Rosacea

Rosacea is a chronic skin disease that causes redness and swelling on the face, scalp, neck, ears, chest, back, and occasionally the eyes. One of the first signs of rosacea is the tendency to flush or blush easily, which often progresses to a persistent redness, pimples, and visible blood vessels in the center of the face spreading to the cheeks, forehead, chin, and nose. Rosacea can mimic other skin conditions, including acne and sunburn, earning it the nickname the great pretender.

The flushing associated with rosacea occurs when blood vessels expand rapidly to accommodate increased amounts of blood flowing through them. As the disease progresses, this redness may become more noticeable and persistent.

An estimated 14 million Americans suffer from rosacea. It primarily appears in adults between the ages of 30 and 50 who have lighter skin, blonde hair, and blue eyes; however, almost anyone can develop rosacea, including children. It often runs in families. Women are afflicted more often than men, and they may experience increased flushing during the menopausal years. However, men tend to get more severe forms of rosacea.

Symptoms vary from person to person. Some of the classic symptoms are:

  • Dry facial skin
  • Pimples that appear as small, red bumps with some containing pus
  • Red lines (telangiectasia) and pimples, but no blackheads, on or around a reddened area on the face
  • Bumps on nose (rhinophyma)
  • Facial burning, stinging, or itching
  • A tendency to blush frequently or easily
  • Flushing after consuming hot drinks, spicy foods, or alcohol
  • Redness thats more pronounced during extreme hot or cold weather
  • Extreme sensitivity to certain facial products or hairspray
  • Persistent redness in the center of the face that gradually involves the cheeks, forehead, chin, and nose
  • Swelling of the nose. In extreme, untreated cases, the nose can become red, misshapen, and bulbous, a condition called rhinophyma.

Scientists arent sure what causes rosacea, although they suspect that heredity and environmental factors play a role. Its also not known what causes the blood vessels to swell, resulting in the flushing and redness that afflicts rosacea sufferers. Theres also a theory that a mite called Demodex folliculorum that lives in hair follicles causes the condition by clogging oil glands that leads to inflammation. Another theory is that rosacea is caused by a bacterium called Helicobacter pylori, which causes an intestinal infection. And there are some scientists who blame the immune system.

Rosacea Treatment

Early treatment of rosacea by a dermatologist is highly recommended because early diagnosis and treatment can control the disease and keep it from progressing. Allowed to progress, rosacea becomes more difficult to treat.

To diagnose and treat rosacea, a dermatologist first identifies the subtype(s) that are present. Each subtype has its own unique signs and symptoms that require different therapies. They include:

Redness, flushing, and visible blood vessels (subtype: Erythematotelangiectatic type rosacea

Extremely sensitive skin is typical in patients with this subtype of rosacea. Stinging and burning may occur if medication is applied to the face, so treatment may begin with a special regimen to repair the damaged skin. Therapy may begin with a non-irritating sunscreen and a barrier-repair emollient thats applied twice a day. Oral antibiotics are often prescribed, followed by more topical medications (azelaic acid, metronidazole, sodium sulfacetamide and sulfur, retinoids) once the skin has calmed to promote further healing. Daily sunscreen should be used indefinitely. It can take months to see noticeable improvement with topicals. People with this rosacea subtype are especially prone to side effects, which may include burning, stinging, itching, and skin irritation when applying the prescribed medications. They should let their dermatologist know if any of these occur. Topical retinoids may cause the skin to feel warm or sting, and redness may temporarily increase. Peeling is also a possibility. Since topical retinoids tend to increase sensitivity to the sun, its important to apply sunscreen before going outdoors. Some patients also experience sensitivity to wind and cold.

Treatments for this subtype include electrocautery, a technique that uses a low-powered electrical device to safely destroy visible blood vessels. The treatment area is numbed, the affected skin is treated with an electric current, and the treated skin is scraped away. More than one treatment is usually required. Side effects include swelling or redness for a day or two. Lasers and other light therapies are used to treat the redness, flushing, and visible blood vessels. They usually require 4 to 8 treatment sessions annually for several years to significantly reduce redness and flushing; at least 2 treatments are required to diminish visible blood vessels. Some patients have reported results that have lasted as long as 8 years once the desired results were achieved. In the hands of an experienced physician, the risk of side effects is low. When they do occur, they are usually limited to temporary bruising, redness, or swelling that can last a few days. Laser and light therapies should be performed by or under the direct supervision of a physician with expertise in the skin, such as a dermatologist. Insurance usually does not cover this treatment because it is considered cosmetic.

Bumps and pus-filled lesions (subtype: Papulopustular rosacea)

This rosacea subtype tends to respond well to treatment, for which there are many options. They usually begin with combination therapy, that is two or more treatments that tend to produce faster, more effective results. Once these are achieved, the patient may be switched to a single therapy. Treatments for this subtype include topical medications such as antibiotics (clindamycin, erythromycin, and metronidazole), azelaic acid, benzoyl peroxide, retinoids, sulfacetamide, and sulfur lotions. Studies have shown that topicals can be just as effective as oral medications; however, topicals may take longer to produce results. Slight improvements are usually noticed within the first month, with more dramatic results coming over the next two months. Side effects are mild and may include burning, stinging, itching or skin irritation, dry or scaly skin, or a rash. Oral medications can include a non-antibiotic dose of doxycycline to stop inflammation and oral antibiotics to treat the bumps and pus-filled lesions. The antibiotics used most often are doxycycline, erythromycin, minocycline, tetracycline, azithromycin, and clarithromycin. Most patients see results in 3 to 4 weeks. Once the rosacea is under control, many patients are switched to a topical therapy to maintain the results. Antibiotic resistance is the primary concern with this treatment. Other side effects include yeast infections in women, nausea, light sensitivity, vertigo, and lupus-like symptoms. Glycolic acid is often used in combination with oral antibiotics to help gain faster control over the rosacea. It may be prescribed as a facial peel, washes, or creams.

Thickening skin (subtype: Phymatous rosacea)

Dermatologic surgical procedures are used to remove the thick skin and resculpt the area. The treatments include laser and light therapies, dermabrasion, and electrocautery. Sometimes they are used in combination. All can be effective, so the procedure thats used depends on several factors, including the patients medical history.

Newer lasers, like the erbium and fractional, can smooth the skin without removing a significant portion of it. For best results, 1 to 3 laser surgery treatments scheduled 4 to 8 weeks apart are needed. Light treatments may require more sessions; for example, 1 to 5 sessions of intense pulsed light (IPL) spaced 3 weeks apart may be needed.

Dermabrasion is a resurfacing technique that treats deep defects in the skin acne scars, heavy wrinkles, thickening skin. A dermatologist uses a surgical tool that sands of the upper layers of the skin. As it heals, the new layers appear smoother in appearance.

Electrocautery removes thickened skin with the hot tip of an electrode that heats up the skin, allowing the top layers to be scraped off.

Side effects for these treatment therapies are low when they are performed by an experienced physician with an excellent knowledge of the skin. Side effects may include temporary bruising, redness, swelling, darker or lighter spots on the skin, and scarring.

Eye problems (subtype: Ocular rosacea)

Rosacea involves the eyes in about half of all cases. This can be severe, even when the rosacea is mild on the skin. Its important to see a dermatologist if eye problems occur because ocular rosacea can impair eyesight if not treated.

The treatment plan for ocular rosacea includes an eyelid hygiene regimen and prescription medications. Eyelid hygiene typically involves gently scrubbing the eyelids several times a day with diluted baby shampoo or an over-the-counter product manufactured for that purpose. Warm or hot compresses are also used on the closed eyes. The most commonly prescribed medications for ocular rosacea are eye drops and oral antibiotics. Side effects include dry eyes and a gritty sensation.

Mild to moderate ocular rosacea often responds to the treatments outlined above. When the condition is severe, it may not respond to these therapies; inform your dermatologist if this is the case and he or she can prescribe an alternative.

To supplement the treatments above, patients are encouraged to incorporate lifestyle modifications into their routine to avoid flare-ups. Recommendations include:

  • Avoid rubbing, scrubbing, or massaging the face so as not to irritate the skin. All soaps, moisturizers, sunscreens, and other products should be applied gently.
  • Steer clear of hot drinks, spicy foods, and alcoholic beverages.
  • Use a broad-spectrum sunscreen with an SPF of 15 or higher. Wear protective clothing, including long-sleeve shirts, long pants, and a wide-brimmed hat, when outside.
  • Avoid hot baths and showers, and try to exercise where its cool. In general, try not to become overheated.
  • Protect your skin from extreme cold.
  • Do not use cosmetics, soaps, moisturizers, and other facial products that contain alcohol or fragrances, which can irritate the skin. Avoid getting hair spray on your face.

It is sometimes helpful to keep a diary of flushing episodes, noting associated foods, products, activities, medications, and other triggering factors. These will vary from person to person.

Rosacea can last for years and rarely reverses itself. It can worsen without treatment, so be sure to see your dermatologist early and regularly if you have been diagnosed with rosacea or suspect you may have it.

Frequently Asked Questions 

Does everyone with rosacea have the same symptoms?

Is there a cure for rosacea?

Does self-treatment work?

Are there emotional effects from the disease?

Does rosacea sometimes disappear for good after one episode?

Are rosacea patients prone to other skin conditions?

What causes rosacea?

Does alcohol use cause rosacea?

Is rosacea life-threatening?

Are some people more prone to getting rosacea than others?


Does everyone with rosacea have the same symptoms?
No, the signs and symptoms of rosacea vary from person to person. Some signs, like visible blood vessels, papules, and pustules, are common, but some people never experience them. They may only have facial redness, or their rosacea may be on their back, chest, or elsewhere on their body.

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Is there a cure for rosacea?
There is no cure for rosacea at this time. However, there are many treatments that diminish the diseases signs and symptoms. A study by the National Rosacea Society showed that 87% of rosacea sufferers say their condition is under control with treatment. These range from topical products and oral medications to laser therapy and laser surgery.

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Can I just treat myself?
Dermatologists, with their expertise in skin, hair, and nail conditions, are best able to diagnose the condition, provide proven treatments, and suggest lifestyle changes to keep the disease in check. Rosacea usually does not go away on its own; in fact, it tends to worsen over time, particularly if not treated. Over-the-counter remedies containing acids, alcohol, and other ingredients can contribute to flare-ups. Thats why its best to consult with a dermatologist.

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Are there emotional effects from the disease?
Yes, and some people with rosacea would say the emotional effects are worse than the physical symptoms. Seventy percent of respondents in one study said rosacea lowered their self-esteem and self-confidence, and 41% said it caused them to avoid public contact and social engagements.

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Does rosacea sometimes disappear for good after one episode?
Its unlikely. Rosacea is a chronic, or long-term, disease. In one study, 52% of the patients with active rosacea had the disease for an average of 13 years; the remainder had an average duration of 9 years.

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Are rosacea patients prone to other skin conditions?
Yes, thats common. Acne is most common, followed by non-melanoma skin cancer, according to one study.

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What causes rosacea?
The cause of rosacea is unknown, although it is believed that rosacea is the result of a combination of genetic and environmental factors.

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Does alcohol use cause rosacea?
No, but alcohol can cause flushing of the skin, which worsens rosacea. In fact, the red bulbous nose that some associate with heavy drinkers is caused by rosacea, not by alcohol abuse, although alcohol consumption worsens the problem.

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Is rosacea life-threatening?
No, but it can be emotionally upsetting and physically disfiguring.

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Are some people more prone to getting rosacea than others?
Yes, adults get it more often than children, and women more often than men. Rosacea also tends to show up more often in people with lighter skin, blonde hair, and blue eyes.

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