What is Rosacea?

Curated by Claudia Shannon / Research Scientist / Honayst

The main symptoms of rosacea are facial flushing, irritated skin, and pimples. Other symptoms include blushing easily and eye problems. Rosacea is common, affecting around 1–20% of the population. However, people frequently receive the wrong diagnosis when they have rosacea, so the true incidence may be a lot higher.

There is currently no cure for rosacea, but people can treat the symptoms using creams and medications. Some foods and beverages can worsen the symptoms, such as dairy products, spicy foods, caffeine, and alcohol. Sun exposure can also make the symptoms worse.

Rosacea is more common in females than males, and it usually develops after the age of 30. This article provides an overview of rosacea, including its treatments, causes, symptoms, home remedies, and possible complications.

Treatments

Although there is currently no cure, various treatments can relieve the symptoms of rosacea. Without treatment, the symptoms may get worse over time. A combination of medications and lifestyle changes generally gives the best results. The following sections look at some possible treatment options for rosacea.

Skin creams

Skin creams can help reduce inflammation and skin discoloration. Doctors may recommend using them once or twice per day. Examples include topical antibiotics, tretinoin, benzoyl peroxide, and azelaic acid.

A doctor may also prescribe camouflage creams that mask blemishes on the skin.

Eye drops

Eye drops can relieve eye symptoms, which occur in ocular rosacea. For example, a doctor may recommend a type of steroid eye drop called blephamide. They may prescribe this for a few days to a week, followed by a break or tapered use.

Antibiotics

Oral antibiotics can have anti-inflammatory effects. They tend to give faster results than topical ones. Examples include tetracycline, minocycline, and erythromycin.

Tetracyclines are antibiotics that can help with eye symptoms. Doxycycline helps improve dryness, itching, blurred vision, and sensitivity to light in people with ocular rosacea.

Isotretinoin

Isotretinoin (Accutane) is an oral medication that people use in severe cases of rosacea (if other treatments have not worked). This is a powerful drug that prevents the skin from making oil. The side effects can be severe.

This medication is not helpful for people with erythematotelangiectatic rosacea.

Laser treatment

Dermatologists can use laser treatment to help reduce visible blood vessels, or telangiectasia. This treatment uses intense pulsed light to shrink them. Although the procedure may cause some pain, most people will not need an anesthetic. Laser treatment can sometimes cause bruising, crusting of the skin, swelling, tenderness, and, very rarely, infection. If a person wishes to remove thickened skin that has developed due to rosacea, they can speak to a cosmetic surgeon. Laser treatment or scalpel surgery can remove excess skin. A carbon dioxide laser can also shrink thickened tissue.

Types

There are four main types of rosacea, according to the American Academy of Dermatology (AAD):

  • Erythematotelangiectatic rosacea: Symptoms include skin discoloration, flushing, and visible blood vessels.
  • Papulopustular rosacea: Symptoms include flushing, swelling, and breakouts that resemble acne.
  • Phymatous rosacea: Symptoms include thickened, bumpy skin.
  • Ocular rosacea: Symptoms include eye redness and irritation and swollen eyelids.

A condition known as steroid rosacea can result from long-term use of corticosteroids, specifically when a person uses them to treat dermatitis and vitiligo.

Symptoms

The signs and symptoms of rosacea can vary considerably from person to person. Rosacea is more common in people with lighter skin. However, the symptoms of rosacea are easier to notice in these skin tones, and few studies have looked into the prevalence of rosacea in people with darker skin. The following symptoms tend to be present in most cases of rosacea:

  • Persistent skin discoloration: This may look like a blush or sunburn that does not go away. It happens when hundreds of tiny blood vessels near the surface of the skin expand.
  • Skin thickening: The skin may get thicker from excess skin tissue. This usually affects the nose and can cause rhinophyma, which affects males much more than females.
  • Flushing: This occurs when the face temporarily darkens. It may spread from the face down to the neck and chest, and the skin may feel unpleasantly hot.
  • Skin bumps and pimples: Small, red, acne-like bumps may develop. These may contain pus.
  • Visible blood vessels: Also called spider veins, or telangiectasia, this commonly affects the cheeks, bridge of the nose, and other parts of the central face.
  • Eye irritation: People may have irritated, watery, or bloodshot eyes. The eyelids can become red and swollen (blepharitis), and styes are common. Rosacea affects the eyes in around 50% of people with the condition. Rarely, vision can become blurred.

People may also have the following secondary symptoms of rosacea:

  • burning or stinging sensations in the skin
  • facial swelling, due to excess fluid and proteins leaking out of the blood vessels
  • dry or rough facial skin

The following symptoms may be useful indicators of rosacea in darker skin:

  • a warm feeling most of the time
  • dry, swollen skin
  • patches of darker skin, or a dusky brown discoloration to the skin
  • persistent acne-like breakouts
  • hard, yellowish-brown bumps around the mouth, eyes, or both
  • a burning or stinging sensation when applying skin care products
  • swollen or thicker skin on the forehead, nose, cheeks, or chin

Causes

Experts are not sure what causes rosacea. However, many believe that the following factors may contribute:

  • Abnormalities in the blood vessels: Skin specialists suggest that facial flushing and spider veins are due to abnormalities in the blood vessels of the face. However, they are unsure as to what causes inflammation in the blood vessels.
  • A skin mite called Demodex folliculorum: This mite lives on the skin and usually causes no problems. However, people with rosacea tend to have more of these mites than others. It is unclear whether the mites cause the rosacea or the rosacea causes the increase in mites.
  • Bacteria called Helicobacter pylori: These gut bacteria stimulate the production of bradykinin, a small polypeptide that causes blood vessels to dilate. Experts suggest that this bacterium may play a role in the development of rosacea.
  • Family history: Many people with rosacea have a close relative with the condition. This means that there may be an inherited or genetic component.

Triggers

For many people, dietary factors can affect rosacea symptoms. Consuming the following foods and beverages may cause or worsen symptoms:

  • hot foods and beverages
  • caffeine
  • dairy products
  • spices and seasonings that contain capsaicin, such as hot sauce, cayenne pepper, and red pepper
  • alcohol, including wines and hard liquors
  • foods containing cinnamaldehyde, such as tomatoes, chocolate, and citrus fruits

Avoiding one or more of these foods and beverages may reduce the risk of flare- ups and help control rosacea. Other factors can aggravate rosacea by increasing blood flow to the surface of the skin. These include:

  • extremes of temperature
  • sunlight, humidity, and wind
  • stress, anxiety, anger, and embarrassment
  • vigorous exercise
  • hot baths and saunas
  • some medications, such as corticosteroids and drugs for treating high blood pressure
  • acute medical conditions, such as a cold, cough, or fever
  • some chronic medical conditions, such as hypertension

Natural remedies

Minimizing exposure to rosacea triggers will help prevent its symptoms. Adopting good skin care practices can also help. The following lifestyle changes and home remedies may help control symptoms if a person uses them alongside medical treatments:

  • Avoid rubbing or touching the face.
  • Wash the face with a gentle cleanser, and avoid using products that contain irritants or alcohol.
  • Avoid comedogenic products. These block the oil and sweat gland openings.
  • Keep the skin hydrated with a gentle moisturizer. Wait for topical medications to dry before moisturizing.
  • Wear a broad-spectrum sunscreen when outdoors.
  • In cold weather, protect the face with a scarf or ski mask.
  • Avoid extreme temperatures.
  • Avoid foods and beverages that might trigger an outbreak.
  • Avoid using over-the-counter steroid creams unless a doctor has recommended them. These may worsen symptoms in the mid to long term.
  • Use an electric shaver when shaving, as this is less likely to trigger flare-ups than a normal razor.

Some people find that using green or yellow pre-foundation creams and powders help mask the skin discoloration.

Reducing stress

Stress is a common trigger of rosacea. Taking any measures to reduce stress levels will help prevent flare-ups. People can reduce stress by following these tips:

  • Get regular exercise.
  • Get good quality sleep.
  • Eat a healthful diet full of nutrients.
  • Try yoga, tai chi, or meditation.

Rosacea can be a source of stress for many people. It can make a person feel embarrassed, frustrated, anxious, or low in self-confidence. Becoming well informed about rosacea may help people manage their emotions, as they may feel more in control and better prepared to manage any possible complications or recurrences. Seeking effective treatments, and speaking to a doctor or mental health professional if necessary, can also help.

Diagnosis

There is no clinical test for rosacea. A doctor can make a diagnosis after examining the person’s skin and asking about their symptoms and triggers. The presence of enlarged blood vessels will help the doctor distinguish it from other skin conditions.

The presence of a rash on the scalp or ears usually indicates a different or coexisting diagnosis. Rosacea signs and symptoms occur mainly in the face. Early diagnosis and prompt treatment can significantly reduce the risk of progression. If the doctor suspects that there may be an underlying medical condition, such as lupus, they may order blood tests or refer the person to a dermatologist.

Summary

Rosacea is a chronic inflammatory skin condition. Symptoms include facial flushing, skin thickening, and eye symptoms. Although there is currently no cure, people can take medications to treat the symptoms. Home remedies can also help. A person can speak to a doctor for any concerns about rosacea.