How to calm a rosacea flare-up

A rosacea flare-up is a period when redness, warmth, burning or bumps get worse. The American Academy of Dermatology (AAD) says flares can happen even when you treat rosacea and avoid your triggers. When one starts, the AAD's advice comes down to a few steps: cool down, remove whatever set it off, treat your skin gently, protect it from sun and wind, stay calm, and follow your dermatologist's plan for flares. This guide collects what the AAD, the NHS and the US National Institutes of Health (NIH) say for each step. It assumes a doctor has confirmed that you have rosacea. If you have not been diagnosed, see a doctor, because other conditions can cause a sudden red face.

For the basics of the condition, see what rosacea is.

First, check for warning signs

Some flares affect the eyes, and those need a doctor quickly. The NHS asks people with rosacea to get an urgent appointment if:

• An eye is painful
• The vision is blurred
• The eyes are sensitive to light
• An eye is red
• An eye feels gritty

The NHS says these can be signs of a serious eye problem called keratitis. The guide to ocular rosacea covers eye symptoms in full.

Step 1: cool down

Heat is one of the most common triggers. The AAD says anything that raises your body temperature can cause a flare. If you feel overheated, it suggests:

• Drape a cold, wet cloth around your neck
• Sip a cold drink
• Use a fan or air conditioning
• Remove a layer of clothing
• Move away from heaters, fireplaces and other heat sources

If exercise set off the flare, the AAD suggests lowering the intensity and cooling down with a towel dipped in cold water, cold water to drink, or ice cubes.

You can keep exercising with rosacea. The AAD suggests exercising somewhere cool, such as an air-conditioned gym or a shaded path at the coolest time of day, or trying swimming in cool water, which can limit flares.

Step 2: remove the trigger

Think about what happened in the hour before the flare. Common triggers, according to the AAD, the NHS and NIH, include sunlight, heat, hot drinks, hot baths, alcohol, spicy food, stress, wind, cold, exercise and some skin, hair and makeup products.

• Sun: go indoors or into shade. The AAD says a few minutes of sunlight can cause flushing and redness.
• Hot drink: let it cool, or switch to an iced one.
• Alcohol or spicy food: stop for now, and write it down.
• A new product: wash it off gently. The AAD says burning, stinging, itching or dry, scaly skin after a product are signs it irritates your skin.
• Wind or cold: cover your face up to just below the eyes with a silk or acrylic scarf.

Step 3: be gentle with your skin

Follow the AAD's skin care advice for rosacea closely:

• Wash with a mild cleanser, using only your fingertips. Skip washcloths and sponges.
• Rinse with warm water, and make sure no cleanser stays on the skin, since leftover cleanser can irritate.
• Pat your face dry with a clean cotton towel.
• Wait until your face is dry, then apply a fragrance-free moisturizer. The AAD says moisturizer on dry skin is less likely to burn or sting.
• Do not rub, scrub or massage the skin, and do not exfoliate.

If you use a prescribed medicine, the AAD says to apply the medicine first, then the moisturizer. Keep using your prescribed treatment as your dermatologist directed.

Step 4: protect from sun and wind

The AAD says the sun is one of the most frequent causes of rosacea flares. Use a fragrance-free, broad-spectrum sunscreen of SPF 30 or higher before going outside, wear a wide-brim hat, and stay out of the midday sun. The guide to sunscreen for rosacea explains what to look for on the label.

In cold weather, the AAD says windburn is common in rosacea-prone skin. Cover your face with a soft scarf and limit time outdoors.

Step 5: stay calm

The AAD says a flare tends to be easier to manage when you keep calm, because stress can be a trigger. In a stressful moment, it suggests taking a deep breath, holding it, and breathing out slowly.

Step 6: follow your dermatologist's plan for flares

The AAD tells people with rosacea to follow their dermatologist's advice for treating a flare, and says treatment can help calm a flare-up. Ask your dermatologist at your next visit what to do when you flare, so you have a plan ready.

For redness that needs to fade quickly, the AAD says a few prescription medicines can fade lasting color fast. Most people see the best results 3 to 6 hours after applying them, and the effect can last up to 12 hours before the color returns. A dermatologist decides whether these suit you. The guide to how rosacea is treated describes them.

What to avoid during a flare

Avoid	Why, per the AAD, NHS or NIH
Hot showers and baths	NIH lists hot baths as a trigger. The AAD suggests warm water instead
Hot drinks	The heat of the drink can cause a flare, the AAD says
Alcohol, especially red wine	A common trigger on all three lists
Spicy food	A common trigger on all three lists
Toners, astringents, scrubs	The AAD says never use an astringent or toner, and stop exfoliating
Products with fragrance, menthol or camphor	The AAD lists them among ingredients that irritate rosacea
Rough fabrics like wool on the face	The AAD says they can trigger a flare

Covering redness with makeup

If you want to cover a flare, the AAD says a green-tinted concealer can hide redness, and a yellow-tinted concealer can hide color changes on light to dark skin. It says water-based or powder makeup is less likely to irritate. Apply a mild, fragrance-free moisturizing cream first, and avoid waterproof makeup and heavy foundations that need makeup remover.

How long a flare lasts

There is no fixed length. The NHS says early rosacea redness usually lasts a few minutes each time. The AAD says sun exposure can bring flushing that lasts for hours. As rosacea progresses, the AAD says redness can stay for weeks or months.

The AAD also warns that each flush can leave the skin red for longer, and that repeated flushing can lead to redness that stays. This is one reason the AAD stresses preventing flares.

Preventing the next flare

The AAD says that by treating rosacea and avoiding what triggers it, many people prevent flares. To find your triggers, it suggests a daily record for at least 2 weeks: food, drinks, products, weather and when you flushed. NIH also recommends a written record. The guide to rosacea triggers walks through the method.

Prepare a flare plan in advance

Flares are easier to handle when you have planned for them. Ask your dermatologist what to do during a flare, since the AAD tells people with rosacea to follow their dermatologist's advice for treating one. Then keep a few items close, based on the AAD's cooling and protection tips:

• A bottle of cold water
• A small towel you can wet with cold water and put around your neck
• A broad-spectrum sunscreen of SPF 30 or higher, fragrance-free
• A wide-brim hat for sunny days
• A soft silk or acrylic scarf for cold, windy days
• Your usual gentle cleanser and moisturizer if you travel

If your dermatologist has prescribed a medicine for flares or for redness, ask exactly when and how to use it, and follow those directions.

Flares on darker skin

On darker skin, a flare can be harder to see. The AAD says that on darker skin tones, the only sign of flushing may be a warm feeling on the cheeks. It lists a warm feeling most of the time, a dusky brown color, and burning or stinging from skin care products as signs of rosacea on darker skin. The same triggers apply to all skin tones. The AAD says the sun is a common trigger for people of every skin tone, so daily sunscreen matters for everyone with rosacea.

When to see a doctor

See a doctor if a flare comes with eye symptoms, if flares come more often or last longer, if the redness no longer fades between flares, or if bumps or burning get worse. The AAD says that with repeated flushing, treatment can become harder, and a dermatologist may need to change the plan. Getting help early makes rosacea easier to manage.