Frequently mistaken for acne or sensitive skin, and treated quite differently.
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Rosacea is a chronic inflammatory condition of the central face — cheeks, nose, chin and forehead. It causes flushing, persistent redness, visible small blood vessels, and in some people papules and pustules that look like spots.
It usually starts between 30 and 50, affects fair skin more visibly but occurs in all skin tones, and it runs a relapsing course. It cannot be cured, but it can be controlled well — and the difference between good and poor control usually comes down to two things.
Daily sunscreen. Ultraviolet light is the single biggest trigger, and sun protection is the most effective preventive measure available. Most people treat it as optional.
Not using a steroid cream on it. This is the most important warning here. Facial redness frequently gets treated with hydrocortisone or a stronger topical steroid, which appears to help briefly and then makes rosacea substantially worse — producing steroid-induced rosacea that is harder to treat than what you started with. If someone hands you a steroid cream for facial redness, question it.
One more thing that is routinely missed: rosacea affects the eyes in a large proportion of people, and ocular rosacea can threaten sight if ignored.
Burning, stinging, tightness and sensitivity — often more troubling than how it looks. Many products that suit other people sting intensely on rosacea skin.
Up to half of people with rosacea have eye involvement, and it sometimes appears before any skin change:
Untreated, this can progress to corneal damage and affect vision — which is why eye symptoms should always be mentioned.
Rosacea in brown and black skin is under-diagnosed because the redness is far harder to see. It presents more as warmth, swelling, burning, papules and darker patches, and it is frequently missed for years.
Not fully settled, but it involves abnormal blood vessel reactivity, an over-active innate immune response, and — in the papulopustular type — Demodex mites, which are present on everyone's skin but in much higher numbers in rosacea. That last point explains why an anti-parasitic cream works so well for some people.
There is a strong genetic component, and it is more common in people of northern European descent.
Rosacea is not caused by drinking. Alcohol can trigger flushing in someone who already has it, but the condition is not a sign of heavy drinking — and neither is rhinophyma, the thickened nose, despite centuries of assumption. This misconception causes real distress and is worth stating plainly.
Rosacea is diagnosed by looking at it, which makes it well suited to remote assessment. Send photographs in natural daylight — a full-face image and close-ups of the affected areas. See our guide to photographing a skin problem.
We cannot examine your eyes. Where ocular symptoms are significant, or vision is affected, that needs an eye assessment and we arrange it.
A mineral sunscreen containing zinc oxide or titanium dioxide, SPF 30 or above, every day of the year. Mineral rather than chemical, because chemical filters frequently sting rosacea skin. This is the most effective single preventive measure and the one most often neglected.
For moderate to severe papulopustular rosacea, low-dose doxycycline is used at an anti-inflammatory dose rather than an antibacterial one — which means it does not drive antibiotic resistance and can be continued longer. Give it six to twelve weeks.
Topical steroids. They give brief apparent improvement and then worsen rosacea significantly, producing a steroid-dependent pattern that is difficult to unwind. If you are currently using one on your face, do not stop abruptly — raise it, because coming off needs managing.
Ocular rosacea is treated with lid hygiene, warm compresses, lubricating drops and often the same oral doxycycline. Persistent or sight-affecting symptoms go to ophthalmology.
Dermatology for rosacea not responding to treatment, or for isotretinoin in resistant cases. Laser and IPL are the effective treatments for permanent visible blood vessels and fixed redness — creams do not remove those. These are generally not funded on the NHS, and we will be straightforward about that rather than implying a cream will fix it.
Seek same-day eye assessment for:
Seek prompt medical assessment for:
Book a routine consultation if:
Keep a brief diary for a few weeks — flare days alongside sun, heat, alcohol, food, stress and products. Trigger lists online are long and largely irrelevant to any individual; most people have two or three, and finding yours is worth more than avoiding everything.
Do not give up exercise — change how you do it. Shorter sessions, cooler environments, a cold towel on the neck, a fan, and cold water to hand. Swimming in a cool pool suits many people. Being red after exercise is uncomfortable, not harmful.
Let hot drinks cool slightly, or use a straw for iced ones. If red wine is a trigger, it may be the only one that is — many people tolerate other alcohol. Cooler showers, and avoid saunas.
Rosacea affects confidence considerably, and the assumption that facial redness means heavy drinking is both wrong and common. It is a legitimate reason to treat more actively, and worth saying out loud at an appointment.
Your NHS GP treats rosacea free, and the prescription treatments — topical ivermectin, metronidazole, azelaic acid, and oral doxycycline — are all cheap generics.
What costs nothing and does most of the work is identifying triggers, and this is genuinely where rosacea management succeeds or fails. Sun, alcohol, spicy food, hot drinks, temperature change, stress and certain skincare all provoke flushing, and they differ between people. A trigger diary for a few weeks is more useful than most prescriptions.
Daily sun protection is the single most effective long-term measure, is available over the counter, and is consistently under-emphasised.
Where a consultation is worth paying for is the mistake that makes rosacea considerably worse: topical steroids. Steroid creams settle the redness for a few days, then rebound — and steroid-induced rosacea is genuinely difficult to unpick, often taking months. If you have been using hydrocortisone on your face, that is worth a conversation.
The other thing regularly missed is ocular rosacea — gritty, red, irritated eyes alongside facial rosacea, which affects a substantial minority and is treated as unrelated dry eye for years.
Where money is wasted: the extensive market of “rosacea skincare”, most of which is expensive moisturiser.
NICE Clinical Knowledge Summary, Rosacea, is the principal reference. It sets out treatment by predominant feature — topical brimonidine for persistent erythema, topical ivermectin or metronidazole for papulopustular disease, and oral doxycycline for more severe or resistant cases.
CKS is explicit that topical corticosteroids should be avoided, since they exacerbate rosacea and can cause steroid-induced rosacea — the basis for the warning above.
CKS emphasises trigger identification and avoidance, alongside daily broad-spectrum sun protection, as core to long-term management.
CKS covers ocular rosacea, recommending lid hygiene and ocular lubricants, with referral where there is corneal involvement or symptoms not responding.
British Association of Dermatologists guidance covers referral criteria — including phymatous change, treatment-resistant disease, and significant psychological impact — and the use of laser or light therapy for persistent telangiectasia, which is not NHS-funded in most areas.
No. Alcohol can trigger flushing in someone who already has rosacea, but it does not cause the condition — and a thickened red nose is not a sign of heavy drinking either, despite the long-standing assumption. Plenty of people with rhinophyma have never drunk at all. It is a damaging misconception and worth correcting.
No, and the distinction matters because the treatments differ. Rosacea has no blackheads or whiteheads, sits centrally on the face, involves flushing and visible blood vessels, and typically starts later in life. Treating rosacea as acne — with scrubs and harsh products — makes it worse.
Because topical steroids suppress inflammation briefly and then cause a rebound flare, producing steroid-induced rosacea that is harder to treat than the original. It is a common sequence: facial redness gets a steroid, improves for a fortnight, then worsens. Do not stop abruptly — it needs managing — but do get it reviewed.
No. Creams reduce inflammation, papules and general redness. Permanent visible blood vessels and fixed background redness respond to laser or IPL, not to topical treatment. Those are usually private, and we would rather say so than let you spend months on a cream expecting something it cannot do.
Not cured, but controlled well. Most people achieve a considerable improvement with daily sun protection, the right topical treatment and trigger management. It is a long-term condition that responds to consistent treatment rather than short courses.
Yes — this is not a token recommendation. UV is the most consistently reported trigger, and daily sun protection does more to prevent flares than anything else. Use a mineral formulation, since chemical filters commonly sting rosacea skin.
No. Exercise can trigger flushing but it is uncomfortable rather than harmful, and the health cost of stopping is real. Exercise in cooler conditions, in shorter bouts, with a fan and cold water to hand. Swimming suits many people well.
Very likely ocular rosacea, which affects up to half of people with the condition and sometimes appears before any skin change. It responds to lid hygiene, warm compresses and often the same oral treatment used for the skin. Left untreated it can affect the cornea, so it is always worth mentioning.
August 23, 2026
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Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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