What Is Rosacea?

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Rosacea is a chronic skin condition characterized by redness and/or bumps on the face. It is caused by inflammation, which is believed to occur due to a combination of genetic predisposition and environmental factors. 

There are four types of rosacea, and the condition can affect the eyes and eyelids as well as the skin. The condition can't be cured, but it can be managed with a skin care regimen, avoidance of triggers, prescription medication, and interventional procedures that can help reduce some of the effects.

What Rosacea Looks Like
Verywell / Nusha Ashjaee

Symptoms

The most common symptoms of rosacea are flushing and erythema (redness) of the cheeks and forehead. It can also affect the chin, neck, and other parts of the body. 

The effects can vary, and occasional flare-ups can occur, but most people with rosacea have some persistent skin manifestations all the time. 

Your symptoms can include:

  • Redness: Typically affecting the cheeks, forehead, and nose 
  • Flushing: Pink or red appearance of the skin, usually without changes in texture 
  • Papules: Solid red bumps, usually in clusters 
  • Pustules: Pus-filled bumps, usually in clusters 
  • Telangiectasia: Tiny visible blood vessels near the surface of the skin 
  • Rhinophyma: Thickened and bumpy skin on the nose

Your condition may be predominantly characterized by just one of these features, or you could have a combination.

Sensory Effects 

Generally, rosacea affects the appearance of the skin with few, if any sensory issues. But it can cause a feeling of skin irritation, discomfort, itching, stinging, or burning of the affected areas. 

Eyes and Eyelids 

Rosacea can affect the eyes, causing itching, dry eyes, discomfort, swelling, or cysts in or near the eyes and eyelids. Eyes can appear to be bloodshot. Cysts and severe swelling can cause long-term damage and may affect vision. 

Causes

Anyone can be affected by rosacea, but it is more common among adults over age 30, especially among those who have a light skin tone. That said, rosacea can begin during childhood and it can affect people of all skin shades and ethnic backgrounds. 

The condition is believed to have genetic and environmental causes. 

Risk factors include:

  • Family history of rosacea
  • Personal or family history of autoimmune disease
  • A diagnosis of inflammatory disease 

Triggers

If you have rosacea, a number of factors can make the skin effects worse. You can experience worsening of your symptoms immediately or days after exposure to any of your rosacea triggers. Sometimes, triggers can induce skin changes that don’t competently resolve.

Common triggers include:

  • Sun exposure
  • Alcohol
  • Spicy food
  • Cigarette smoke
  • Hot or cold temperatures

You may also develop worsening symptoms in response to medications, food, detergents, soaps, or fabrics. 

Pathophysiology

The process at play in rosacea involves inflammation and dilation (widening) of the blood vessels. The inflammation may produce redness, bumps, or sensory discomfort.

Some experts suggest that infection may have a role in rosacea as well. 

The condition is associated with a number of other illnesses, including celiac disease, Crohn’s disease, and rheumatoid arthritis.

Diagnosis

Rosacea is a clinical diagnosis based on the appearance of the skin and the pattern and timing of the symptoms. The skin’s appearance can resemble other conditions. Rosacea can look like acne, the butterfly facial erythema of lupus, or allergies.

Generally, the person's medical and symptom history and triggers can help differentiate these skin reactions. But when the diagnosis is not clear, tests such as blood tests can help identify inflammatory conditions such as allergies or lupus.

There are four types of rosacea: 

  • Type 1: Erythematotelangiectatic rosacea is described as vascular rosacea. It is predominated by skin redness with blood vessels that are visible directly underneath the skin. 
  • Type 2: Papulopustular rosacea, also called inflammatory rosacea, is characterized by clustered papules or pustules.
  • Type 3: Phymatous rosacea is typified by hardened bumps and thickened skin. Rhinophyma, which is a condition in which there are hardened nodules on the nose, is a common aspect of this type of rosacea.
  • Type 4: Ocular rosacea is predominated by symptoms affecting the eyes and eyelids. This type may also affect the skin.

Treatment

If you have been diagnosed with rosacea, you will need to avoid the common triggers as well as any other factors that make your condition worse. Skin care is important too. Be sure to use gentle soaps to cleanse your face and to use moisturizer sparingly. 

Your doctor will likely advise that you use sunscreen to protect your skin from sun exposure. Avoiding heat and sweat can help prevent flare-ups too. 

Prescription treatments include oral medications and topical products to apply directly to your skin or eyes. Most prescriptions used in the treatment of rosacea are anti-inflammatories or antibiotics. Depending on the severity of your condition, you may be given a prescription to use every day or a prescription to use as needed.

Laser treatment procedures can reduce some of the cosmetic effects of rosacea.

Coping

Strategies for coping include learning about your condition, connecting with others who have rosacea (possibly through support groups), and learning to optimize your use of makeup and cover up so that you can gain a sense of control about the appearance of your skin. 

Living with rosacea can present a number of emotional challenges. Skin flare-ups can worsen when you are under stress or in response to other emotions such as depression. And being unsatisfied with your facial appearance can lead to depression and anxiety, which may result in a cycle of mood and skin problems. 

If your skin condition is taking a toll on your well-being, be sure to discuss your feelings with your doctor. You may benefit from counseling or mindfulness training for reducing stress.

A Word From Verywell

Rosacea is a chronic condition that necessitates lifetime management. If you think you may have rosacea, be sure to see a doctor about it. 

Lifestyle adjustments can help prevent skin outbreaks and keep the effects to a minimum. You may also benefit from prescription medication and/or interventional procedures. Other strategies for coping include using makeup to cover affected areas of skin and seeking out emotional and social support to share your feelings about your condition.

You can live a happy and healthy life with rosacea without being self-conscious about your appearance. In fact, if you are a confident person, your participation in a support group may be very beneficial for others who are having a hard time coping with their skin condition.

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