What Is Rosacea?

Rosacea is a chronic skin condition that causes inflamed, red facial skin. Symptoms typically appear on the nose and cheeks, but the condition can also affect the eyes. It can also affect the forehead and chin and, less commonly, the neck and chest. About 14 million people in the United States have rosacea. 

The exact cause of this inflammatory skin condition is unknown. However, researchers suspect environmental and genetic factors. Stress, heat, and sun exposure can all trigger a rosacea flare. You're also more likely to develop rosacea if you're assigned female at birth, between the ages of 30 and 50, or have family members with the condition.

While there is no cure for rosacea, treatment options like topical or oral medications can help manage symptoms. 

Types  

Rosacea is categorized into different types based on which part of the body it affects and how the inflammation appears on the skin.

Erythematotelangiectatic Rosacea (ETR)

Also known as vascular rosacea, ETR is the most common type of rosacea. It causes small patches of flushed, red skin on the face. In more moderate to severe cases, you may notice visible blood vessels.

Papulopustular Rosacea

Also called inflammatory rosacea, papulopustular rosacea causes facial redness and small, pus-filled bumps, or pustules, that might look like acne. This type of rosacea often occurs after or in combination with ETR.

Phymatous Rosacea

Phymatous rosacea is a more severe type of rosacea that causes facial skin to thicken and become bumpy. It typically affects the nose, but it might also appear in areas like the chin, cheeks, forehead, and ears.

People with phymatous rosacea can later develop rhinophyma—a condition where damaged connective tissue and oil glands cause the nose to enlarge and appear swollen, red, and bumpy.

Ocular Rosacea 

Ocular rosacea affects the eyes and eyelids. Skin symptoms may or not be present. Diagnosis requires at least one eye inflammation symptom, including:

• Watery or bloodshot appearance
• Dryness
• Itching
• Burning or stinging
• Sensitivity to light
• Blurred vision

Without treatment, ocular rosacea can damage eyes and affect eyesight.

Rosacea Symptoms 

Rosacea symptoms can vary depending on the severity of the condition. The most common sign of rosacea is red, inflamed facial skin. People with rosacea often experience flare-up periods, when facial redness symptoms are more severe, and remission periods, when there are no symptoms. However, rosacea is a chronic inflammatory condition that doesn't go away, and symptoms can get worse if left untreated.

The most common symptoms for all types of rosacea include:

• Flushing and facial redness 
• Tingling or burning sensation from reddened skin
• Rough, scaly patches of red skin
• Red or pus-filled bumps and pimples
• Visible blood vessels
  

If you have a darker skin tone, rosacea may not appear red. It may look like brown discoloration or yellow-brown bumps.

Rosacea typically affects the center of the face, including the nose and cheeks. It can also affect the ears, sides of the face, neck, scalp, and chest. Over time, rosacea symptoms can progress from flushing to more severe bumpy rashes and visible blood vessels. If rosacea affects the eyes, it can cause eye damage or vision loss.

Other more severe symptoms of rosacea include:

• Skin thickening 
• Red, itchy, watery, or dry eyes 
• Swollen eyelids and redness at the eyelash base 

Causes and Risk Factors

Researchers do not know what causes rosacea. Certain genetic and environmental factors may contribute to inflammation that causes skin redness and swelling.

Rosacea appears to run in families, so this skin condition may be hereditary. One theory is that people with rosacea don't effectively process a protein called cathelicidin. This protein helps protect against skin infections that can cause redness and swelling. Other people may be born with sensitive skin more prone to inflammation and rosacea flares from environmental stressors like ultraviolet light, wind, or heat.

Other theories link certain skin microbes and bacteria to rosacea. For example, studies show that people with rosacea have abnormally large numbers of a particular type of skin mite. These Demodex mites live on every person's skin, particularly near hair follicles, but having more of these mites may cause irritation. On the other hand, people without rosacea can also have high numbers of Demodex mites. More research is needed to determine if people with rosacea are more sensitive to them.

Other research suggests that a bacterial infection caused by H. pylori, a type of bacteria that infects the stomach, may cause People with rosacea tend to have H. pylori in their intestines. However, people without rosacea can also have H. pylori.

People with the following characteristics are at a greater risk of developing rosacea:

• Between 30 and 50 years of age
• Assigned female at birth
• Fair skin, with or without blonde hair and blue eyes
• Northern European ancestry, such as Celtic or Scandinavian
• A family history of rosacea
• Acne cysts or nodules

While people assigned female at birth are more likely to get rosacea, people assigned male at birth are more likely to get severe rosacea, including ocular and phymatous rosacea.

Diagnosis

Rosacea is usually diagnosed by a dermatologist, a doctor who specializes in the skin, hair, and nails. There is no medical test for rosacea, but your dermatologist will examine your skin and eyes for rosacea symptoms and ask questions about your skin and medical history.

Some medical conditions, like lupus and allergic reactions, can mimic rosacea symptoms. Your healthcare provider may do medical tests to rule out other conditions. 

If your dermatologist suspects you have moderate or severe ocular rosacea, they may refer you to an ophthalmologist—a doctor who specializes in eye and vision care—for additional testing.

Rosacea Treatment

Rosacea treatment focuses on reducing symptoms and preventing condition progression that can damage your tissues and eyes. More severe phymatous or ocular rosacea may require additional surgery and medical intervention. 

Medications

Topical and oral medications can help treat the appearance and discomfort of rosacea. People with ocular rosacea are often instructed to soothe symptoms by applying warm compresses to the eyes, using a gentle eye cleanser, and using prescription eye drops to help dryness and inflammation.  

Creams, gels, and ointments that can help treat flushing, redness, and mild rashes include:

• Antibiotics: A class of medications often used to treat bacterial infections, but whose anti-inflammatory properties help treat rosacea (for example, metronidazole)
• Antiparasitics: A class of medications used to treat infections caused by parasites, including Soolantra (ivermectin)
• Vasoconstrictors: A class of medications used to temporarily narrow blood vessels, including Rhofade (oxymetazoline) and Mirvaso (brimonidine)
  

Rosacea that resembles acne can be treated with other topicals, such as:

• Sodium sulfacetamide and sulfur: Medications that help stop bacterial growth on the skin
• Retinoids: A class of compounds (made from vitamin A) used to reduce wrinkles and signs of aging (though these should be used with extreme caution, as most people with rosacea are highly sensitive to topical retinoids)
  

Absorica, Claravis, and Zenatane (isotretinoin) are oral medications that can help treat rosacea redness or acne. Isotretinoin can also help treat thickened skin, a symptom of rosacea.

Laser and Light Therapy

Laser and light therapy can help shrink visible blood vessels and reduce redness on the skin. It typically takes several sessions to see results, but results can last for years. Laser therapy can also help remove tissue in areas of thickened skin caused by phymatous rosacea.

Insurance does not usually cover this expensive procedure. You may also encounter side effects like burns, blisters, and skin discoloration. These usually fade in one to two weeks.

Surgery

Surgery using a scalpel or abrasion tool can help remove severely thickened skin caused by phymatous rosacea. This treatment option is usually reserved for severe rosacea that significantly affects a person's quality of life. Surgery may also involve reshaping the nose or face affected by thickened skin.

How to Prevent Rosacea Flares

While you can't prevent rosacea once you have it, you can reduce the frequency of rosacea flare-ups caused by environmental triggers. Avoiding triggers and following your dermatologist's treatment plan is the most effective way to prevent rosacea flares.

Here are some ways to avoid and minimize rosacea triggers:

• Wear sunscreen and limit sun exposure
• Reduce stress through exercise or meditation
• Avoid overheating from hot baths, fireplaces, and exercise
• Avoid skin-irritating skincare ingredients like menthol, camphor, sodium lauryl sulfate, and alcohol
• Avoid spicy food and hot beverages
• Limit alcohol
• Cover your face in windy and cold conditions

Related Conditions

A 2018 review of 29 studies published in the Journal of the American Academy of Dermatology found that people with rosacea often have other systemic disorders—conditions that affect multiple body systems—linked to an inflammatory response.

While the connection isn't fully understood, the review found a variety of potential comorbid conditions, including:

• Depression
• High blood pressure
• Heart disease
• Anxiety
• Diabetes
• Migraine
• Rheumatoid arthritis
• H pylori infection
• Ulcerative colitis 
• Dementia
  

Living With Rosacea

While there's no cure for rosacea, you can manage your symptoms. Treatment depends on the severity of the symptoms. Finding what works best for you may take time and require trying different treatments. 

Rosacea can affect self-esteem, social health, and overall quality of life. It can contribute to symptoms of anxiety and depression. Therefore, psychological support can be an important aspect of treatment.

Managing rosacea is important because the condition can become more severe if left untreated. For example, ocular rosacea can lead to severe eye damage, and skin thickening can permanently damage tissue. Fortunately, medical treatment and lifestyle changes can prevent flare-ups, as well as prevent the rosacea from progressing.