Rosacea

Symptoms

• flushing: episodes of facial reddening, often with heat or burning
• persistent redness of the cheeks, nose, chin or forehead
• visible blood vessels (telangiectasia)
• bumps and pimples (papules and pustules), without blackheads
• burning, stinging, sensitivity to skincare products
• dry, rough or swollen skin
• thickened skin, especially of the nose (rhinophyma), mostly in men
• eye symptoms: dryness, grittiness, redness, burning, swollen eyelids, recurrent styes

Types of rosacea

Dermatologists now describe rosacea by its features (phenotypes) rather than strict subtypes, since people often have more than one:

Rosacea vs acne

Other conditions that can look similar include seborrheic dermatitis, perioral dermatitis, lupus, contact dermatitis and steroid-induced rosacea from prolonged use of steroid creams on the face.

Causes

The cause is not fully understood. Contributing factors include:

• an overactive innate immune response in the skin
• abnormal blood vessel reactivity and nerve signaling, causing flushing
• higher numbers of Demodex mites on the skin
• genetic predisposition and family history
• sun damage to blood vessels and connective tissue

Rosacea is not caused by poor hygiene or alcohol, though alcohol can trigger flares.

Common triggers

• sun exposure, the most common trigger
• heat: hot weather, hot baths, saunas
• hot drinks
• alcohol, especially red wine
• spicy foods
• emotional stress
• strenuous exercise
• cold wind
• some skincare products and cosmetics containing alcohol, menthol, fragrance or witch hazel
• certain medicines that widen blood vessels

Triggers vary. Keeping a diary helps identify yours.

Diagnosis

Rosacea is diagnosed by examination and history. No specific test is needed. Skin tests or a biopsy may be done to exclude other conditions. People with eye symptoms should see an eye doctor.

Treatment

Skincare and sun protection

• daily broad-spectrum sunscreen SPF 30 or higher; mineral sunscreens (zinc oxide or titanium dioxide) are often better tolerated
• gentle, fragrance-free cleansers and moisturizers
• avoid scrubbing, toners with alcohol and exfoliants
• green-tinted makeup can neutralize redness

Prescription creams and gels

• ivermectin cream: for bumps and pimples; also targets Demodex
• metronidazole cream or gel
• azelaic acid cream, gel or foam
• brimonidine or oxymetazoline cream: temporarily reduce redness for several hours
• minocycline foam

Oral medicines

• low-dose doxycycline (anti-inflammatory dose) or other tetracyclines for moderate to severe papulopustular rosacea
• isotretinoin at low doses for severe or treatment-resistant cases

Procedures

• vascular laser or intense pulsed light (IPL) to reduce visible vessels and persistent redness
• laser resurfacing or surgery for rhinophyma

Ocular rosacea

Warm compresses, eyelid hygiene, artificial tears, and sometimes oral doxycycline or prescription eye drops.

Rosacea in darker skin

Rosacea is under-recognized in people with brown and Black skin because redness is harder to see. Clues include persistent warmth and stinging, dusky or violet-brown discoloration, acne-like bumps without blackheads on the central face, skin that reacts to many products, and eye irritation. Granulomatous rosacea, with firm yellow-brown bumps around the eyes and mouth, may be more common. A dermatologist experienced with skin of color can make the diagnosis.

A daily routine for rosacea-prone skin

1. Morning: rinse with lukewarm water or a gentle, soap-free cleanser; pat dry; apply any prescription cream; follow with a fragrance-free moisturizer and a mineral sunscreen.
2. During the day: reapply sunscreen when outdoors, wear a wide-brimmed hat, and carry a cool water spray or fan for heat.
3. Evening: cleanse gently, apply prescription treatment, then moisturizer.
4. Testing new products: try a small amount near the ear or jawline for 3 days before using it on the whole face.

Products labeled "for sensitive skin" are not always gentle. Short ingredient lists are usually safer.

Rosacea and diet

No specific diet cures rosacea, but some foods and drinks trigger flushing in many people: alcohol (red wine in particular), hot drinks, spicy foods, and foods high in cinnamaldehyde such as tomatoes, chocolate and citrus. Letting hot drinks cool, cutting back on alcohol and noting how specific foods affect you are reasonable steps. Research on gut health and rosacea is ongoing; there is not yet enough evidence to recommend probiotics as treatment.

Outlook

Rosacea is long-term, with flares and calmer periods. Early treatment helps prevent progression to persistent redness and skin thickening. With trigger management and treatment, most people achieve good control.

Frequently asked questions

What are the first signs of rosacea?

Early signs are frequent flushing or blushing, then persistent redness across the cheeks and nose. Visible small blood vessels, sensitive skin that burns or stings, and acne-like bumps may follow. Eye irritation can come before skin symptoms in some people.

What triggers rosacea flares?

Common triggers include sun exposure, heat, hot drinks, alcohol, spicy food, stress, strenuous exercise, cold wind and some skincare products. Triggers vary between people, so tracking flares helps.

Can rosacea be cured?

There is no cure, but rosacea can be controlled very effectively. Combining trigger avoidance, sun protection, gentle skincare and prescription treatments clears or greatly reduces symptoms for most people. Laser treatment helps with persistent redness and blood vessels.

Is rosacea the same as adult acne?

No. Rosacea was once called acne rosacea, but it is a different condition. It causes flushing and redness, has no blackheads or whiteheads, and mainly affects the central face in adults. Some acne treatments can irritate rosacea.

Does rosacea affect the eyes?

Yes. Ocular rosacea affects more than half of people with rosacea, causing dry, gritty, red or burning eyes and swollen eyelids. Rarely, it affects the cornea and vision, so eye pain or blurred vision needs prompt assessment.