Type 1 rosacea can be confusing and frustrating, especially when much of the advice treats “rosacea” as one single thing. This guide focuses specifically on type 1 rosacea (erythematotelangiectatic rosacea, or ETR), in plain language, with a clear look at treatments, side effects, and the real role of azelaic acid.
What Is Type 1 Rosacea?
Type 1 rosacea (erythematotelangiectatic rosacea, ETR) is a chronic facial skin condition where the main features are:
- Frequent flushing
- Persistent redness (especially on the cheeks, nose, forehead, and chin)
- Often visible, fine blood vessels on the surface (telangiectasia)
People with type 1 rosacea often describe:
- Burning, stinging, or sensitivity
- Skin that looks red or “hot” even when they are not doing much
- Triggers like heat, alcohol, spicy food, stress, or sun making everything worse
Unlike acne, this form of rosacea is driven mainly by changes in the blood vessels and the immune system in the skin, not by blocked pores or oil overproduction.
Can You Self‑Diagnose Type 1 Rosacea?
You can often suspect type 1 rosacea from the pattern of symptoms:
- Long‑term facial flushing and redness, mostly in the centre of the face
- Redness that worsens with classic triggers (heat, alcohol, exercise, spicy food, hot showers, UV)
- Burning or stinging with products that other people tolerate easily
However, you should not rely on self‑diagnosis alone. Other conditions can look very similar, including:
- Seborrheic dermatitis (red, flaky patches)
- Allergic or irritant contact dermatitis
- Lupus and other autoimmune conditions
- Photodamage, perioral dermatitis, or even menopausal flushing
A GP or dermatologist can:
- Confirm that it is rosacea
- Check for other types (like papules/pustules or eye involvement)
- Rule out conditions that might require blood tests, different treatments, or more urgent care
So use your own observations as a starting point, but treat a professional diagnosis as essential.
Most Effective Topical Treatments for Type 1 Rosacea (Plus Side Effects)
For type 1 rosacea, the focus is on calming persistent redness and flushing. The main topical prescription options that directly target redness are vasoconstrictors (they narrow blood vessels), plus a few emerging anti‑inflammatory options.
Brimonidine Gel (e.g. Mirvaso)
What it does
Brimonidine is an alpha‑2 adrenergic agonist. When applied to the skin, it temporarily narrows superficial blood vessels. This:
- Reduces visible redness for several hours
- Helps with the “background red” that doesn’t go away on its own
How well it works
Clinical studies show brimonidine gel can significantly reduce facial erythema in type 1/vascular rosacea within 30 minutes, with effects lasting up to about 12 hours. It is widely recommended as a first‑line option for persistent redness rather than for bumps or spots.
Common side effects
This is where things get important for real‑world use:
- Burning, stinging, itching or dryness at the application site
- Patchy pallor (very pale areas) next to redder zones
- “Rebound” or worsening redness and flushing as the drug wears off
- In some people, a general flare or exacerbation of rosacea symptoms
Because of this, many dermatologists introduce it carefully: a small area test, low frequency at first, and clear instructions to stop if redness dramatically worsens.
Oxymetazoline Cream 1%
What it does
Oxymetazoline is an alpha‑1 adrenergic agonist. Similar to brimonidine, it works by narrowing small blood vessels in the skin. It is designed for persistent facial redness rather than spots.
How well it works
Clinical trials show that once‑daily oxymetazoline 1% cream:
- Significantly reduces persistent erythema in many people with rosacea
- Has a good safety and tolerability profile over long‑term use
Common side effects
Most side effects are mild and temporary:
- Application‑site redness, dermatitis, itching, or burning
- Occasionally a feeling of skin tightness or discomfort
- Rarely, a worsening of rosacea symptoms in some users
Systemic (whole‑body) side effects are uncommon, but people with serious heart disease or those on certain blood pressure medications should check with a doctor before use.
Topical Timolol (Off‑Label)
What it does
Timolol is a beta‑blocker eye‑drop solution that some dermatologists use off‑label, applied to the skin, for vascular problems such as superficial blood vessels. In ETR, it may:
- Reduce redness and warmth
- Slightly improve visible vessels in some patients
How well it works
A small split‑face randomized study in mild‑to‑moderate ETR showed:
- Improved redness scores
- Better comfort (less burning/warmth) after a few weeks
Because it is off‑label, it is more of a niche option used by experienced clinicians rather than a standard first‑line prescription.
Common side effects and cautions
Locally, timolol can cause:
- Mild stinging or irritation
- Dryness
Systemically, because it is a beta‑blocker, there is a theoretical risk of:
- Slowed heart rate
- Low blood pressure
- Breathing problems in people with asthma or COPD
That is why it is generally avoided or used very carefully in anyone with respiratory or heart rhythm issues.
Dapsone 5% Gel
What it does
Dapsone is an anti‑inflammatory drug with antioxidant and immune‑modulating effects. Topical 5% gel is more commonly known in acne, but small studies have explored its use in rosacea, including erythematotelangiectatic presentations.
How well it works
In a prospective study of people with ETR:
- Dapsone 5% gel used for 12 weeks improved clinical redness scores and symptoms such as burning
- Quality of life measures also improved
It is not yet a mainstream ETR treatment, but it is an interesting emerging option in selected cases.
Common side effects and cautions
Topically, most reactions are mild:
- Burning or stinging
- Redness
- Dryness or irritation
Systemic (whole‑body) risks like haemolysis and methaemoglobinaemia are rare with topical use but are more of a concern in people with G6PD deficiency or on certain other medications.
Barrier‑Supportive, “Vehicle” or Phospholipid Gels
What they do
Some studies look at “drug‑free” gels or emulsions designed specifically for rosacea:
- Ultra‑deformable phospholipid gels
- Gentle, fragrance‑free, non‑irritating bases
Alone, they do not constrict blood vessels or strongly change the immune response. Instead, they:
- Improve hydration and barrier function
- Reduce general stinging and burning
- Make it easier to tolerate prescription treatments
How well they work
Trials show modest but real improvements in redness and comfort compared with basic placebo vehicles, and they are often recommended as part of the skincare foundation for rosacea.
Common side effects
Generally very well tolerated, but:
- Some people can still experience mild burning or stinging
- Allergic or irritant reactions to certain ingredients (e.g. preservatives) are possible, though less common
Most Effective Dermatological (In‑Office) Treatments
Topicals are just one part of type 1 rosacea care. For persistent redness and visible vessels, in‑office procedures are often the real workhorses.
Vascular Lasers and Intense Pulsed Light (IPL)
The main tools here include:
- Pulsed dye laser (PDL)
- KTP (532 nm) laser
- Long‑pulsed Nd:YAG laser
- Intense pulsed light (IPL)
What they do
These devices target haemoglobin in blood vessels. Heat is delivered into the vessel, causing it to collapse or be reabsorbed over time. This:
- Reduces visible broken capillaries and telangiectasia
- Softens background redness
- Can improve flushing frequency in some patients
How well they work
Studies consistently show that a series of sessions (for example, 3–5 treatments spaced a few weeks apart) can produce:
- 50–75% reduction in visible vessels for many patients
- Meaningful lightening of background redness
Results vary, but for structural vessel changes, lasers and IPL are among the most effective options available.
Common side effects
- Temporary swelling, redness, and mild bruising
- Short‑term darkening or crusting of treated vessels
- Rarely, blisters, pigment changes (lighter or darker patches), or scarring
Choosing an experienced practitioner and adjusting settings for your skin type makes a big difference to both safety and outcome.
Combining Topicals and Devices
In practice, dermatologists often combine:
- Daily skincare and sun protection
- A vasoconstrictor cream (like oxymetazoline)
- A series of laser or IPL sessions
Combination approaches can:
- Improve redness faster and more completely
- Allow lower doses or less frequent use of topicals
- Prolong remission between flares
Is There a Cure for Type 1 Rosacea?
Right now, no.
Rosacea is considered a chronic, relapsing condition. That means:
- The underlying tendency to flush and develop redness remains
- Symptoms can improve a lot (even to the point of looking “cleared”)
- Flares can still return with triggers, stress, or changes in treatment
The goal is management, not cure:
- Reduce the intensity and frequency of flares
- Minimise day‑to‑day redness and discomfort
- Protect the barrier so skin feels as comfortable and “normal” as possible
With the right combination of trigger management, skincare, topicals, and sometimes in‑office procedures, many people achieve long remissions and a big improvement in quality of life.
Adjunct: Where Azelaic Acid Really Fits In (And Why “Rosacea = Azelaic” Is Misleading)
If you search online, azelaic acid is often sold as a universal “hero” for all rosacea. The reality is more nuanced, especially for type 1.
What Azelaic Acid Actually Does
Azelaic acid is a dicarboxylic acid used at prescription strengths (15–20%) and in some cosmetic formulas. Its main actions are:
- Anti‑inflammatory: reduces certain inflammatory mediators and reactive oxygen species in the skin
- Modulation of the innate immune system: down‑regulates pathways that are overactive in rosacea, such as cathelicidin and kallikrein‑5
- Comedolytic / keratin‑modulating: normalises how skin cells in the follicle mature and shed, helping to prevent clogged pores
- Mild sebostatic effects (mainly shown in acne): can reduce sebaceous gland activity and oiliness in some settings
Because of this, azelaic acid has strong evidence in papulopustular rosacea (the subtype with spots and bumps – that post is coming next) and in acne, where it improves both inflammation and redness.
Why the Evidence Is Not Purely “Type 1”
The key gap:
- Most clinical trials of azelaic acid in rosacea were done in papulopustular rosacea
- Redness improvement in those studies is often tied to the reduction of inflamed bumps, not to pure flushing or broken vessels
For pure type 1 (flushing + visible vessels and little or no acne‑like bumps):
- There are no robust trials showing that azelaic acid alone significantly reverses telangiectasia or dramatically reduces flushing
- Its benefits are more about inflammation and overall skin behaviour than about directly shrinking blood vessels
Is It Still Useful If You Have Type 1?
Potential benefits in a type 1‑dominant person include:
- Calming some inflammatory signals that can sit “in the background” of rosacea
- Helping with coexisting oiliness, large pores, and texture issues
- Improving post‑inflammatory marks or subtle unevenness
However, important caveats:
- At 15–20%, azelaic acid is not always “gentle” for very sensitive ETR skin; burning and stinging are common early side effects
- It does not replace vasoconstrictors or laser/IPL when the main problem is flushing and visible vessels
A realistic way to think about it:
- Azelaic acid is an adjunct that can be very helpful if you have mixed features (for example, type 1 rosacea plus oiliness, visible pores, or occasional papules)
- It is not the primary, targeted answer to pure, vessel‑driven type 1 redness
So when you see “azelaic acid is great for rosacea” online, it is partially true, but incomplete. You need to know which type of rosacea you have and which problem you are actually trying to solve: blood vessels and flushing, or bumps and oil and texture, or both.
For type 1 rosacea, the most important steps are:
- Get a proper diagnosis so you know your subtype(s)
- Build a gentle, protective routine and identify your triggers
- Use targeted redness tools (vasoconstrictor topicals, lasers/IPL) when appropriate
Understanding what each treatment actually does - vascular, inflammatory, barrier, or sebaceous - makes it much easier to choose options that match your skin, instead of just following generic “rosacea” advice.
References
-
Wilkin J, et al. Standard classification of rosacea. J Am Acad Dermatol. 2002.
-
Steinhoff M, et al. Rosacea. Nat Rev Dis Primers. 2016.
-
Two AM, et al. Rosacea: Practical Guidance and Challenges for Clinical Management. 2024.
-
Gallo RL, et al. Rosacea pathophysiology: Innate immunity and neurovascular dysregulation. J Invest Dermatol.
-
Fowler JF, et al. Once-daily brimonidine tartrate gel 0.33% for the treatment of persistent facial erythema of rosacea. J Drugs Dermatol.
-
Moore A, et al. Oxymetazoline cream 1% for the treatment of persistent facial erythema associated with rosacea. J Am Acad Dermatol.
-
Rusu A, et al. A randomized, controlled, split‐face study of topical timolol maleate in erythematotelangiectatic rosacea. J Cosmet Dermatol.
-
Wozniacka A, et al. Efficacy of topical dapsone 5% gel for the treatment of erythematotelangiectatic rosacea. Dermatol Pract Concept. 2024.
-
Neuhaus IM, et al. Improving treatment of erythematotelangiectatic rosacea with vascular lasers and IPL. Semin Cutan Med Surg. 2016.
-
van Zuuren EJ, et al. Interventions for rosacea. Cochrane Database Syst Rev.
-
Berardesca E, et al. Tolerability and efficacy of ultra‑deformable phospholipid gels in rosacea. J Eur Acad Dermatol Venereol.
-
Tuchayi SM, et al. Rosacea: Pathogenesis and therapeutic correlates. J Cutan Med Surg. 2024.
-
Draelos ZD. The role of skincare in rosacea. Cutis.
-
Thiboutot D, et al. Azelaic acid 15% gel in the treatment of papulopustular rosacea. Arch Dermatol.
-
Elewski BE, et al. A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in papulopustular rosacea. Arch Dermatol.
-
Kircik LH. Azelaic acid: A review of its mechanism of action and clinical applications. J Drugs Dermatol.
-
Zouboulis CC, et al. Long-term effect of azelaic acid peel on sebum production in acne. Dermatol Ther.
-
Schlessinger J, et al. Azelaic acid in dermatology: Mechanisms and clinical applications.
-
van Zuuren EJ, et al. Topical therapies for rosacea: An evidence-based review. Br J Dermatol.
-
Medicines and Healthcare products Regulatory Agency. Brimonidine gel (Mirvaso): risk of exacerbation of rosacea. Drug Safety Update.