What Is Rosacea?

Rosacea is a skin condition characterized by reddening of the face. In the early stages, it may appear like blushing or a sunburn on your nose and cheeks. It can eventually cause acne-like bumps, and, in some cases, it may lead to changes in the skin that include permanent thickening and swelling.

Rosacea may be linked to other medical conditions—those that put you at risk for rosacea and those that you're more likely to develop because you have rosacea.

This article explains possible causes of rosacea, triggers that lead to flare-ups, treatment options, and related disorders.

Overview

It's estimated that 415 million people worldwide have rosacea. People of Scandinavian or Celtic descent may be more likely to have the condition, but rosacea can affect anyone.

In the past, many people didn't realize they had a serious problem until permanent changes to their skin had taken place. Today we have more facts about rosacea:

• Symptoms usually begin after the age of 30.
• Women usually experience changes in the skin of the cheeks and chin.
• Men are more likely to see rosacea effects on their noses.
• The symptoms tend to be more severe in men.
  

Causes

Rosacea looks similar to adult acne and is often mistaken for it, and while there are similarities, they are not the same. Both are disorders related to the pores, known as the pilosebaceous unit. This is the area where the hair follicle, the hair shaft, and the sebaceous gland are located.

With rosacea, face pores are inflamed for different reasons than with acne, and pimple-like lesions are common, but there are no blackheads (comedones) like there are with acne.

While researchers aren't certain of the exact causes of rosacea, several ideas, as well as risk factors, have surfaced. Some of these include:

• The hair follicle mite Demodex folliculorum may be related, although this relationship has been called into question. Some people with rosacea have more of the mite on their skin, but others who have this mite have no symptoms.
• Infection with Helicobacter pylori has been linked with rosacea and there is some evidence that H. pylori, the same bacteria which causes stomach ulcers, may play some type of role in rosacea. With H. pylori the relationship does not mean that the bacteria are present in the skin, but rather a skin response to the bacteria in the intestinal tract may play a role.

Signs and Symptoms

Rosacea is categorized according to four subtypes related to the skin and eyes: facial redness, acne-like breakouts, thickening of the skin, and eye disorders.

Rosacea Skin Symptoms

There are several skin features that commonly occur with rosacea. Symptoms vary, but people may have any combination of the following:

• Red, sometimes swollen, the skin around the middle of the face—the forehead, cheeks, and nose
• Red bumps that may have pus in them similar to acne
• Tiny blood vessels, called telangiectasias, over the nose and cheeks that are visible up close but appear as a red blush at a distance
• An enlarged, pitted, bulbous nose, called rhinophyma, which occurs as fibrous tissue and sebaceous glands enlarge
• Burning or stinging in the skin
  

Rosacea of the Eye Symptoms

Roughly 20% of people with rosacea experience ocular rosacea, or rosacea of the eye, before they show symptoms of skin problems. Ocular rosacea sometimes occurs without any facial changes.

Symptoms often begin with red and swollen eyelids and a feeling as if something, such as a piece of sand, is in the eye. If you are having any eye symptoms at all, talk to your healthcare provider, who may recommend seeing an ophthalmologist. There are many treatments that may be used, including taking a supplement of omega-3-fatty acids.

Triggers

Symptoms of rosacea usually wax and wane. Periods of remissions may be followed by flare-ups, which are usually triggered by external factors.

The following triggers can bring out symptoms.

Sun Exposure

Use sunscreen with an SPF of 30 or higher every day if you have rosacea. Avoid being in the sunlight during the middle of the day, and seek shade when you do need to be outdoors. Even a little bit of direct sun exposure can result in flushing and redness.

Stress

Not everyone with rosacea has flare-ups due to stress, but if you find that it causes your skin to become inflamed, be sure to practice stress-reducing breathing and make time for relaxing activities or rest.

Heat

Hot weather or activity that causes you to become overheated can cause symptoms. During hot days, take cool showers or use cold, wet cloths on your neck to lower your body temperature. When you work out, exercise in an air-conditioned room. During cold weather, avoid sitting too close to a fireplace or heat source.

Your skin can also react to hot baths, showers, and drinks.

Drinking Alcohol

If you find you're sensitive to alcohol, you should limit your intake to just one or two drinks. Diluting alcohol with club soda, water, or non-alcoholic mixes can also help. White wine is less likely to cause symptoms than red wine.

Spicy foods

Hot foods are a common trigger for rosacea. To avoid breakouts or reddening, choose mild foods.

Wind and Cold

Cover your face in windy weather and protect your skin from exposure to cold weather.

Differential Diagnoses

The facial features seen with rosacea are fairly common, but there are other conditions that can look very similar, in addition to adult acne. Some of these include:

• Dermatomyositis
• Allergic contact dermatitis
• Drug-induced erythema
• Emotional (blushing)
• Lupus
• Photosensitive eruptions

Associated Conditions

Rather than being an isolated phenomenon, research has shown some links between rosacea and other conditions including:

• There appears to be some link between irritable bowel syndrome and rosacea, although the precise relationship is not yet understood.
• People with rosacea appear to have an increased risk of breast cancer (25% higher), non-melanoma skin cancer, and liver cancer, but how these are related is not currently known.
• Rosacea has also been found to have a significant correlation with the development of dementia, especially Alzheimer's disease.
• Other conditions that have been linked to some degree with rosacea include Parkinson's disease, anxiety, and depression.

Most of the studies looking into these links were published in 2016 and 2017 so there is still much to learn about the possible association of rosacea with other conditions.

Treatment

There are several treatments that may help with rosacea, depending on the severity of your symptoms. These include:

Oral Medicine

Several agents can be used to treat rosacea. Erythromycin and tetracycline are the main oral antibiotics used. Other antibiotics that are commonly used are doxycycline, Flagyl (metronidazole), and Minocin (minocycline).

Some people only need to take antibiotics for flare-ups, while others have to take antibiotics every day to suppress symptoms. Usually, it is best to go with the smallest dose possible to give the desired results. The antibiotics help more with the red bumps and acne-like lesions on the face. They don't help as much with the redness and blood vessels.

Isotretinoin (Accutane) has been used for stubborn rosacea but must be taken with caution, as it can cause severe skin and lip dryness, depression, and birth defects when taken by pregnant women.

Topical Medicine

Several topical agents can also be used to treat rosacea. The most commonly used agent is Metrogel (metronidazole).

In April 2022, the Food and Drug Administration (FDA) approved Epsolay (benzoyl peroxide) 5% cream to treat adults with inflammatory lesions, including papules and pustules caused by rosacea. Epsolay is slowly released, requiring a once-daily application.

Other topical agents include Finacea (azelaic acid), sulfacetamide, and sulfur lotion that can be found in a flesh-colored formulation to help hide some of the redness. Soolantra (ivermectin) has also emerged as a therapy for rosacea. This is a topical medication used to kill mites (such as with scabies) and is prompting researchers to look more closely at the possibility of certain skin mites having a role in the condition.

Lasers

Laser therapy uses the heat from wavelengths of light to essentially collapse the tiny blood vessels that become visible with rosacea. There are different types of laser treatments. Those used for rosacea include V-beam lasers and Intense Pulsed Light (IPL) therapy.

Surgery

The enlarged nose cannot be reversed with medicine. Cryosurgery, laser surgery, and electrosurgical therapy have been used for this with variable effectiveness. Electrosurgery and laser therapy are useful for blood vessels.

A Word From Verywell

The most important first step in managing rosacea is to recognize you are dealing with the condition and that it is not adult acne. Most treatment approaches include both treating the rash and recognizing and avoiding the triggers which can make it worse. When the condition has been present for a prolonged period of time, cosmetic surgery may be helpful for some people.

If you've been diagnosed with rosacea, you may feel anxious to learn that rosacea has been linked with some conditions ranging from Parkinson's disease (rosacea is an independent risk factor) to breast cancer. Unfortunately, it's too early to understand the significance of these findings.

What these findings do suggest is that you should consider making an appointment to visit with your healthcare provider and discuss these findings, especially to make sure you are up to date on cancer screening tests and more. In fact, sometimes a little concern can leave someone with a predisposition in a better position than someone without a predisposition who isn't worried. Being proactive can make a difference in your health.