Rosacea is a common facial skin disorder that causes redness on the cheeks, nose, and forehead. Although rosacea can occur in anyone, it most commonly affects middle-aged women with fair skin, blue eyes, and blonde hair. It is characterized by flushing, redness, pimples, pustules, and dilated blood vessels. Most patients with rosacea have eye involvement with symptoms including dryness, redness, tearing, tingling/burning sensation, foreign-body sensation, light sensitivity, and blurred vision. Besides skin and eye symptoms, rosacea can cause anxiety, embarrassment, and depression. It can have a substantial impact on the overall quality of life.

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What is Rosacea?

Rosacea is a chronic skin condition affecting millions worldwide. It primarily affects the face, causing redness, flushing, and visible blood vessels. It can also lead to bumps and pimples, thickened skin, and in some cases, eye problems.

People with fair skin who blush easily might be at a higher risk for the disorder. Adults over 30 years of age are more likely to be affected. However, rosacea occasionally occurs in adolescents and rarely in children. Rosacea appears more often among women than men, but men tend to have more severe symptoms. One possible reason could be that men do not seek medical treatment until rosacea becomes advanced. A family history of rosacea multiplies the likelihood of the disorder.
Besides its aesthetic concerns, rosacea can have a significant psychosocial impact on patients and cause anxiety, embarrassment, and low self-esteem.

Treatment can help alleviate rosacea symptoms. The first step in treating rosacea is to advise the patient to identify and avoid triggers such as UV light, spices, weather changes, and alcoholic beverages. Universal skin care recommendations for all patients with rosacea include pH-balanced skin cleansers (as opposed to soaps), broad-spectrum sunscreen with SPF 30 or higher and regular use of moisturizers. Rosacea often causes the skin to become sensitive and irritable; irritating products should be avoided. 
Certain therapies can help reduce the symptoms of the disorder. The choice of therapy is guided by the signs and symptoms present for the individual patient. The majority of the therapies aim to reduce inflammation. Certain laser therapies can be used but should be avoided in pain-sensitized patients.

Common Types of Rosacea

There are several types of rosacea, including erythematotelangiectatic, papulopustular, phymatous, and ocular. These subtypes of rosacea are not mutually exclusive, meaning multiple subtypes can occur simultaneously. Each type has its own symptoms and treatment options, and it's important to consult a dermatologist for an accurate diagnosis and personalized treatment plan. 

Read on to learn more about each type:

  • Erythematotelangiectatic

    Erythematotelangiectatic rosacea (ETR) appears as flushing and persistent redness of the central face. It often occurs before or simultaneously with the bumps and pimples of papulopustular rosacea. Visible blood vessels may also be noticed during this condition. People with these signs of rosacea tend to have very sensitive skin and may sometimes feel as if their skin stings or burns. 

    Common triggers of erythematotelangiectatic are caffeine, spicy foods, chocolates, or other things, depending on what your skin may be sensitive to. Avoidance of triggers, adherence to skin care advice, and consequent application of adequate non-irritating skin care can significantly prevent its aggravation and improve the patient’s quality of life.

  • Papulopustular

    The papulopustular rosacea (PPR) symptoms may occur along with the facial redness and flushing of erythematotelangiectatic rosacea.

    Common symptoms of papulopustular rosacea include:

    • Papules or bumps that come and go

    • Temporary or permanent facial redness, primarily on the central face

    • Burning and stinging

    • Small visible blood vessels (telangiectasia)

    • Raised, scaly red patches known as plaques

    The papules and pustules of this type of rosacea may resemble acne, which also affects the back, shoulders, and chest quite frequently.

    This type of rosacea occurs most commonly in middle age and affects women more commonly than men.

  • Phymatous

    Phymatous rosacea can affect the nose (rhinophyma), chin (gnatophyma), forehead (metophyma), ears (otophyma) and eyelids (blepharophyma). Rhinophyma, the most frequent location, shows marked skin thickenings and irregular surface nodules. Scarring and telangiectasia symptoms and increased sebaceous glands are also observed during phymatous rosacea.

    Rhinophyma was once thought to be caused by heavy alcohol use. However, rhinophyma occurs equally in people who do not use alcohol and those who drink heavily. The problem is much more common in men than in women.

What Causes Rosacea?

Knowing the causes of rosacea is important for seeking proper treatment. The exact causes of rosacea are unknown, but it is believed to be a combination of hereditary and environmental factors. Triggers for rosacea include sun exposure, extreme temperatures, stress, spicy foods, alcohol, and certain skin mites and bacteria. Common causes of rosacea are:

  • Genetics

    Genetics may not be a direct cause of rosacea but is considered a contributing factor to the development of rosacea. Research suggests multiple genetic variations may increase a person's susceptibility to developing rosacea. However, environmental factors and triggers also play a significant role in the development and progression of the condition.

  • Abnormal immune system response

    An abnormal immune system response is one of the proposed mechanisms underlying rosacea; genetics may contribute to this response. Certain genetic variations may affect the function of the immune system and its response to triggers that lead to inflammation and redness in the skin. However, it is important to note that the relationship between genetics and immune dysfunction in rosacea is complex and needs to be fully understood.

  • Environmental factors (sun exposure, extreme temperatures, and wind)

    Environmental factors, such as sun exposure, extreme temperatures, and wind, can cause inflammation and dilation of blood vessels in the skin, leading to redness and visible blood vessels. While these environmental triggers do not directly cause rosacea, they can exacerbate existing symptoms and contribute to the condition's progression.

  • Demodex mites

    Demodex mites are tiny, eight-legged parasites living on humans' and other animals' skin. These mites are typically harmless and may even play a role in maintaining healthy skin, but in some cases, they may overpopulate and cause skin irritation and inflammation. There is evidence to suggest that these mites may contribute to rosacea. Reducing their population through treatment may help alleviate symptoms.

Procedures That Remedy Rosacea

The causes and symptoms of rosacea vary greatly from person to person. Treatment should be tailored to each patient, considering symptoms, trigger factors, and the patient’s wishes. The management of rosacea usually consists of combinations of topical treatments and clinical therapies. The following are some treatments used for rosacea:

  • Chemical peels

    While chemical peels can effectively treat certain skin conditions, they can also cause significant irritation and inflammation in individuals with sensitive skin or rosacea. Therefore, very low-concentration and mild chemical peels can manage the redness and enlarged blood vessels often associated with this condition. 

    A chemical peel can also treat the acne-like bumps that rosacea can cause by exfoliating the top layer of the skin, which is then replaced by new, healthier skin cells.

    Find doctors who offer Chemical Peel
  • Laser therapy

    Laser therapy is not the ultimate cure for rosacea. It is a common approach for managing its symptoms and may require multiple sessions to achieve optimal results. Laser therapy targets the blood vessels in the skin that contribute to redness and visible blood vessels in rosacea patients. This treatment can reduce the appearance of redness and improve the overall texture and tone of the skin.

  • Intense pulsed light (IPL) therapy

    Intense pulsed light (IPL) therapy can reduce the appearance of redness and improve the overall texture and tone of the skin in rosacea patients. It is a non-invasive treatment option for rosacea that uses high-intensity pulses of light to target the blood vessels in the skin that contribute to redness and visible blood vessels.

    Find doctors who offer IPL Treatment

Frequently Asked Questions

No, rosacea is not contagious. A virus or bacteria do not cause it, so it cannot be spread from person to person through direct contact or airborne transmission. However, in rare cases, Helicobacter pylori, which is associated with digestive issues, has been found in some individuals with rosacea. In these cases, treating the underlying bacterial infection may improve rosacea symptoms. But remember, rosacea is not contagious.

The exact causes of rosacea are not fully understood. However, certain foods are thought to trigger or worsen symptoms in some people. Common triggers include spicy foods, alcohol, hot beverages, and foods high in histamines, such as cheeses, fermented foods, and cured meats. Other potential triggers include dairy products, citrus fruits, tomatoes, and chocolate. However, not all individuals with rosacea will be sensitive to the same foods, and triggers can vary widely from person to person.

There is no strong evidence for rosacea treatment. Topical and oral medications and lifestyle changes, such as avoiding triggers like spicy foods, alcohol, and sun exposure, can help alleviate the symptoms. People suffering from rosacea may also benefit from certain topical and clinical therapies. Common treatment modalities include topical gels, IPL treatment, laser therapy, and mild chemical peels.

Yes, rosacea can affect people of any age. However, it is most commonly seen in adults between 30 and 50. Rosacea is more common in women than men, but men tend to have more severe symptoms when they develop the condition.

Although it is less common, rosacea can also occur in children and teenagers. In children, rosacea may be misdiagnosed as eczema, allergies, or fungal infection.

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