Rosacea is one of the most common, yet often misunderstood, skin conditions among adults aged 30 to 60. In fact, an estimated 16 million Americans have rosacea, but only a fraction are being treated for the disorder, according to the National Rosacea Society (NRS). Persistent redness and flushing, bumps and pimples, and visible blood vessels on the face are just a few of the primary symptoms of rosacea, signs that can be misdiagnosed as other conditions.
Rosacea does not only affect a person’s physical appearance, it also has an impact on their confidence and emotional health. The NRS reports that while nearly 90% of rosacea patients said this condition had lowered their self-confidence and self-esteem and 41% reported it had caused them to avoid public contact or cancel social engagements, 70% reported medical treatment had improved their emotional and social wellbeing. As more people become aware of the condition and the environmental, dietary, genetic, and lifestyle factors that play a critical role in its onset and exacerbation, it’s also one of the most frequent skin diagnoses made by dermatologists today. “Genetic factors play a significant role in rosacea, with studies estimating that heritability accounts for 46% of the risk,” says Lydia Sarfati, CEO and founder of Repêchage. “People who are fair-skinned with Fitzpatrick skin types 1 and 2 and have a genetic disposition are at a greater risk, but we are finding that higher Fitzpatrick skin types, such as 3 and 4 or higher, can also be genetically predisposed, though it may be missed or underdiagnosed. Women are more likely to get rosacea, however, cases in men can be more severe.” According to an article published in the National Library of Medicine, factors that can exacerbate the condition include immune dysregulation, microbiome alterations, hormonal influences, and psychosocial distress, as well as ultraviolet radiation, air pollution, dietary factors, alcohol consumption, smoking, skincare practices, and climate.
Red Zone
We asked skincare professionals about rosacea and how to help rosacea-prone clients find relief in the spa setting. Here’s what they said:
Why do you think adult rosacea has become so prevalent in recent years?
“A few things are converging. First, awareness has improved. People are actually getting diagnosed now instead of just thinking they have sensitive skin. Beyond that, I think chronic stress, environmental pollution, and our overstimulated skincare habits are genuinely contributing. We’re seeing clients who have been over-exfoliating, using actives that are too harsh, and essentially stripping their barrier for years before they come to us. Once the barrier is compromised, the skin becomes much more reactive. Add in climate extremes and increasing UV exposure, and the skin is under constant stress. Adult-onset rosacea, particularly in women going through perimenopause, is also something we’re seeing more of, likely tied to hormonal shifts and inflammation.”—Cindy Vo, RN, nurse injector at Serenity Aesthetics & Wellness (San Francisco)
Are estheticians able to diagnose rosacea?
“Estheticians are not technically allowed to diagnose the skin. They can analyze it, but only medical doctors can diagnose skin diseases. They must stay within their license. When speaking to the client, remember the language that you use, how you position your recommendations, and how you analyze the skin. What you say to your clients is very important. Be professional and have integrity. That said, there is a lot that estheticians can do to help alleviate symptoms of the condition. When a rosacea patient sees a medical doctor, the doctor might not be looking at the patient in a holistic manner. They are looking at a specific symptom and trying to fix that. But our body is a wonderful complex of many different organs put together, and if we don’t have a holistic approach, we’re usually worse off because we’re not treating the body as a whole.”—Sarfati
What are the types of rosacea?
“Vascular rosacea manifests as a butterfly rash on the center of the face caused by vasodilation of the capillaries and increased cortisol production. This can be exacerbated by heat exposure, drinking alcohol, and stress. Inflammatory rosacea has the vascular component, but there is the addition of inflammatory exacerbation, which is related to gastrointestinal health. Ocular rosacea is when you not only have symptoms of inflammation but also have outbreaks of pustules and papules, which may be itchy, leading to infection, acne scars, and hyperpigmentation.”—Sarfati
How does an early rosacea diagnosis help clients avoid bigger problems with their skin later in life?
“Early diagnosis is critical because rosacea is a progressive condition if left unmanaged. Addressing it in the early stages can help prevent more advanced symptoms like persistent redness, visible blood vessels, thickened skin, and long-term sensitivity. With the right treatment plan and lifestyle changes, clients can better control inflammation, strengthen the skin barrier, and maintain a more balanced, healthy complexion over time.”—Marc Ronert, M.D., Ph.D., co-founder and CEO, Image Skincare
What precautions should spas take during facials while dealing with rosacea-prone clients?
“The biggest principle is that less is more. Rosacea-prone skin does not respond well to overstimulation. Heat is a major trigger, so steam should be avoided or used very cautiously. Aggressive exfoliation, strong actives, and extractions in inflamed areas should also be minimized. Product selection is critical. Avoid ingredients like alcohol, menthol, eucalyptus, fragrance, or high concentrations of acids, and instead focus on calming, barrier-supportive formulations. Massage should be gentle and more lymphatic-focused rather than stimulating, and it’s important to continuously check in with the client throughout the treatment. Even small adjustments can make a big difference in how their skin responds.”—Vo
What are some tips for educating clients about at-home care for rosacea?
“I always guide clients toward simplicity and consistency. A gentle cleanser, a fragrance-free moisturizer, and daily SPF are the foundation. Mineral sunscreen is often better tolerated for rosacea-prone skin. The biggest issue I see is overuse of actives and over-exfoliation, so scaling back is often part of the process. I also encourage clients to track their triggers, whether that’s food, stress, or environmental factors. Patterns show up quickly, and it helps them feel more in control of their skin. The goal is to help clients understand their skin and manage it with confidence.”—Vo