Rosacea

Published by Bupa's Health Information Team, March 2011.

This factsheet is for people who have rosacea, or who would like more information about it.

Rosacea (previously known as acne rosacea) is a common skin condition. It can cause redness bumps, pimples and spots on the face, usually the cheeks and nose. It's most common in middle-aged people.

About rosacea

Rosacea is a skin disorder that can cause redness, bumps, flushing or noticeable blood vessels, usually on the centre of your face. You may have some or all of these symptoms. Rosacea sometimes looks like acne and other skin disorders.

Women are more likely to get rosacea, but the symptoms are often more severe in men. People who are fair-skinned and blush easily are thought to be more likely to get rosacea. But it may be that the condition is more noticeable on fair skin. Rosacea isn’t an infection and it’s not contagious. The condition can run in families but it’s not clear whether this means it’s inherited.

                        Rosacea

            Reproduced under licence from Wellcome Images

Symptoms of rosacea

Rosacea usually starts with flushing on your forehead, nose and cheeks. Over several months or even years, the flushing becomes a darker shade of red and your skin stays this colour all the time. After a while, bumps and spots develop.

The symptoms of rosacea vary from person to person. If you have rosacea, you may have the following symptoms:

• small red bumps (papules)
• pus spots (pustules)
• small blood vessels
• sensitive skin that may burn, sting or itch.

Rosacea can also cause problems around your eyes. It often affects your eyelids, which can become red, itchy and sore.

Rosacea may make your skin sensitive to sunlight, so your symptoms may be worse after you have been out in the sun.

Rosacea can make you self-conscious, embarrassed and anxious and because of this it can also disrupt your social life.

Complications of rosacea

In severe cases, the skin of your nose can thicken and look red and bumpy. This is known as rhinophyma and is more common in men than in women.

You may get conjunctivitis and inflammation of your eyelids (blepharitis), and it may feel like you have grit in your eyes. In severe cases, rosacea can affect the eye itself, but this is rare.

Causes of rosacea

Doctors don’t fully understand what causes rosacea. There may be a problem with the blood vessels in the skin of your face which makes them dilate too easily.

There are a number of triggers that can make rosacea worse for some people, but they aren’t thought to cause rosacea. These include:

• sunlight
• stress
• alcohol
• exercise
• hot and cold temperatures
• spicy food

If you think you have rosacea, you should visit your GP.

Diagnosis of rosacea

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Rosacea is usually fairly easy for doctors to recognise by examining your skin.

Treatment of rosacea

Rosacea can’t be cured but there are treatments to help control the symptoms. Starting treatment when your rosacea is at an early stage may help to prevent it from getting worse.

Self-help

It’s important that you identify and avoid the triggers that cause flushing such as spicy food and sunlight.

You should apply sunscreen to your face when you go out in the sunshine. Make sure it has a sun protection factor (SPF) of 30 or higher.

Cosmetics designed for rosacea or redness can be very effective. They usually have a green tint which hides the redness.

Rosacea isn’t an infection. There is no need for you to wash your skin more extensively if you have this condition. When you wash your face you can use soap and water or, if your skin is sensitive, you may want to wash with water alone or use an emollient. Don’t rub or scrub your face with washcloths or use sponges on your face as these can irritate your skin. If you need cleanser, apply it with your hands, rinse with lukewarm water and pat dry with a towel.

Medicines

If you have mild rosacea with some bumps and spots, your GP may offer you an antibacterial cream or gel such as metronidazole. If your symptoms don’t improve with metronidazole, your GP may prescribe azelaic acid. Both of these products can irritate your skin and cause some redness and dryness. If this happens, talk to your GP. These creams can take at least eight weeks to work but often work more quickly.

If your rosacea is severe or the creams don’t work, your GP may prescribe you antibiotic tablets such as tetracycline, oxytetracycline or erythromycin. You will usually need to take these for six to 12 weeks. Once the symptoms have been controlled you may be able to stop taking the medication. However, long-term treatment may be required if symptoms return.

Stronger treatment such as isotretinoin may be an option if your rosacea is severe. Your GP will refer you to a dermatologist for this.

Eye symptoms of rosacea can be treated with antibiotic tablets such as oxytetracycline. Your GP will refer you to an ophthalmologist, a doctor who specialises in eye health, if you have severe eye problems.

Non-surgical treatments

Laser treatment can be used for visible blood vessels and sometimes flushing. It’s important that your symptoms have been controlled before you have laser treatment. It’s not suitable for all skin types so speak to your GP for more information. You may need several treatments for it to be effective.

In more severe cases, camouflage creams can be used to improve the appearance of your rosacea. The waterproof creams last for around 12 to 18 hours on your face. The creams blend into your skin colour to make your rosacea less noticeable. Skin camouflage can help to build your confidence and self-esteem. If you’re interested in skin camouflage you should speak to your GP. He or she can refer you to a member of the British Association of Skin Camouflage (BASC), or the Red Cross skin camouflage service. You will be shown how to apply the cream and how to match the colour to your skin tone. One visit is usually enough to give you information about skin camouflage and create a skin match. Unfortunately, wearing heavy make-up may make your rosacea worse, so camouflage alone is a last resort.

Surgery

If you have a bulbous nose affected by rhinophyma, you may consider cosmetic surgery. Your GP or dermatologist can give you more information.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.