Rosacea is a common skin disease that causes redness and acnelike bumps in the central part of the face. (1) 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. (2)
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. (3)
A rosacea diagnosis can be upsetting. But the more you learn about this condition, the easier it will be to cope.
Signs and Symptoms of Rosacea
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)
- Skin redness in the center of the face (may spread to the cheeks, forehead, or chin)
- Visible broken blood vessels
- Swollen skin
- Stinging or burning skin
- Dry skin
- Frequent blushing or flushing
- Skin redness and swelling
- Acne-like breakouts or pimples
- Broken blood vessels
- Raised skin patches
- Burning or stinging skin
- Enlarged or thickening skin around the nose
- Large pores
- Broken blood vessels
- Eye redness and irritation
- Watery eyes
- Gritty sensation in the eyes
- Sensitivity to light
- Blurred vision
- Itchy and dry eyes
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.
Causes and Risk Factors 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)
- Increased number of?demodex mites?on the face (These microorganisms live on everyone's?skin, but there are often more of them in people with rosacea.)
- Irritated hair follicles
- Sun damage
- Temperature extremes — hot, cold, exposure to strong winds
- Extreme exercise
- Stress and anxiety
- Hormonal changes
- Spicy food
- An abnormal immune system response, triggered by the protein cathelicidin
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. (1,2,3) It affects an estimated 16 million people in the United States. (4)
It’s worth noting that rosacea isn’t caused by poor hygiene, nor is rosacea a contagious skin disease. (1,5)
How Is Rosacea Diagnosed?
There isn’t a specific medical test to diagnose rosacea, but your doctor can make a diagnosis after conducting a physical examination of your skin, assessing your family history, and ruling out other conditions. If you have rosacea eye symptoms, you may also need to see an ophthalmologist. (6)
Initially, you may see your primary doctor for symptoms. In all likelihood, your doctor will refer you to a dermatologist, a medical doctor specializing in skin conditions.
Conditions That May Resemble Rosacea
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. 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.
Prognosis 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)
Duration of Rosacea
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)
Treatment and Medication Options for Rosacea
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. 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)
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)
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
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.
How Diet Can Affect Rosacea: What to Eat and What to Avoid
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)
- Spicy foods
- Hot drinks (tea, coffee, hot chocolate)
- Alcohol (red wine, gin, Champagne, beer)
- High-histamine foods (fermented cheese, citrus fruits, spinach, eggplant, mushrooms)
- Dairy (yogurt, sour cream, cheese)
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)
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.
Prevention of 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)
Complications of Rosacea
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)
Research and Statistics: Who Has Rosacea?
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, though children can get rosacea, too.
Women are somewhat more likely than men to get rosacea, though 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)
BIPOC and Rosacea
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)
- A persistent warm feeling
- Dry, swollen skin
- Patches of darker skin or a dusky brown discoloration to your skin
- Acne-like breakouts that don't go away with acne treatment
- Yellowish-brown, hard bumps around your mouth or eyes
- Burning or stinging when you apply skin-care products
- Thickening skin on the nose, cheeks, chin, or forehead
Related Conditions of Rosacea
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)
Resources We Love
Depending on the severity of your symptoms, living with rosacea can take an emotional toll on you. This condition can be unpredictable, with your symptoms worsening or improving as you get older.
Staying informed can help. A number of organizations have websites with comprehensive, up-to-date material about rosacea, including the latest?research and treatment options. We’ve created a?page highlighting some of the best online resources.
In addition, your doctor may recommend clinical trials you could participate in, as well as support groups where you can find encouragement from those who know exactly what you’re going through.
Additional reporting by Deborah Shapiro.
Editorial Sources and Fact-Checking
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- Rosacea Resource Center.?American Academy of Dermatology.
- Rosacea.?National Health Service. January 15, 2020.
- Skin Conditions by the Numbers.?American Academy of Dermatology.
- Frequently Asked Questions.?National Rosacea Society.
- Mayo Clinic: Diagnosis and Treatment.?Mayo Clinic. September 6, 2019.
- Red Skin and Rashes Are Not Always the Result of Rosacea.?National Rosacea Society. June 6, 2016.
- Lupus Symptoms.?Lupus Foundation of America. March 10, 2017.
- Rosacea: What Is It??Harvard Health Publishing. December 2018.
- Rosacea: Diagnosis and Treatment.?American Academy of Dermatology.
- Rosacea: Treatment Can Reduce Your Discomfort and Improve Your Quality of Life.?American Academy of Dermatology.
- Rosacea.?American Academy of Family Physicians. August 27, 2018.
- Factors That May Trigger Rosacea Flare-Ups.?National Rosacea Society.
- Weiss E, Katta R. Diet and Rosacea: The Role of Dietary Change in the Management of Rosacea.?Dermatology Practical and Conceptual. October 2017.
- Oge L, Muncie H, Phillips-Savoy AR. Rosacea: Diagnosis and Treatment.?American Family Physician. August 1, 2015.
- Bhargava R, Chandra M, Bansal U, et al. A Randomized Controlled Trial of Omega 3 Fatty Acids in Rosacea Patients With Dry Eye Symptoms.?Current Eye Research. October 2016.
- Rosacea: Prevention. Cleveland Clinic. October 10, 2019.
- Ocular Rosacea. Mayo Clinic. June 25, 2020.
- Study Estimates 415 Million People Affected by Rosacea Worldwide. National Rosacea Society. Summer 2018.
- Rosacea: Who Gets and Causes. American Academy of Dermatology.
- Diagnosing Rosacea in Darker Skin Can Often Be Difficult.?National Rosacea Society. August 20, 2017.
- Alexis AF, Callender VD, et al. Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience.?Journal of the American Academy of Dermatology. June 2019.
- People With Skin of Color Can Get Rosacea. American Academy of Dermatology.
- Vera N, Patel NU, et al. Rosacea Comorbidities.?Dermatology Clinics. June 2018.