Approximately 14 million people in the United States have rosacea – many more go undiagnosed – and it is more common in women (particularly during menopause) than in men. Common symptoms include frequent redness or flushing of the face and small red lines, and, in advanced stages, thickened skin. Although rosacea usually affects the face, it can affect parts of the upper body. Although there is no cure for this condition, symptoms can be treated and controlled. Common treatment options include antibiotics and proper skin care (especially of the eyelids if chronic infections are a problem).
Rosacea is an incurable condition affecting fourteen million Americans. Despite the high number of afflicted people, 78% of the United States population admits to have never heard of rosacea.
Typically, signs of rosacea begin to appear after a person's thirtieth birthday. These first signs show as reddened patches of skin. Over time, the red patches can develop small bumps or thickened bumps within them. The disorder can also cause the skin to have a flushed appearance, and blood vessels are often apparent.
People with rosacea tend to be fair skinned and to blush easily. Although there is no cure for rosacea, proper skin care can keep flare-ups minimal. Rosacea is not contagious and most experts believe it is caused by an underlying condition involving overactive blood vessels. Nonetheless, the medical community remains unsure of its cause. Studies have shown, however, that 33% of all diagnosed rosacea patients are of Irish heritage and 40% have an immediate family member coping with the disorder.
Common triggers of a rosacea outbreak include extreme cold weather, hot weather, physical and emotional stress, strenuous exercise, hot baths, spicy foods, exposure to the sun, and alcohol consumption. Typically, a person diagnosed with rosacea can easily name the circumstances that cause their rosacea to flare up. Avoiding or limiting these situations can help keep flare-ups to a minimum.
The symptoms of rosacea often vary from person to person. Although the condition has a number of common symptoms, not everyone will experience all of the possible symptoms. The common symptoms of rosacea include:
flushing
persistent redness
papules and pustules
visible blood vessels
thickened skin
eye irritation
These symptoms are explained below.
Flushing (when your skin turns red) is usually the first sign of rosacea. Episodes of flushing can last up for up to five minutes. The flush can spread to your neck and chest, and you may experience an unpleasant feeling of heat.
With rosacea, episodes of flushing are sometimes followed by episodes of persistent facial redness. This redness is like a blush or a patch of sunburn that does not go away.
If you have rosacea, you may develop:
papules: round red bumps that rise from your skin
pustules: pus-filled swellings
These spots will appear on your face and are similar to teenage acne. However, unlike acne, your skin should remain free of blackheads (small, blocked pores).
If you have rosacea, you may experience inflammation of the small blood vessels in the surface of your skin. This can cause your skin to appear red and swollen, producing the sort of blotchy skin that is often associated with excessive alcohol consumption. This can be upsetting for people with rosacea, as people often mistakenly assume that they are heavy drinkers.
The medical name for visible blood vessels is telangiectasia.
In the most serious and developed cases of rosacea, the skin can thicken and form excess tissue, usually around the nose. This causes the nose to take on a large, bulbous appearance. This is known as rhinophyma.
Rhinophyma is a rare symptom of rosacea. When it does occur, it is usually more common in men than women.
Over half of people with rosacea also experience symptoms that affect their eyes, such as:
feeling like there is something in your eyes
dry eyes
sensitivity to light (photophobia)
irritated and bloodshot eyes, which can often lead to related eye conditions such as blepharitis (inflammation of the eyelids)
Rosacea that affects the eyes is known as ocular rosacea.
Other symptoms associated with rosacea include:
a burning or stinging sensation on your face
dry, rough skin
raised red patches, known as plaques, on your skin
facial swelling
not being able to use skin care products because your skin is sensitive to them
Most people with rosacea have periods when their symptoms are particularly troublesome, followed by periods where their symptoms are less problematic.
Permanent damage to the face, such as scarring, almost never occurs in rosacea.
Although researchers have been trying to determine the causes of rosacea for more than a century, none have been definitely proven. One theory suggests that people who have Irish, English, or Eastern European ancestry may be more susceptible to the condition. The condition may also be inherited. Some people believe that certain triggers, such as spicy foods, wind, or irritating products, can cause symptoms to flare up. Most experts believe it may be caused by a number of related factors. These are outlined below.
Many dermatologists (skin specialists) believe that abnormalities in the blood vessels of the face may be a major contributing factor for rosacea. This may explain the symptoms of flushing, persistent redness and visible blood vessels. However, it is not known what causes these abnormalities.
Demodex folliculorum is a microscopic mite (tiny insect) that may contribute to rosacea. These mites usually live harmlessly on human skin, but higher numbers of mites have been found on people with rosacea. However, it is uncertain whether the mite is a cause or an effect of rosacea.
Helicobacter pylori bacteria, which are found in the digestive system, have been suggested as a possible cause of rosacea, although the link is not proven. The bacteria may stimulate the production of a protein called bradykinin, which is known to cause blood vessels to expand.
Rosacea seems to run in families. However, it is not known which genes are involved or how they are passed on.
Most people who have rosacea notice that certain triggers make their symptoms worse. Different people can have different triggers, but the most commonly reported ones include:
exposure to sunlight
stress
hot weather
exposure to wind
strenuous exercise
alcohol
hot baths
cold weather
spicy foods
humidity
caffeine (found in tea, coffee and cola)
dairy products
acute (short-term) medical conditions, such as a cold or fever (high temperature)
chronic (long-term) medical conditions, such as high blood pressure (hypertension)
vasodilatory medicines, which are often used to treat high blood pressure
Although anyone can develop rosacea, you may be more likely to develop rosacea if you:
Are a woman
Have fair skin and light hair and eye color
Are between the ages of 30 and 60, especially if you're going through menopause
Experience frequent flushing or blushing
Have a family history of rosacea
Rosacea can cause complications that affect you physically and psychologically.
Rosacea that affects your eyes (ocular rosacea) can lead to a number of eye conditions.
Blepharitis (inflammation of the eyelids) is the most commonly reported eye condition resulting from rosacea. It can usually be successfully treated by adopting a daily eye-cleaning regime and by using antibiotic tablets and creams.
Up to 1 in 20 people with rosacea may experience symptoms that affect their cornea (the clear outer layer at the front of the eyeball). This can:
make your eyes bloodshot and watery
cause scarring of your cornea
In severe cases, if it is not treated, ocular rosacea can lead to vision loss. Your doctor may refer you for treatment with an ophthalmologist (a doctor who specializes in eye conditions and their treatment or surgery).
Any chronic (long-term) condition can have an adverse psychological effect, but rosacea can be particularly troublesome because it affects your appearance. This can change how you feel about yourself and also how you interact with other people.
Many people with rosacea have reported feelings of:
low self-esteem
embarrassment
frustration
It is important to come to terms with the fact that you have a chronic condition which, although incurable, is controllable. Persevering with your treatment plan and avoiding your individual triggers are the best ways of controlling your rosacea symptoms.
As your physical symptoms begin to improve, you will start to feel better psychologically and emotionally.
If you have rosacea, try to take comfort knowing that you are not alone. There are millions of people, in the US and across the world, who are living with the condition.
Speak to your doctor if you are feeling depressed as a result of your condition. They may recommend further treatment.
Though there's no way to eliminate rosacea, effective treatment can relieve signs and symptoms. Most often this requires a combination of prescription treatments and certain lifestyle changes on your part.
Your doctor also may recommend certain moisturizers, mild cleansers, sunscreens and other products to improve the health of your skin. If hot flashes appear to trigger your rosacea, you might ask your doctor what treatment options are available for the signs and symptoms of menopause.
You may need a combination of prescription-strength topical medication (lotion, cream or gel) and oral medication (pill, capsule or tablet) to treat rosacea.
Topical medications. Medications you apply to your skin once or twice daily may help reduce inflammation and redness. They may also be used along with oral medications or as part of a maintenance program to control symptoms. Common topical medications include antibiotics such as metronidazole (Metrocream, Metrogel, others), tretinoin (Atralin, Renova, others), benzoyl peroxide and azelaic acid (Azelex, Finacea). These topical applications can cause skin irritation, redness, dry skin, and stinging or burning of the skin.
Oral antibiotics. Doctors may prescribe oral antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria. Oral antibiotics are also prescribed because they tend to work faster than topical ones. Common prescription oral antibiotics include tetracycline, minocycline and erythromycin. Possible side effects include stomach discomfort, diarrhea, nausea or vomiting, and sore mouth or tongue.
Isotretinoin. Isotretinoin (Accutane, Amnesteem, others) is a powerful oral medication sometimes used for severe cases of inflammatory rosacea if other treatment options fail to improve symptoms. Usually prescribed for cystic acne, isotretinoin works to inhibit the production of oil by sebaceous glands. People who take it need close monitoring by a dermatologist because of the possibility of serious side effects, including depression and suicidal thoughts, bone or joint pain, and skin infection or rash. Also, this drug causes birth defects if taken during pregnancy. If you plan to become pregnant or suspect that you are pregnant, stop taking this medicine and check with your doctor.
Your doctor may treat ocular rosacea with oral antibiotics or steroid eyedrops.
The duration of your treatment depends on the type and severity of your symptoms, but typically you'll notice an improvement within one to two months. Because symptoms may recur if you stop taking medications, long-term regular treatment is often necessary.
Enlarged blood vessels, some redness and changes due to rhinophyma often become permanent. In these cases, surgical methods, such as laser surgery and electrosurgery, may reduce the visibility of blood vessels, remove tissue buildup around your nose and generally improve your appearance.
One of the most important things you can do if you have rosacea is to minimize your exposure to anything that causes a flare-up. Find out what factors affect you so that you can avoid them. Keep a list of things that trigger your flare-ups, and try to avoid your triggers.
Here are other suggestions for preventing flare-ups:
Wear broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher to protect your face from the sun.
Protect your face in the winter with a scarf or ski mask.
Avoid irritating your facial skin by rubbing or touching it too much.
Wash problem areas with a gentle cleanser (Dove, Cetaphil).
Avoid facial products that contain alcohol or other skin irritants.
When using moisturizer and a topical medication, apply the moisturizer after the medication has dried.
Use products that are labeled noncomedogenic. These won't clog your oil and sweat gland openings (pores) as much.
Avoid overheating.
Avoid wearing makeup.
Avoid drinking alcohol.
You can take steps to prevent your symptoms of rosacea from flaring up.
Avoiding known triggers can help reduce the severity and frequency of your rosacea symptoms. To establish what is triggering your symptoms, you could keep a diary of your daily activities to record their impact on your symptoms.
Advice about how to avoid some of the common triggers of rosacea is explained below.
Sunlight
As sunlight is the most commonly reported trigger of rosacea, it is recommended that you use sunscreen every day, even on overcast days.
A sunscreen cream with a sun protection factor (SPF) of at least 30 is recommended. Using sunscreens specifically designed for children may help reduce any irritation to your skin.
During the summer months, minimize your exposure to the sun, particularly in the middle of the day when the sun is at its hottest. However, remember that the sun can also be very strong in the morning and evening, so you will need to take adequate precautions at these times as well.
To reduce your exposure to the sun:
regularly apply sunscreen to your skin
wear a wide-brimmed hat
Stress
After sunlight, stress is the second most reported trigger of rosacea. Successfully managing your stress levels can help control your rosacea symptoms.
You can reduce stress by:
taking regular exercise
eating a healthy, balanced diet
getting the right amount of sleep
As strenuous exercise can trigger an outbreak of rosacea, a low-intensity exercise program, such as walking or swimming, may be better than high-intensity activities, such as running or aerobics.
You may also want to try some relaxation techniques, such as:
deep breathing exercises
meditation
other exercises
Food and drink
The most commonly reported food- and drink-related triggers are alcohol and spicy foods. You may want to completely remove these from your diet to see if your rosacea improves.
However, there are many other dietary triggers that can adversely affect some people with rosacea. Include information about how your diet affects your rosacea symptoms in your rosacea diary.
Cold weather
Covering your face and nose with a scarf can help protect your skin from cold temperatures and wind.
If you need to spend considerable time outside during cold weather, you can protect your face with a balaclava.
The advice below about skincare techniques may also help control your rosacea symptoms:
Do not rub, scrub or massage your face. Doing so can irritate your skin.
Use a moisturizer to soothe your skin if it feels sore.
Do not use make-up. Neither use scented soaps, alcohol-based skin cleansers or other facial or hair products that contain ingredients that might irritate your skin, such as alcohol and fragrances.
Look for products that are suitable for sensitive skin or non-comedogenic (will not block pores and cause spots).
Gently clean your skin every morning and evening using a gentle, non-abrasive cleanser.
Rinse your face with lukewarm water and allow your skin to dry thoroughly before you apply any medication.
Men may find that using an electric razor, rather than a blade, helps reduce skin irritation.
Do not use steroid cream unless you are specifically instructed to by your doctor. It may make your symptoms worse.