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My cheeks skin gets red and inflamed and nose becomes dry . I moisturize and apply nsaid it gets better but it reaches back it has been going on for a while

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rosacea diagnosis treatment

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I now have strong textbook evidence. Here is a thorough answer.

Your Symptoms Sound Like Rosacea

Based on what you describe - recurring redness and inflammation of the cheeks, dryness of the nose, improvement with moisturizer and anti-inflammatory treatments, but recurrence - the most likely diagnosis is rosacea, specifically the erythematotelangiectatic (ETR) subtype. This is a chronic inflammatory skin condition that is very manageable but almost always comes back if treatment is stopped.
Here is a clinical photo showing how rosacea typically looks (cheek redness + nasal involvement):
Papulopustular rosacea with cheek and nasal redness

What Is Rosacea?

Rosacea is a chronic inflammatory skin disease of unclear cause. It affects the convex surfaces of the face - the cheeks and nose are the most commonly affected areas, followed by the forehead and chin. It characteristically spares the skin around the eyes. It most often affects light-skinned people aged 30-50, though it can occur in anyone.
The four recognized subtypes are:
  1. Erythematotelangiectatic (ETR) - redness, flushing, and sometimes scaling. Skin is easily irritated and stings/burns. This fits your description closely.
  2. Papulopustular - acne-like red bumps and pustules alongside the redness
  3. Phymatous - thickening of skin, especially the nose (rhinophyma)
  4. Ocular - dry/irritated eyes (affects about 1 in 3 rosacea patients)
(Andrews' Diseases of the Skin, Clinical Dermatology, p. 292)

Why Does It Keep Coming Back?

This is the key thing to understand: rosacea is a chronic disease, not a one-time flare. The disease will recur in most patients if all therapy is stopped. Moisturizer and NSAIDs (like ibuprofen cream or similar topicals) reduce inflammation temporarily, but they do not address the underlying skin changes. You need maintenance therapy to keep it controlled long-term.

Common Triggers (things that make it worse)

  • Sun exposure (the most universal trigger)
  • Cold or hot weather
  • Hot drinks, spicy food, alcohol
  • Emotional stress, embarrassment
  • Hot baths/showers
  • Exercise
Avoiding your personal triggers is considered first-line management.
(Textbook of Family Medicine 9e, p. 931)

What Actually Helps

Topical (applied to skin) - for long-term maintenance:

  • Metronidazole 0.75% or 1% gel/cream - best evidence (Grade A), the go-to first-line option for rosacea control. Prescription products like Metrogel or Rosasol.
  • Azelaic acid 15% or 20% - also first-line with strong evidence (Grade A)
  • Topical ivermectin 1% cream - newer option with strong evidence
  • Plain moisturizers help with skin barrier but do not treat the disease itself

Oral antibiotics - for moderate to severe disease:

  • Doxycycline - the most widely used. A low anti-inflammatory dose (40 mg extended-release, brand name Oracea) works just as well as 100 mg once daily but with fewer side effects. Usually used for 2-3 months until lesions clear, then switched to topical maintenance.
  • The goal of antibiotics in rosacea is anti-inflammatory, not antimicrobial.

Sun protection:

  • Strict, daily broad-spectrum sunscreen is essential. This alone reduces flare frequency significantly.

What to avoid on your skin:

  • Harsh cleansers, scrubs, astringents
  • Topical steroids (can worsen rosacea with rebound flares)
  • Anything that causes irritation or burning

For persistent redness and visible blood vessels:

  • Laser (pulsed-dye laser) and intense pulsed light (IPL) treatments significantly reduce persistent redness and telangiectasia. A 2024 meta-analysis (PMID 39240125) confirmed both IPL and pulsed-dye laser are effective for rosacea management.
(Andrews' Diseases of the Skin, p. 294; Textbook of Family Medicine 9e, p. 931)

Important: See a Dermatologist

You should see a dermatologist (or at minimum a GP/family doctor) for a proper diagnosis before starting prescription treatment. While your symptoms are very consistent with rosacea, other conditions can look similar:
  • Seborrheic dermatitis - also causes facial redness and flakiness
  • Lupus (SLE) - can cause a "butterfly rash" across cheeks and nose
  • Contact dermatitis - skin reaction to a product
  • Perioral/perinasal dermatitis - often triggered by steroid creams
A doctor can distinguish these quickly on examination. If it is rosacea, they can prescribe topical metronidazole or azelaic acid, which are far more effective than what you're currently using and can keep the disease controlled long-term rather than just temporarily.
Bottom line: What you're experiencing sounds like chronic rosacea. The reason it keeps coming back is that NSAIDs and moisturizers are not the right long-term tools - you need prescription topical therapy (metronidazole or azelaic acid) as maintenance, trigger avoidance, and daily sun protection. Please consult a dermatologist for a confirmed diagnosis and treatment plan.
Disclaimer: This is educational information only, not a diagnosis. Please see a qualified healthcare provider for evaluation and treatment.
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