- Rosacea is a chronic skin condition that causes redness of the face, though the ears, chest and back also may be affected.
- The causes of rosacea aren’t well understood, though they may be related to blood vessel or immune system disorders.
- There are four main types of rosacea, each with its own set of symptoms and treatment options.
- Rosacea currently has no cure, but there are many treatments that can help improve the look and feel of your skin.
Rosacea is a common skin disease that causes parts of the face to turn red. Bumps and swelling may also develop. Signs of the condition may come and go, depending on the type of rosacea you have. Your exposure to rosacea triggers, such as stress, alcohol or spicy foods, also may cause symptoms to flare up.
While rosacea can’t be cured, lifestyle adjustments as well as topical creams and medical procedures may help you manage your symptoms. Working with a dermatologist is important to limit facial skin damage and help prevent further complications of rosacea.
What Is Rosacea?
Rosacea, an inflammatory skin disorder, is most likely related to problems with blood vessels or the immune system. It often starts as a tendency to become easily flushed. Rosacea symptoms usually first appear on the cheeks, nose and forehead. Having dilated blood vessels that can be seen just under the skin anywhere on the body is a condition known as telangiectasia, and can be caused by rosacea, aging, or pregnancy.
Depending on the population group being studied, anywhere from 1 to 20 percent of people have rosacea, according to the National Institutes of Health. The National Rosacea Society estimates that about 16 million Americans have rosacea.
Rosacea is more common in people with fair skin, and is usually diagnosed in adulthood. However, children and people of any race or ethnic background can develop rosacea. Women are more likely to have rosacea, but men tend to have more severe symptoms. Having rosacea affects self-esteem and can lead to emotional stress if not treated effectively.
Signs and Symptoms of Rosacea
The symptoms of rosacea vary depending on the type of disease. There are essentially four main kinds of rosacea. A dermatologist can look at your medical history and examine your facial skin to make a diagnosis.
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. The skin may feel sensitive and may sting. Affected skin also may be rough and dry. People with ETR tend to blush more easily than others and turn red quickly after exposure to triggers, such as alcohol or a hot bath.
Acne rosacea is sometimes mistaken for a traditional acne breakout. Along with a reddening of the skin, symptoms of acne rosacea include bumps (known as papules), pimples (pustules), and swelling. Rosacea with acne is a relapsing condition, typically made worse by triggers.
Rhinophyma is sometimes considered the end stage of acne rosacea. The main symptoms are large bumps or nodules that form on the lower part of the nose.These bumps are permanent unless removed by a dermatologist.
When rosacea leads to a redness and itchiness of the eyes, the condition is called ocular rosacea. In some cases, ocular rosacea and accompanying eye problems form first. Then the traditional signs of rosacea become visible elsewhere on the face. Swollen eyelids and sensitivity to light are other common eye symptoms of ocular rosacea.
What Causes Rosacea?
Researchers still don’t understand the cause of rosacea. It is not the result of poor hygiene. Rosacea is associated with abnormalities of the small blood vessels of the face. The reddening of the skin is often due to blood vessels near the surface that have widened (dilated) significantly, making that increased blood flow more apparent just under the skin.
Researchers have also identified cathelicidins, which are small protein-like structures that are essential to the body’s immune system, as possible key players in the development of rosacea.
Environmental factors may also be to blame. In particular, research suggests that a type of little dust mite, known as demodex, can live in the hair follicles of the eyelashes and trigger a rosacea flare-up. Family history may also play a role in determining who gets rosacea. Because a combination of factors may be at work in this troublesome skin condition, it remains a challenge for dermatology experts to pinpoint specific causes.
Rosacea makes the skin sensitive, so it’s especially vulnerable to a variety of triggers. If you have rosacea, you may have noticed that certain foods or beverages can lead to a flare-up. Many rosacea patients, however, aren’t triggered by food. For those who are, some of the more common triggers include:
- Spicy foods
- Hot beverages
- Fermented foods, such as vinegar, yogurt and dry cheese
- Some fruits
- Certain drugs, such as medications to lower blood pressure
Stress and anxiety can also act rosacea triggers. Similarly, very cold and windy weather, along with getting a sunburn and spending time in very high temperatures may cause redness to return to the face. Hot baths and showers also may cause facial redness.
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 anything or to anyone who has the condition.
The best rosacea treatment for you will depend on the type and severity of your condition. Modern dermatology has a variety of topical and oral medications and other procedures that can help. For many people treatment of rosacea actually involves a combination of treatments.
Certain oral antibiotics, such as tetracycline and doxycycline, can help treat rosacea acne and pustules by preventing any further bacterial growth on the skin and by reducing inflammation. Side effects may include flu-like symptoms and, unfortunately, a skin rash.
Several types of topical gels, creams and ointments are available to treat rosacea. For ETR, brimonidine tartrate topical gel can start to produce results within 30 minutes of application. It’s a highly selective alpha 2 agonist medication that causes the small arteries and veins near the skin’s surface to constrict. In some cases, brimonidine tartrate can cause eye stinging and discomfort, along with nausea and headache.
A similar medication, called oxymetazoline hydrochloride is a topical cream that makes noticeable improvements to skin experiencing pimples and moderate-to-severe rosacea.
Azelaic acid is another widely used topical rosacea acne treatment with anti-inflammatory properties. It works by decreasing swelling and facial redness, while killing the bacteria in pustules on the face.
Laser treatment for rosacea help get rid of the dilated blood vessels near the skin’s surface, however they don’t prevent new ones from appearing later on. In many cases, multiple treatments are needed to significantly reduce redness. Laser therapy may also be helpful in treating rhinophyma and reshaping the nose to a more normal, healthier appearance.
The main side effect of laser treatments is the appearance of a rash or spots on the treated skin. But these tend to clear up within a couple of weeks.
Intense pulsed light (IPL) targets rosacea with beams of light in specific wavelengths that can reach the hemoglobin in the blood vessels of the face. IPL can reduce inflammation, redness, pimples, and it can 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 is an invasive procedure done 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.
With dermabrasion, a doctor uses a special device to abrade or sand off the top layer of skin damaged by rosacea. The idea is that the procedure will stimulate the healing of the next layer of skin. It’s an aggressive procedure and not right for everyone. People with especially sensitive skin may want to try another option, as scarring is possible in some cases.
Rosacea Flare-up Prevention
Once you know your triggers for rosacea flare-ups, you can help protect your skin by avoiding them.
Using strong sunscreen (at least SPF 30) regularly on your face can help, as well as limiting your sun exposure during the hottest, sunniest parts of the day. 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.
If you know that spicy or fermented foods, alcohol, hot beverages or certain fruits and vegetables cause flare-ups, avoid these items as much as possible. Keeping a food diary, in which you also note rosacea flare-ups, may help you identify dietary triggers if you’re not sure about certain foods and beverages.
Careful skin care
Some types of makeup, moisturizers and other skin care products can trigger a rosacea episode. Scrubbing your face too hard can do likewise. Use mild skin products and be gentle when washing and showering.
Rosacea is a chronic skin condition, meaning it will be with you forever. Many questions linger about which genes may be involved in rosacea and what other conditions, such as autoimmune diseases, may be associated with rosacea.
Fortunately, researchers in dermatology continue to learn more about the disease and are developing treatments that can help patients manage symptoms and improve their quality of life.
Get diagnosed as soon as you notice symptoms so your dermatologist can work with you on rosacea treatment plan. By making lifestyle changes, such as regular use of sunscreen and gentle cleansers while also avoiding known triggers, you can start a treatment or combination of treatments that may help minimize any complications and limit the progression of rosacea.