What Is Rosacea? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Rosacea is a common skin disease that causes redness and acne-like bumps in the central part of the face. It can develop on the cheeks, nose, forehead, and chin, and sometimes spreads to other parts of the body, like the ears, back, or chest.
This is a chronic inflammatory condition. Once rosacea sets in, flares can happen at any time. The length and severity of flares vary. Some people have symptoms that last a few weeks, others a few months.
A rosacea diagnosis can be upsetting. But the more you learn about this condition, the easier it will be to cope. (1,2,3)
Rosacea doesn’t only cause skin redness. You may also experience other symptoms, depending on the type of rosacea you have.
The four types of rosacea are erythematotelangiectatic, papulopustular, phymatous, and ocular.
The symptoms associated with these four types include: (2)
You might mistake rosacea for another skin condition, or even downplay the condition if you have milder symptoms. But you shouldn’t ignore persistent redness in your face.
Learn More About Signs and Symptoms of Rosacea
With any type of inflammatory condition, understanding the underlying cause is among the first steps to reducing flares.
The exact cause of rosacea is unknown. (1) Even so, doctors and researchers have isolated possible causes and triggers of this condition.
In some cases, rosacea redness is due to dilated blood vessels and increased blood flow to the skin surface. Factors that can trigger this response include: (1,3)
Keep in mind that different people have different triggers, so you’ll need to get to know your own body, says Anna D. Guanche, MD, a board-certified dermatologist based in Calabasas, California. Your rosacea might be triggered by one of the above, or several of the above.
Even though some people have a higher risk for rosacea, the condition can happen to anyone — even newborns and children. But the likelihood of developing this condition is greater in people over 30, and more women develop rosacea than men. Rosacea can also run in families. It affects an estimated 16 million people in the United States.
It’s worth noting that rosacea isn’t caused by poor hygiene, nor is rosacea a contagious skin disease. (1,2,3,4,5)
Diagnostic criteria for rosacea were ratified in 2017 by the global ROSacea COnsensus (ROSCO) panel and subsequently approved by the American National Rosacea Society. Two primary features were identified, and either one on its own can indicate a rosacea diagnosis: phymatous changes, which typically involve thickening or enlarging of the skin; and persistent centrofacial erythema, in which the skin on the central part of the face (nose, cheeks, forehead, and chin) is persistently red and may become more red or inflamed at times due to certain triggers.
In the absence of one of these primary features, the panel’s guidelines suggest that a diagnosis can also consider two or more major features as well as some minor ones. Major features include flushing, telangiectasia (visible veins, often called “spider veins”), inflammatory papules or pustules, and ocular manifestations. Minor features include burning, stinging, edema, and dry sensation of the face.If you have rosacea eye symptoms, you may also need to see an ophthalmologist. (6)
Rosacea can look like several other conditions; some people may think their skin redness is the result of acne or an allergic reaction. It isn’t until the condition worsens that they seek medical attention.
Although rosacea can mimic other skin problems, it also has its own distinctive signs.
Conditions that can be mistaken for rosacea include: (7)
Lupus is a chronic inflammatory autoimmune condition that can cause a reddish skin rash over the nose and face, usually in a butterfly shape.
The difference is that lupus doesn’t usually cause bumps and pimples. These symptoms are more likely to occur with rosacea. Also, lupus causes symptoms that you won’t find with rosacea, such as a fever and arthritis. (8)
Some people mistake rosacea for normal acne. There is a rare condition called rosacea fulminans, which involves the sudden onset of inflammatory facial papules and pustules, possibly with swelling and abscesses.
But if you have a breakout that looks like acne but doesn’t behave like acne, you might be dealing with a case of rosacea instead, says Erum Ilyas, MD, a board-certified dermatologist based in the Philadelphia area. “This might include a pimple that never comes to a head, or popping a pimple and having nothing come out, yet it looks worse after,” she continues.
Rosacea and acne can occur together. (5) But while acne can develop over the entire face and on different parts of the body, rosacea is often limited to the central part of the face. Rosacea symptoms can occur beyond the face, but this is rare. (1,2)
Similarly, you can have dermatitis at the same time as rosacea. (7) To make a distinction, know that dermatitis usually causes scaling or flaking around the scalp, eyebrows, and beard area. These symptoms aren’t typical of rosacea.
The course of this chronic condition is different for each patient and depends on several factors, including family history and genetics, skin sensitivity, exposure to sunlight, extreme temperatures, and consumption of foods that trigger flares, such as alcohol and spicy dishes. (9)
There’s no cure for rosacea, but while it doesn’t go away, the severity and frequency of symptoms may fluctuate and change over time. And treatment can help control symptoms. (1)
Various treatments can reduce redness and other symptoms, improving your skin’s appearance and reducing the frequency of flares. (6)
Once your doctor makes a definitive diagnosis, you’ll work together to determine the best treatment plan for your skin. There’s no one-size-fits-all approach. Your doctor may prescribe a medication, monitor your skin for improvement, and then recommend a different medication if the one you’re currently taking doesn’t work.
Topical Gels and Creams
Your doctor may first prescribe a topical antibiotic or anti-inflammatory cream or gel. (6) Topical antibiotics are common first-line treatments to reduce pink bumps, whereas a nonsteroidal anti-inflammatory can reduce skin irritation that leads to redness and acneiform lesions, notes Tsippora Shainhouse, MD, a board-certified dermatologist based in Los Angeles.
Or you may receive a topical cream designed to constrict the blood vessels in your face. This helps reduce blood flow, and subsequently lessens flushing and redness.
Along with medication to constrict your blood vessels, your doctor may prescribe a drug to kill bacteria on your skin, which can improve rosacea pimples and acne, along with redness and other skin irritation. Results aren’t immediate; it can take up to three to six weeks to see improvement. (6)
Your doctor may also prescribe a topical medication against the demodex mite called ivermectin (Soolantra), which is approved by the U.S. Food and Drug Administration (FDA) for certain types of rosacea.
If creams and gels don’t work, the next line of defense is an oral antibiotic. These drugs fight inflammation and eliminate bacteria to improve redness, bumps, and eye symptoms. (6,10)
Another option is a powerful oral acne medication called isotretinoin (Accutane). It can clear up acne, redness, and swelling. This drug can cause serious birth defects, so your doctor will only prescribe isotretinoin when antibiotics don’t work and you’re not pregnant or planning to become pregnant. (6)
Light Therapy
If oral medication and creams don’t improve skin, talk to your doctor about laser or light therapy. This type of therapy can reduce the size of blood vessels in your face and remove excess skin around your nose.
Although light therapy can improve skin, new blood vessels may reappear and skin thickening may return, requiring additional treatments. (11)
Eye Drops
If you have ocular rosacea, your doctor can prescribe eye drops to reduce inflammation, redness, light sensitivity, and other symptoms. Additionally, applying a warm compress over your eyes and gently cleansing your eyelids with baby shampoo can reduce symptoms. (6,11)
Alternative and Complementary Therapies
A rosacea treatment plan doesn’t only include medication. Changing your habits to avoid certain triggers may also improve your skin. (12)
Starting a rosacea diary is one of the first steps to pinpointing your triggers. Keep track of days when symptoms appear or worsen, and then write down everything that happened on this day. What did you eat? What type of activity did you perform (such as exercise or working in the garden)? Were you exposed to cold or hot temperatures?
Also, make a note of your emotional state during this time. Were you under a lot of stress or anxiety? This type of diary can help narrow down the underlying cause of your flares.
Certain types of foods play positive and negative roles in flare management. For the most part, you need to avoid any foods and drinks that increase blood flow to your face. These include: (13)
On the other hand, foods you should eat include those that fight inflammation. Some people have had excellent results with a high-fiber diet (prebiotic) consisting of leafy greens, lentils, asparagus, and other fiber-rich foods. (14)
Foods rich in omega-3 fatty acids may reduce your body’s inflammatory response, improving symptoms associated with ocular rosacea. (15,16)
Of course, just because a particular food or drink is a known rosacea trigger doesn’t mean it’s a trigger for you — which is why it’s important to keep track of what you eat and how that may affect your symptoms.
Learn More About Eating Right for Rosacea
You can’t prevent or cure the condition, but there are ways to manage it and reduce flare-ups. If you can identify which behaviors and environmental factors trigger your flares, you can do your best to avoid them. Common triggers include: alcohol and spicy foods, stress, intense exercise, exposure to hot or cold weather, as well as sun and wind. (17)
Rosacea can lead to complications if left untreated. (1) Redness can gradually worsen or become permanent. What’s more, untreated rosacea increases the risk for skin enlargement around the nose. (1) Talk to your doctor about any redness that doesn’t go away, or redness that comes and goes.
Ocular rosacea can lead to complications in the cornea, which can ultimately result in loss of vision. (18)
Researchers estimate that rosacea affects 415 million people worldwide and about 16 million Americans. (19)
Most people who get rosacea are between 30 and 50 years old, although children can get rosacea, too.
Women are somewhat more likely than men to get rosacea, although they’re less likely to have severe rosacea. (20)
Rosacea tends to occur more frequently in people of certain ethnicities, such as descendants of Scandinavian or Celtic families who are fair-skinned with blond hair and blue eyes. (20) But it also occurs in people who have darker skin — and it may take longer for their doctors to diagnose rosacea, because skin redness isn’t always as apparent. (21)
Studies have shown that while rosacea is not a rare condition among Black, Indigenous, and People of Color (BIPOC) populations, delayed diagnosis is common, which can worsen treatment outcomes. (22)
“As a dermatologist of color, I always worry that our resident physicians aren’t taught to look for other signs and symptoms of rosacea outside of rosy cheeks to accurately make a diagnosis,” says Dr. Ilyas. “Most of my patients of color are only diagnosed with rosacea once it has become severe and potentially scarring.”
The American Academy of Dermatology recommends that people of color should see a dermatologist if they notice the following facial symptoms: (23)
Research has suggested a number of other health conditions are associated with rosacea. It’s not clear whether there’s a cause-and-effect relationship, but the following conditions may occur with rosacea:
Migraines, diabetes, dementia, and other autoimmune conditions have also been associated with rosacea. Researchers continue to examine and evaluate the significance of these connections and why they occur. (24)
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