Rosacea
- Dr Amber Akhter, Lead Physician at Bupa
Rosacea is a common skin condition that mainly affects your face. Your skin looks red, and you may have bumpy or pus-filled spots. You can usually treat rosacea by avoiding anything that triggers flushing, and taking medicines to control your symptoms.
About rosacea
Rosacea is a lifelong skin condition that flares up and down. It makes your skin look red and flush easily. It mainly affects the middle part of your face, especially your:
- cheeks
- chin
- nose
- forehead
Sometimes rosacea also affects other parts of your body, such as your neck, chest, and ears. Your eyes may be sore, watery, or irritated too.
Rosacea is most common in people with pale skin that burns easily in the sun. But it can affect anyone with darker skin as well. You may first develop the condition when you’re aged between 30 and 50. You may have been prone to blushing as a child or teenager. Rosacea is more common in women than in men. But men may have more severe symptoms.
Rosacea used to be called acne rosacea because it sometimes looks like acne.
Types of rosacea
Rosacea may be divided into four different types based on your symptoms and how severe they are. These rosacea types are:
- papulopustular rosacea: this is the most common type, especially in women, causing flushing and red spots on your face
- phymatous rosacea: your skin gets thicker, and you may notice lumps and bumps on your nose, chin, forehead, ears, and eyelids
- erythematotelangiectatic rosacea: the middle part of your face looks red, often with burning, stinging, or itching
- ocular rosacea: your eyes feel sore and dry and may be sensitive to light – you may notice this before your skin starts to look red
Many people have more than one type of rosacea. This is because they have different symptoms at different times.
Causes of rosacea
Doctors don’t yet know why some people have rosacea and other people don’t. But they think that rosacea may be caused by a combination of several things, including your genes, immune system, and environment.
Rosacea causes may include:
- a problem with your immune system, which causes too much inflammation in your skin
- a problem with tiny blood vessels in your skin – this increases the blood flow to your face, causing flushing
- damage to your skin caused by too much sun
- a problem with the way your skin works
- having unusually high numbers of tiny mites that live naturally in your skin
You’re more likely to develop rosacea if you have fair skin that burns easily in the sun. Rosacea may be more common in some families. You can’t catch the condition from anyone else.
If you have rosacea, certain things may trigger your symptoms. These include sunlight or exposure to ultraviolet (UV) rays, vigorous exercise, hot drinks, and stress. Hot flushes, caused by the menopause or an overactive thyroid gland, can make rosacea flushing worse. For more information on rosacea symptom triggers, see our self-help for rosacea section.
Symptoms of rosacea
Rosacea can affect your skin in lots of ways. It may look like acne. But if you have rosacea, your skin won’t be greasy – it’s usually dry and peeling instead. Some people with acne have rosacea too. Rosacea can also affect your eyes.
Skin symptoms
Rosacea may cause:
- redness of your face, especially your cheeks and forehead
- regular flushing or blushing, which lasts for a few minutes at a time
- thickened skin with noticeable pores
- small pink or red bumps (papules) and pus-filled spots (pustules) on your nose, forehead, and chin – the spots aren’t usually sore and don’t cause scarring
- tiny broken blood vessels on your face, especially your cheeks and forehead – these are called spider veins, thread veins, or telangiectasias
If you have brown or black skin, the redness can be harder to see – the first noticeable rosacea symptoms may be small bumps and spots on your face. Not everyone with rosacea is prone to flushing. Rosacea flushing usually happens very quickly when something triggers it. It may come and go at first. But if your rosacea gets worse, your skin may eventually look red all or most of the time.
Some people with rosacea also have:
- a burning or stinging feeling on their skin
- a puffy face – this can last for a few days at a time
- dry, rough, and scaly skin on your face – this can look like seborrhoeic dermatitis
Rosacea can thicken your nose over time so it looks bigger, red, and bumpy. This is called rhinophyma. It’s more common in men.
Eye symptoms
If rosacea affects your eyes, you may have:
- a gritty feeling in your eyes
- stinging, burning, and weeping eyes
- sore or scaly eyelids
- a lump or cyst on your eyelid (called a chalazion)
- pain in your eyes – this may be caused by inflammation of your eye
If you have any of these eye symptoms, it’s important to speak to your GP or optometrist. These eye symptoms can be mistaken for eye infections (conjunctivitis ) or blepharitis. They can also be signs of serious eye conditions, such as keratitis, which need to be treated quickly.
Diagnosis of rosacea
Many people with mild rosacea don’t contact their GP. They treat their symptoms themselves. But it’s important to see your GP if your symptoms are severe or bothering you. Treating rosacea early may stop it getting worse.
Rosacea is usually diagnosed from your symptoms. Your GP will check your skin for signs of rosacea, such as redness, spots, and thickening. They’ll also check your eyes. They’ll ask you:
- about your symptoms, when you get them and how long they last
- whether you’re prone to flushing – and when this started
- if you’ve noticed any specific triggers, such as sunlight
- whether your symptoms are affecting your daily life
- if rosacea runs in your family
- whether you have any other medical conditions or take any regular medicines
Your GP may refer you to a dermatologist (a doctor who specialises in skin conditions) or an ophthalmologist (a doctor who specialises in eye conditions) if:
- your symptoms are severe
- normal treatments aren’t working
- they’re not sure if you have rosacea
You don’t usually need any tests to diagnose rosacea. But a dermatologist may suggest some tests to rule out other medical conditions. These tests may include:
- blood tests to check for systemic lupus erythematosus (SLE)
- a skin biopsy to check for other skin conditions
Self-help for rosacea
There are several things you can do yourself to help ease rosacea symptoms. If you have mild rosacea, you may not need any other treatment. But if self-help measures aren’t working, it’s important to speak to your GP.
Avoiding triggers
Avoiding common rosacea triggers may help to keep your symptoms under control, including redness and flushing. Rosacea triggers vary from person to person. You may be able to work out some of your triggers if you keep a daily diary of your symptoms. Common triggers include:
- sun or UV exposure
- hot or humid environments, including central heating
- hot, cold, or windy weather
- feeling very stressed
- too much exercise
- spicy foods
- hot drinks
- hot baths
- alcohol
You may find your skin is more sensitive to certain skincare ingredients, especially if it’s red, dry, and prone to spots. These skincare ingredients include:
- astringents
- toners
- menthol
- camphor
- sodium lauryl sulfate (found in most shampoos)
Some medicines may make rosacea worse. These include:
- calcium channel blockers
- amiodarone
- corticosteroids for your skin or nose
- some antidepressants and medicines for anxiety – these may cause dry eye symptoms
If you’re taking any of these medicines, speak to your GP or pharmacist.
Self-care advice
- A general skincare routine may help to calm your skin and prevent flare-ups. Use a gentle soap-free cleanser on your face – apply it with your fingers.
- Moisturise regularly with a non-greasy emollient.
- Use sunscreen products every day to protect your skin from UVA and UVB rays – your GP may prescribe a strong sun block containing zinc oxide or titanium dioxide.
- Avoid the midday sun and wear a wide-brimmed hat when you’re outside in the sun.
- Massaging your face regularly may help to stop it looking puffy.
Wearing yellow- or green-tinted make-up may help to disguise any redness. If your skin is very red, your GP may be able to refer you to a local skin camouflage service on the NHS. Or you can contact the charity Changing Faces for advice from specialist skin camouflage practitioners.
If rosacea is affecting your eyes, you may be able to reduce or ease your symptoms by:
- avoiding wearing eye make-up
- cleaning your eyelids with lid hygiene wipes
- using warm eye compresses
- using dry eye products, such as artificial tears
- wearing UV-protection sunglasses
Having rosacea can be very distressing. If your rosacea is affecting your mood, or you’re feeling anxious, speak to your GP. They may recommend you have some counselling.
Treatment of rosacea
Rosacea can’t be cured. But lifestyle changes, medicines, laser, and surgery may help to control the redness, spots, and other symptoms. The aim of rosacea treatment is to keep your skin as clear as possible.
Choosing the right treatment usually depends on which symptoms you have, and how severe they are. You may need to try several different treatments before you find the right one for you. You may need to try different treatments at different times. Or you may need a combination of treatments. Your GP will discuss all of the treatments with you.
Medicines
If you have mild rosacea, you may not need to use medicines regularly – you may just need to treat your symptoms when they flare up. Your GP will prescribe different medicines depending on your symptoms.
Mild-to-moderate symptoms are usually treated with skin creams or gels.
Your GP may prescribe brimonidine gel if your face is very red. This medicine works by reducing the blood flow to your face. You use it once a day every day. The redness may flare up again when you stop using it.
If your skin is very inflamed and you’re prone to spots, your GP may prescribe anti-inflammatory creams or gels. These medicines include:
- azelaic acid
- ivermectin
- metronidazole (an antibiotic)
Your GP or pharmacist will tell you how long to use these creams or gels for. Some of these medicines can cause side-effects, especially if you have sensitive skin. Ivermectin and brimonidine aren’t suitable for pregnant or breastfeeding women
If these creams or gels aren’t helping your spots, your GP may prescribe antibiotic tablets. Antibiotics are thought to help rosacea by reducing inflammation. You take them twice a day for 6 to 12 weeks. You may need to take them again for a while if your symptoms flare up. These antibiotics include:
- oxytetracycline
- tetracycline
- erythromycin
These antibiotics aren’t suitable for everyone, such as people with kidney problems. Oxytetracycine and tetracycline aren’t suitable for pregnant or breastfeeding women. Your dermatologist will discuss all of the pros and cons of taking antibiotics with you.
You may be prescribed doxycycline tablets if you can’t take other antibiotics. If your skin is very inflamed and your rosacea doesn’t affect your eyes, your GP may prescribe low-dose doxycycline tablets.
If your skin is very inflamed and other treatments aren’t working, a dermatologist may prescribe isotretinoin tablets. Lots of people find that isotretinoin helps to clear up their rosacea. But this medicine can cause a lot of side-effects, including mood changes. So your doctor will discuss all of the pros and cons before you take it.
You can’t take isotretinoin tablets if you’re pregnant or breastfeeding, or think you might be pregnant. This is because the medicine can harm your baby. You’ll be asked to do a pregnancy test before you’re given your prescription and once a month while you’re taking isotretinoin. You’ll also need to use very reliable contraception for one month before starting isotretinoin, while you’re taking it and for one month afterwards.
Always read the patient information leaflet that comes with your medicine and ask your pharmacist for advice if you have any questions.
Other treatments
If medicines aren’t helping to ease persistent redness or noticeable veins, your dermatologist may suggest you try laser facial resurfacing. Laser treatments treat rosacea by shrinking the blood vessels on your face without hurting the surrounding skin. Laser therapies include:
- pulsed dye laser
- neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy
If you have rhinophyma, your dermatologist may suggest you have laser therapy or surgery to make your nose smaller.
Complications of rosacea
Rosacea doesn’t usually cause serious complications. But it can get worse over time.
Rosacea fulminans is a rare complication of rosacea. It starts suddenly and causes large red bumps, spots, and cysts on the face. This may cause scarring. Rosacea fulminans is usually treated with corticosteroid tablets to reduce inflammation and isotretinoin tablets.
Ocular rosacea can lead to serious eye conditions if it isn’t treated. These eye conditions include:
- keratitis – inflammation of the cornea
- conjunctivitis – inflammation of the tissue lining the eye and eyelid
- anterior uveitis – inflammation of the iris or ciliary body
Rosacea can affect your day-to-day activities if you’re trying to avoid anything that triggers your symptoms. It can lead to anxiety and depression.
Doctors don’t yet know exactly what causes rosacea. The condition may be caused by a combination of several things, including your genes, immune system, and environment. For more information, see our causes of rosacea section.
Rosacea can cause lots of different symptoms. It mainly affects your face. The five most common symptoms are a red face, regular flushing, thickened skin, small spots on you face, and tiny broken blood vessels. For more information, see our symptoms of rosacea section.
Rosacea triggers vary from person to person. But the most common trigger is sunlight or UV exposure. Hot weather, stress, and spicy foods are also common triggers. For more information on rosacea triggers, see our self-help for rosacea section.
Using a gentle skin cleanser and moisturiser may help to calm down mild rosacea symptoms. Your GP can prescribe medicines to reduce any skin redness and treat spots. Using artificial tears and warm compresses may calm down your eyes. For more information, see our self-help for rosacea and treatment of rosacea sections.
Corticosteroids
Laser resurfacing
Laser skin resurfacing is a procedure to remove the outer layers of the skin on your face and encourage new skin to grow.
Other helpful websites
Discover other helpful health information websites.
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- Victoria Goldman, Freelance Health Editor
