Hi, Thanks for posting your query to HCM. After reading your query the important of the diagnosis I can make out is Rosacea or better known as Acne Rosacea. This problem affects young to middle-aged adults, more commonly females characterized by papules and pustules, redness with flushing and dilatation of small vessels on facial convexities. Adult onset acne appears to be less of possibility as according to your history you are adult person and the lesions explained by you do not have any close resemblance with acne lesions. Now the treatment and the outcome of this problem is very variable. We dermatologists are actually sometimes feel helpless despite giving so many of the therapies because of waxing and waning of the episodes. Though in topical formulation we prescribe metronidazole 1% cream/ 0.75% gel which is effective but in other options azelaic acid 20% cream and 15% gel, 0.025% retinoic acid, 0.1% adapalene gel can also be tried. In oral therpy tetracyclines such as minocycline, lymecycline and doxycycline can be tried or lastly Oral isotretinoin can be the option under dermatological guidance only. The best option would be to consult a good dermatologist and to have long term follow up for best of the result. In between kindly avoid the triggering factors such as hot drinks, spicy food, alcohol or any drugs if you are taking (such as for blood pressure). Lastly kindly do not think it as a part of some underlying illness and calm down yourself as stress too is a very important aggravating factor !! Hope to have provided the best information regarding your problem Dr Sanjay K Kanodia MD (Dermatology & STD/Venereology)