.

Research into the microbiome, barrier repair, and personalized medicine promises even better options ahead.

When Should You Seek Evaluation?

If you notice persistent facial redness, flushing, bumps, or sensitivity that affects your daily life, don't wait—early intervention prevents progression. A dermatologist can diagnose rosacea (often clinically, without tests) and create a tailored plan. At Nashville Dermatology Physicians, Drs. Berti offer expert evaluation and combine medical management with cosmetic treatments like Cutera Laser Genesis for optimal results. Many patients see significant improvement in redness, texture, and confidence.

You're not alone—rosacea is treatable, and clearer skin is achievable. Contact us today to schedule a consultation and take the first step toward calmer, healthier skin!

Contact 615.212.2517 for appointment or request on website.

1001 Health Park Dr.

Suite 470

Brentwood, TN