Rosacea 101: What It Is, Symptoms, Causes and Treatments

• Rosacea is a chronic skin condition that causes redness primarily on the face, but also affects the ears, chest and back.
• The causes of rosacea aren’t well understood, but may be related to blood vessel abnormalities or immune system disorders. 
• There are four types of rosacea, each with their own set of symptoms and treatment options.
• Although there is no cure for rosacea, there are many treatments that can help improve the look and feel of skin.

Rosacea is a common skin condition that causes areas of the face to develop redness; bumps and swelling may also occur. Symptoms are intermittent at the start but may become more persistent over time. Triggers include stress, heat, alcohol and spicy foods.

While rosacea can’t be cured, the symptoms can be managed through lifestyle changes, topical creams and medical procedures. It is important to work with a dermatologist to limit skin damage and help prevent further complications; without treatment, rosacea symptoms usually worsen.

What Is Rosacea?

Rosacea is an inflammatory skin disorder related to abnormal blood vessels or the immune system, although the exact cause is unknown. The primary symptom is a tendency to frequently flush as a direct result of hundreds of minute blood vessels dilating near the surface of the skin.

Rosacea symptoms usually present first on the cheeks, nose and forehead. In its early stages, symptoms will occasionally flare up and then dissipate. Eventually, repeated flare-ups will cause permanent damage to blood vessels, resulting in persistent redness.

Rosacea is considered a common skin disorder, but the prevalence varies by population. Overall, 1–20% of people have rosacea, according to the National Institutes of Health (NIH); the National Rosacea Society estimates that number to be about 16 million Americans.

Rosacea is a highly visible skin condition that affects self-esteem and can lead to emotional stress if not treated effectively.

Who tends to have it?

Rosacea is more commonly seen in fair-skinned individuals than dark-skinned, however one study suggests this may be due to darker skin tones concealing redness and that people of any race or ethnic background can indeed develop rosacea. 

There is also some evidence to suggest that genetic differences put lighter skin types at more risk of developing rosacea, but the root variance is currently unknown. 

Women are more likely to develop rosacea, but the reason why has not yet been established. Men are more likely to suffer from severe symptoms of rosacea, such as those caused by rhinophyma. 

Signs and Symptoms of Rosacea

There are four main types of rosacea, with symptoms varying according to type. A dermatologist can review your medical history and examine your skin to determine your specific type.

Erythematotelangiectatic rosacea (ETR)

ETR symptoms include a red, flushed appearance and visible, broken blood vessels (often referred to as spider veins), usually isolated to the nose and cheeks. Skin may feel sensitive and sting; it can also feel rough and dry. Additionally, individuals with ETR tend to experience both persistent and transient erythema. 

Persistent erythema refers to a continual redness, the severity of which depends less on triggers. On the other hand, transient erythema (also called a flare-up) is a sudden flushing of the skin as a direct result of a trigger. The latter causes significantly more redness, but quickly dissipates.

Acne rosacea

Acne rosacea is sometimes mistaken for a traditional acne breakout (clinically known as acne vulgaris). Along with a reddening of the skin, symptoms of acne rosacea include bumps (known as papules), pimples (pustules) and swelling.

In order to differentiate between the two conditions, look for comedonal acne (blackheads and whiteheads) as these will only appear in cases of acne vulgaris.

Rhinophyma

Rhinophyma is a rare form of rosacea and is most commonly seen in men. The nose will appear deformed—enlarged and bulbous—with enlarged pores, thickened skin and the presence of papules. Treatment involves several surgical options.

Ocular rosacea

Ocular rosacea is an inflammation of the eyes that causes redness, itchiness and a burning sensation. This type often develops alongside ETR rosacea and sometimes appears before the symptoms of ETR present. Swollen eyelids and sensitivity to light are other common eye symptoms of this type.

What Causes Rosacea?

Researchers have yet to identify all the causal factors of rosacea, however, certain individuals are genetically predisposed to develop it; some environmental factors can cause symptoms or cause them to worsen. 

Although the scope of genetic causes has not been definitively established, rosacea is correlated to abnormalities of the small blood vessels of the face. The reddening of the skin is due to an excessive dilation of blood vessels near the skin’s surface, which makes increased blood flow to that area more apparent. 

Additionally, researchers have found that rosacea is linked to an immune system with a higher than average inflammatory response. 

Environmental factors may also cause rosacea to develop in some people. In particular, research shows that a type of dust mite, known as demodex, can live in the hair follicles of the eyelashes and trigger a rosacea flare-up when present in abnormally large numbers.

Triggers

Rosacea causes increased skin sensitivity due in part to its highly reactive inflammatory response, and in part to overly dilated blood vessels in the skin. This has been found to lead to transepidermal water loss, making skin dry and more easily irritated. 

This sensitivity creates susceptibility to a variety of food triggers in those with rosacea including: 

• Hot sauce, cayenne pepper and red pepper
• Alcohol, including wine and hard liquor
• Hot beverages
• Fermented foods, such as vinegar, yogurt and dry cheese
• Some fruits, such as bananas and pineapple

However, there are also other nonfood triggers which include:

• Certain drugs, such as medications to lower blood pressure
• Hot baths
• Skin care products and hairspray
• Stress and anxiety 

These triggers are not only irritating to sensitive skin, they can also result in flare-ups that temporarily worsen rosacea symptoms. Stress, for example, can cause a sudden increase in heart rate, which boosts blood flow and increase redness in the face.

Is it contagious?

Rosacea isn’t contagious. Unlike a viral or bacterial infection, you can’t pass it on to anyone else, and you don’t acquire it by being exposed to anyone with this condition.

Rosacea Treatments

Rosacea treatments will depend on the type and severity of your condition. There are a variety of dermatological topical treatments, oral medications and procedures. For many people, a combination of treatments offers the most relief. 

Medication

Oral antibiotics, such as tetracycline and doxycycline, can reduce symptoms by fighting the bacteria that causes rosacea acne and pustules. 

Many people are infected with Helicobacter pylori bacteria, which is associated with rosacea and is transmitted through saliva or contaminated food and water; it is often dormant. Antibacterial treatment has been found to effectively reduce symptoms of rosacea by targeting this bacteria.

Side effects include flu-like symptoms and skin rash.

Creams

Several types of topical gels, creams and ointments are available to treat rosacea. For ETR, brimonidine tartrate topical gel can produce results within 30 minutes of application. This type of medication works by causing the small arteries and veins near the skin’s surface to constrict, which reduces the warmth and redness that results from excess blood flow. 

In some cases, brimonidine tartrate can cause eye irritation and discomfort, along with nausea and headache.

A similar medication, oxymetazoline hydrochloride, is a topical cream that results in noticeable improvements to skin with pimples and moderate to severe rosacea.

Azelaic acid is another widely used topical rosacea acne treatment that has anti-inflammatory properties. It works by decreasing swelling and facial redness, while killing the bacteria in pustules on the face.

Laser treatments

Laser treatments for rosacea help reduce the dilated blood vessels near the skin’s surface, however they don’t prevent new blood vessels from appearing.

In many cases, multiple treatments are required to significantly reduce redness. Laser therapy may also be helpful in treating rhinophyma and reshaping the nose to a more normal state.

The main side effect of laser treatments is the appearance of a rash or spots on the treated skin. However, these tend to clear up within several weeks.

IPL

Intense pulsed light (IPL) is similar to laser surgery, but instead of a tightly focused beam of light, IPL sends scattered waves of light that penetrate the skin’s outer surface to treat the layers beneath. 

This type of therapy is highly effective for more severe cases of ETR because the beams of light can effectively target more pronounced blood vessels. It is also particularly effective for younger rosacea patients, because they tend to have higher water levels in their skin tissue. IPL relies on heating water in the skin to injure damaged skin cells, which the body then heals, leaving undamaged skin in its place.

IPL can reduce inflammation, redness,and  pimples, and treat uneven skin tones caused by rosacea. Multiple sessions may be required for severe cases. Side effects, such as redness or blisters, are usually short-lived.

Electrosurgery

Electrosurgery is an invasive procedure performed by inserting a thin needle under the surface of the skin. The needle transmits a small electrical current to the blood vessels, causing them to clot and then shrink, easing redness in the face. Certain types of electrosurgery combined with skin grafting may also help treat rhinophyma.

Scabs form, but they tend to disappear within a week; there is a slight chance of scarring.

Dermabrasion

With dermabrasion, the provider uses a wire brush or a rough-edged wire brush to abrade or sand off the top layer of damaged skin. New skin cells then replace the damaged cells as the treated area heals.

Dermabrasion is a skin resurfacing procedure that leaves the face red, swollen and sensitive. These symptoms can persist for a few days to several weeks. Those with sensitive skin should avoid this treatment as it can produce scarring in some instances.

Rosacea Flare-up Prevention

Avoiding flare-ups of rosacea primarily involves protective measures against sun and cold, as well as avoiding triggers, adjusting diet and making lifestyle changes.

Sun protection

Using strong sunscreen (at least SPF 30) regularly on your face can help protect your skin and reduce the risk of rosacea flare-ups. You should also limit your sun exposure when the sun is at its peak – between 10 a.m. and 4 p.m. 

Cold weather and wind may also cause a flare-up, so protecting your face with a scarf and limiting your time outside in the cold is recommended.

Diet

Avoid any spicy or fermented foods, alcohol, hot beverages or any fruits and vegetables that you have identified as triggers. Keep a food diary to note rosacea flare-ups can help you identify dietary triggers if you’re not sure about certain foods and beverages.

Skin care

Some types of makeup, moisturizers and other skin care products can trigger a rosacea episode. Products containing alcohol, witch hazel and fragrance are common ingredients to avoid.

Avoid scrubbing your face; be gentle with your skin and use mild skin care products.

Cigarette smoking

While little information is available to link rosacea and smoking, many studies have found that there is a connection between the two. 

One recent study found that there is actually a decreased risk of rosacea among current smokers, but an elevated risk for people who once smoked, then quit. These findings have been supported by studies, while other studies have found smoking actually increases the risk of developing rosacea. 

In any event, the link between rosacea and smoking suggests that avoiding cigarettes altogether is a good preventative measure for avoiding rosacea. 

Takeaway

Rosacea is a chronic skin condition that causes facial redness, and while it is most commonly diagnosed in adults with fair skin, it may be just as likely to appear in those with darker skin. If you notice rosacea symptoms, visit your dermatologist for a diagnosis so that you can formulate a treatment plan. 

Although there is no cure for rosacea, there are ways to ease the symptoms. Some are lifestyle changes such as regularly using sunscreen and avoiding known triggers; you can also consider antibacterial medications or undergo IPL treatments. 

These methods will help ease redness and sensitivity, and improve the overall appearance and health of your skin.