Rosacea is a common skin problem. Skin is sensitive and prone to inflammation commonly causing redness and more pronounced blood vessels of the central face, in addition to red bumps and pustules. Less commonly, the inflammation can affect the eye (ocular rosacea), or be so significant that it causes enlargement of facial features like the nose (rhinophyma) or chin (gnathophyma). Patients can have permanent redness of the face, or be more prone to flushing, in which case the redness fluctuates.
The exact cause for rosacea is still unknown, however genetics and immune dysfunction leading to hypersensitivity to certain triggers are thought to play a role.
Women are much more likely than men to be affected by rosacea, especially women between the ages of thirty and fifty. People with lighter skin are more likely to develop rosacea, as are those with a family history.
Additionally, there are many known triggers for rosacea, including:
- Extreme temperatures, on their own or transitioning quickly
- Sunlight exposure
- Food & drink including alcohol, spicy foods, temperature hot foods, caffeine
- Certain treatments for acne can flare underlying rosacea
- Emotional or situational stress
Rosacea has a variety of presentations but typically manifests with underlying inflammation and skin sensitivity. Skin can appear: flushed, swollen, and have signs of increased dryness with rough or scaly textures. Rosacea can also share qualities with acne like inflamed bumps and pustules. More prominent and an increased number of burst blood vessels is also a common finding. Skin can feel like it is burning, itching or stinging.
The increased inflammation associated with rosacea can make the skin thicker in places like the chin (gnathophyma) or nose (rhinophyma). Rosacea can also present as inflammation on and around the eyes (ocular rosacea) leading to more visible blood vessels, large cysts, and poor vision, along with the aforementioned symptoms of rosacea found on the rest of the face.
A diagnosis of rosacea will be confirmed by physical exam of the skin in combination with questions about the history of symptoms (sensations in the skin, flushing with certain exposures, etc.) and family history.
Treatment and Prevention
Daily sun protection and gentle skin care are the basis of a common treatment plan for many patients with rosacea. Also, topical creams and oral medications may be prescribed. Lasers can target the associated redness, blood vessels, or enlargement of facial features.
There is no absolute way to prevent rosacea, but avoiding triggers and maintaining a good skin care routine outlined by a dermatologist can decrease flares.
What causes rosacea?
Although the exact cause of rosacea is unknown, various theories about the disorder's origin have evolved over the years. Facial blood vessels may dilate too easily, and the increased blood near the skin surface makes the skin appear red and flushed. Various lifestyle and environmental factors -- called triggers -- can increase this redness response. Acne-like bumps may appear, often in the central face. This may be due to factors related to blood flow, skin bacteria, microscopic skin mites (Demodex), irritation of hair follicles, sun damage,an abnormal immune or inflammatory response, or psychological factors.
Is rosacea contagious?
No. Rosacea is not considered an infectious disease, and there is no evidence that it can be spread by contact with the skin or through inhaling airborne bacteria. The effectiveness of antibiotics against rosacea symptoms is widely believed to be due to their anti-inflammatory effect, rather than their ability to destroy bacteria.
Is rosacea hereditary?
Although no scientific research has been performed on rosacea and heredity, there is evidence that suggests rosacea may be inherited. Nearly 40 percent of rosacea patients surveyed by the National Rosacea Society said they could name a relative who had similar symptoms.
In addition, there are strong signs that ethnicity is a factor in one's potential to develop rosacea. In a separate survey by the Society, 33% of respondents reported having at least one parent of Irish heritage, and 26% had a parent of English descent. Other ethnic groups with elevated rates of rosacea, compared with the U.S. population as a whole, included individuals of Scandinavian, Scottish, Welsh or eastern European descent.
Can rosacea be diagnosed before you have a major flare-up?
It is sometimes possible to identify "prerosacea" in teenagers and persons in their early 20s. These individuals generally come to the dermatologist for acne treatment and exhibit flushing and blushing episodes that last longer than normal. The prolonged redness usually appears over the cheeks, chin, nose or forehead. These patients also may find topical acne medications or certain skin-care products irritating.
Once identified, these rosacea-prone individuals can be counseled to avoid aggravating lifestyle and environmental factors known to cause repeated flushing reactions that may lead to full-blown rosacea. If you recognize the symptoms of prerosacea in a younger family member or others, they might be advised to consult a dermatologist.
Is there any kind of test that will tell you if you have rosacea?
There are no histological, serological or other diagnostic tests for rosacea. A diagnosis of rosacea must come from your physician after a thorough examination of your signs and symptoms and a medical history. During your exam you should explain any problems you are having with your face, such as redness, flushing, the appearance of bumps or pimples, swelling, burning, itching or stinging, or other information.
Will my rosacea get worse with age?
There is no way to predict for certain how an individual's rosacea will progress, although physicians have observed that the signs and symptoms tend to become increasingly severe without treatment. Moreover, in a National Rosacea Society survey, about half of rosacea sufferers said without treatment their condition had advanced from early to middle stage within a year. Fortunately, compliance with medical therapy and lifestyle modifications to avoid rosacea triggers has been shown to effectively control its signs and symptoms on a long-term basis.
How long does rosacea last?
Rosacea is a chronic disorder, rather than a short-term condition, and is often characterized by relapses and remissions. While at present there is no cure for rosacea, its symptoms can usually be controlled with medical therapy and lifestyle modifications. Moreover, studies have shown that rosacea patients who continue therapy for the long term are less likely to experience a recurrence of symptoms.
How does menopause affect rosacea?
The hot flashes sometimes associated with menopause may bring on a flare-up or even the initial onset of rosacea.
How can I find a rosacea specialist?
As with most disorders, there is no formal medical specialty devoted to rosacea alone. The appropriate specialist for rosacea is a dermatologist, who specializes in diseases of the skin, or for those with eye symptoms, an ophthalmologist.
Does rosacea cause facial swelling, burning or itching?
Facial burning, stinging and itching are commonly reported by many rosacea patients. Certain rosacea sufferers may also experience some swelling (edema) in the face that may become noticeable as early as the initial stage of the disease. The same flushing that brings on rosacea's redness can be associated with a build-up of fluid in the tissues of the face. It is also believed that in some patients this swelling process may contribute to the development of excess tissue on the nose (rhinophyma), causing it to become bulbous and bumpy.
If you experience any of these symptoms, discuss them with your physician.
I suffer from regular acne in addition to rosacea. Is this common?
Rosacea and acne usually appear separately, but some patients are affected by both. Special care is necessary in treating patients with both conditions because some standard medications for acne vulgaris can make rosacea worse.
Is dry, flaky skin typical with rosacea?
It has been estimated that approximately half of all rosacea sufferers may appear to experience dry skin. With treatment, this dryness often eases along with disappearance of papules and pustules. To combat dry, flaky skin, use a moisturizer daily after cleansing and applying medication. You should develop a treatment plan with your dermatologist to ensure all of the products you use are appropriate for rosacea, including over the counter cleansers and moisturizers.
Is oily skin common for rosacea sufferers?
There is no standard skin type for rosacea patients. Many sufferers experience dry, flaky skin, while others may have normal or oily skin, or both. The key is to identify your skin type and with the help of a dermatologist, develop a skin care routine suitable for you.
I've been using medication for some time now and it has cleared my pimples and reduced my redness, but it also seems to have made me develop more spider veins. What's going on?
Visible blood vessels (telangiectasia) sometimes develop with rosacea and were likely always there, but were hidden or less noticeable because of your redness. Once medication has diminished the redness, it is not uncommon for spider veins to become more noticeable. These can be camouflaged with makeup, or treated with a laser.
Can rosacea involve the eyes?
Yes. Known as ocular rosacea, eye symptoms may include a watery or bloodshot appearance and a dry, gritty feeling with burning, itching and/or stinging. Individuals with rosacea may be prone to styes, light sensitivity and blurred vision. Eye involvement may appear before or after any skin signs or symptoms, and individuals who suspect they may have ocular rosacea should consult a dermatologist or ophthalmologist for appropriate therapy. Left untreated, ocular rosacea can affect vision permanently.
What are the most common lifestyle and environmental factors that aggravate rosacea or trigger flare-ups?
According to a National Rosacea Society survey, some of the most common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, heavy exercise, hot baths, heated beverages and certain skin-care products.
How effective is avoiding lifestyle and environmental factors?
In a survey of 1,221 rosacea sufferers by the National Rosacea Society, 96 percent of those who believed they had identified personal triggers said avoiding those factors had reduced their flare-ups.
How long after a rosacea trigger will a flare-up occur?
Although there is no data available on how quickly a rosacea trigger may lead to a flare-up, the time is likely to vary depending on the individual and the nature of the trigger. Try monitoring your individual case to see how quickly your rosacea responds. And remember, while a wide range of factors have been identified as potential triggers, not every trigger affects every individual every time.
Is there any relationship between rosacea and allergies?
Allergies may cause flushing, which frequently triggers rosacea symptoms. As with more common rosacea triggers, identifying and avoiding allergens -- the substances you are reacting to -- may also help control your rosacea.
Will exercise cause my rosacea to flare up?
Any activity such as exercise that causes flushing or overheats the face has the potential to spark a rosacea flare-up. The good news is that signs and symptoms may be avoided or reduced by managing your workout. Ways to help reduce the incidence of flare-ups include working out in the early morning or late evening when weather is cooler; working out more frequently but for shorter intervals; keeping cool indoors by running a fan or opening a window; and cooling off by keeping a damp towel on your neck, drinking cold fluids or chewing on ice chips. Choosing low-intensity exercise or water aerobics may also be useful.
How do I determine what causes a flare up?
Rosacea signs and symptoms may be prompted by a vast array of environmental and lifestyle factors that differ from one individual to another. As with an allergy, it is useful to keep a diary to pinpoint the particular elements that may prompt a flare-up in your individual case.
Can rosacea be cured?
While rosacea cannot be cured, medical treatments are available that can control or eliminate its various signs and symptoms.
How is rosacea treated?
The signs and symptoms of rosacea vary substantially from one patient to another, and treatment must therefore be tailored by a physician for each individual case.
When appropriate, laser treatments may be used to decrease visible blood vessels, reduce extensive redness or correct disfigurement of the nose.
Eye symptoms are commonly treated with oral antibiotics and ophthalmic therapy.
In addition, rosacea patients are advised to identify and avoid lifestyle and environmental factors that may aggravate their individual conditions. Patients may also benefit from gentle and appropriate skin care. Additionally, green-tinted cosmetics can camouflage the redness caused by rosacea.
How does laser therapy work?
To remove visible blood vessels or reduce extensive redness, vascular lasers target tiny blood vessels just under the skin. Generally, at least three treatments are required, depending on the severity of redness or visible blood vessels. A CO2 resurfacing laser may be used to remove unwanted tissue and reshape enlarged facial structures like the nose.
Why are antibiotics prescribed for rosacea? Is it a bacterial infection?
It is unknown exactly why antibiotics work against rosacea, but it is widely believed that it is due to their anti-inflammatory properties, rather than their bacteria-fighting capabilities.
What medications are used for rosacea besides antibiotics?
Physicians may use a variety of medications to help control rosacea in individual patients. Products containing a sulfur drug or azelaic acid may be prescribed as an alternative or adjunct to antibiotic therapy, and a cardiovascular medication is sometimes used to control severe flushing. Other medications may also be considered, especially in cases that do not respond to initial therapy.
What about long-term side effects?
There is virtually no risk of systemic side effects with topical treatments, other than allergic reactions. Possible side effects associated with oral antibiotic therapy include upset stomach, increased sensitivity to sun exposure, tooth discoloration, diarrhea, allergic reactions and vaginal yeast infections. Talk to your physician about potential side effects of any medication prescribed.
If I take long-term medication consistently, will it lose its effectiveness?
Topical therapy usually controls rosacea on a long-term basis, without loss of effectiveness.
Should I still use my medication between flare-ups?
Rosacea is characterized by flare-ups and remissions, but continuous treatment between flare-ups can prevent them.
How should I care for my skin?
For those with rosacea, a skin care routine recommended by many dermatologists starts with a gentle face wash each morning. A mild cleanser, that is not grainy or abrasive, should be used. A soft pad or washcloth can be used, but avoid rough washcloths, loofahs, brushes or sponges.
Next, rinse the face with lukewarm water several times and blot it dry with a thick cotton towel. Never pull, tug, scratch or treat the face harshly. If prescribed a topical medication, allow the skin to air dry for several minutes before applying. Let the medication soak in for an additional 5-10 minutes before applying a moisturizer with SPF 30 or higher.
What skin-care products are appropriate to use with rosacea?
Rosacea prone skin is sensitive and may be easily irritated. Patients should avoid using any products that burn, sting or irritate their skin. The following ingredients/products should be avoided: alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus oil, clove oil and salicylic acid. A useful rule of thumb may be to select products that do not have harsh or unnecessary ingredients.
Broad-spectrum (UVA and UVB) SPF 30 or higher is recommended on a daily basis. This is especially important for rosacea patients, whose facial skin may be particularly susceptible to sun damage and consequent rosacea flare-ups. Physical blockers utilizing zinc or titanium dioxide are recommended as chemical sunscreens can cause irritation.
How do I control flushing/blushing?
As always, the best offense is a good defense. Individuals with rosacea should identify and avoid environmental and lifestyle factors that cause flushing. A prescription topical is available and may improve persistent facial redness, and in severe cases, certain oral medications may be prescribed.
Do steroids induce rosacea?
While effective in treating certain skin conditions, long-term use of topical steroids may prompt rosacea-like symptoms informally called "steroid-induced rosacea". Some physicians may prescribe a short course of a topical steroid to immediately reduce severe inflammation, but should not be used longer than directed. if you are concerned about a medication you are taking, you should discuss this with your physician.
Are there support groups for rosacea sufferers?
The National Rosacea Society is the world's largest support organization for rosacea, offering information and educational services to hundreds of thousands of rosacea patients and health professionals each year.
While face-to-face support groups are not well established, rosacea sufferers can find online chat groups and forums through www.yahoogroups.com and www.rosacea-support.org.