Background Rosacea, a chronic inflammatory skin disorder, affects patients’ physical health. The risk of anxiety disorders in patients with rosacea may be 2–3 times higher than that in the general population. However, the key factors influencing anxiety in rosacea remain unclear, and whether alleviating the subjective symptoms of rosacea can further improve treatment outcomes and quality of life requires further investigation. Methods A retrospective cross-sectional study of 482 newly diagnosed rosacea patients (West China Hospital) was conducted, with grouping into anxiety/non-anxiety groups for risk factor analysis. After that, a 6-week sub-analysis compared 64 patients receiving conventional carvedilol therapy vs. 32 receiving carvedilol + subjective symptom-targeted treatment, using univariate/multivariate logistic regression and pre−/post-treatment symptom/quality-of-life/psychological status comparisons. Results Patients with erythematotelangiectatic rosacea (ETR) had significantly higher Hospital Anxiety and Depression Scale-Anxiety (HADS-A) scores ( p = 0.03). Multivariate analysis revealed that moderate-to-severe burning sensation (odds ratio [OR] = 1.63), dryness (OR = 1.90), and pruritus (OR = 2.76) were independent risk factors for anxiety (all p < 0.05). Compared with the conventional group, the targeted group exhibited superior improvements in Investigator’s Global Assessment (IGA) scores ( p = 0.025), Patient Self-Assessment (PSA) scores ( p = 0.002), subjective symptoms, HADS-A scores ( p = 0.002), and Dermatology Life Quality Index (DLQI) scores ( p = 0.033). patients with erythematotelangiectatic rosacea (ETR) had significantly higher. Conclusion Subjective symptoms are independently associated with rosacea-related anxiety. Targeted treatment addressing subjective symptoms is associated with improvements in both overall clinical outcomes and psychological status, highlighting the necessity of systematic assessment and management of subjective symptoms in clinical practice.