Rosacea Protocol

This protocol targets people with mild to moderate rosacea — persistent facial redness, visible blood vessels, and occasional inflammatory papules/pustules. It focuses on the subtype 1 (erythematotelangiectatic) and subtype 2 (papulopustular) presentations that are most responsive to topical management.

Severe rosacea, ocular rosacea, or rhinophyma (thickened skin, usually on the nose) require professional dermatological care and often prescription treatments beyond what OTC products can address.

Key differences from other skin concerns:

• Most exfoliating acids (AHA, BHA) are poorly tolerated and should be avoided initially
• Retinoids are often too irritating — if introduced at all, it must be extremely slowly
• Benzoyl peroxide is generally too harsh for rosacea-prone skin
• Fragrance, essential oils, and alcohol-based products are common triggers
• Heat, spicy food, alcohol, and intense exercise can trigger flares — these are management factors, not product choices

• Centella asiatica / madecassoside — One of the few botanicals with genuine calming evidence. Can be layered under moisturiser.
• Prescription metronidazole 0.75–1% — First-line prescription for papulopustular rosacea. Requires a dermatologist.
• Prescription ivermectin 1% (Soolantra) — Effective for papulopustular rosacea, particularly when Demodex mites are a factor. Requires prescription.
• Prescription brimonidine (Mirvaso) / oxymetazoline (Rhofade) — For persistent background redness. Prescription only. Can cause rebound redness — discuss risks with your dermatologist.

• Omega-3 (1–2g EPA+DHA daily) — Moderate evidence for reducing systemic inflammation. May help reduce baseline redness and inflammatory flare severity.
• Vitamin D (1,000–2,000 IU daily) — Rosacea patients often have lower vitamin D levels. Correcting deficiency may support immune regulation.
• Nicotinamide (500mg twice daily) — Strong evidence for skin DNA repair. May provide additional anti-inflammatory support.

Probiotics (particularly Lactobacillus strains) have emerging but inconclusive evidence for rosacea. If gut health is a concern, this is worth discussing with a gastroenterologist.

Topical management is only half the picture. Common rosacea triggers include:

• Heat — Hot showers, saunas, hot beverages (let coffee cool slightly)
• UV exposure — The most consistent trigger. Mineral sunscreen daily, no exceptions.
• Spicy food — Capsaicin is a vasodilator. If you notice flushing after spicy meals, reduce intake.
• Alcohol — Red wine is the most commonly reported trigger, but any alcohol can cause vasodilation.
• Intense exercise — Counterintuitively, exercise is still recommended for overall health. Cool down strategies help: exercise in cooler environments, use a cool towel, and splash cold water on your face post-workout.
• Emotional stress — Hard to avoid, but mindfulness and stress management have measurable effects on rosacea flares.

Keep a trigger diary for 4 weeks to identify your personal pattern. Not all triggers affect everyone equally.

• Treating rosacea like acne — most acne products will make rosacea worse
• Using AHA/BHA exfoliants on rosacea-prone skin (too irritating for most)
• Applying products to damp or warm skin (increases absorption and irritation)
• Using chemical sunscreens that sting reactive skin — switch to zinc oxide
• Not giving the minimal routine enough time before adding actives
• Ignoring lifestyle triggers while focusing only on products

Weeks 1–2: Simplified routine reduces new irritation. Skin may start feeling less reactive.

Weeks 4–6: Azelaic acid begins reducing papules and background inflammation. Redness may modestly improve.

Weeks 8–12: Clearer picture of what the protocol can achieve. Persistent redness may require prescription options.

Ongoing: Rosacea is a chronic condition. Management is ongoing, not curative. The goal is sustained control with minimal products.