What Is Rosacea? Symptoms, Causes, and Treatments

Woman with Redhair Applying Skin Products to Mask Some Skin Irritation
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The Mayo Clinic describes rosacea as a "skin condition that causes blushing or flushing and visible blood vessels in your face." Often mistaken for acne, the signs and symptoms of rosacea  (pronounced roh-ZAY-sha) may flare up for weeks to months, subside, and later return.

The National Rosacea Society notes that this common ailment affects over 16 million Americans and 415 million people worldwide and is predominant in people over 30.

We spoke to two board-certified dermatologists to learn more about how to treat rosacea through methods that range from topical remedies to laser therapy, along with its potential causes and symptoms.

Meet the Expert

What Is Rosacea?

Rosacea is a common, chronic skin condition. "It most often involves the central face (nose, cheeks, forehead, chin) but can also spread to the ears, neck, chest, and back," Dr. Kim says. "It is characterized by redness of the face and a tendency to "flush and blush." Both women and men of all skin colors can be affected, but it is more commonly seen in women with lighter skin types. It usually develops after the age of 30." 

There are four types of rosacea: erythematotelangiectatic (vascular), papulopustular (inflammatory), phymatous, and ocular. 

  • Erythematotelangiectatic Rosacea: Dr. Kim says redness, flushing, and dilated blood are associated with erythematotelangiectatic rosacea. This form of the skin condition may "progress to visibly dilated capillaries or blood vessels," according to Dr. Faloloa.
  • Papulopustular Rosacea: If you are experiencing acne-like breakouts, you may have papulopustular rosacea. 
  • Phymatous Rosacea: With phymatous rosacea, the skin typically thickens and has a granulomatous texture. 
  • Ocular Rosacea: Ocular rosacea affects your eyes and eyelids, cousin them to become red and irritated.

What Causes Rosacea?

While rosacea affects millions of people, medical professionals are still trying to figure out what exactly causes it. "Although we do not know the exact cause of rosacea, there is a complex interplay of hereditary, vascular, immunologic, and environmental factors that has yet to be elucidated with more research," Dr. Kim says.

While there is more research to be done, existing studies indicate genetics, immune reaction, microorganisms, environmental factors, and neurovascular dysregulation are among the known contributing factors for rosacea. Ultraviolet (UV) exposure may also play a role in causing and triggering the skin condition.

What Are the Symptoms of Rosacea?

Rosacea primarily affects the face and can present itself through symptoms such as redness, visible veins or blood vessels, and facial flushing. Acne-like papules can also surface during a rosacea flare-up.

According to the Mayo Clinic, some of the most common rosacea symptoms include:

  • Facial flushing: Persistent flushing in the central part of the face. 
  • Visible veins: Small blood vessels on the nose and cheeks break and become visible.
  • Swollen bumps: Pimples on the face that resemble acne. 
  • Burning sensation: The skin may feel hot and tender.
  • Eye problems: Dry, irritated, swollen eyes and eyelids. 
  • Enlarged nose: Thick skin on the nose, causing the nose to appear bulbous.

In addition to redness, there are a few other telltale signs of rosacea. "Skin affected by rosacea tends to be hypersensitive and can display itching, burning, stinging, sensitivity, tightness, tenderness, and discomfort," Dr. Faloloa says. "Because the manifestation, triggers, and treatments vary widely, getting guidance on the best possible treatments for you is important."

How to Treat Rosacea

The most common treatment for rosacea are topical or oral prescription medications, avoidance of rosacea triggers, laser and light therapy, and the use of soothing skincare products. 

"While there is currently no cure for rosacea, it can be treated with lifestyle changes combined with medical treatment," Dr. Faloloa explains. "The best treatments are those with anti-inflammatory, anti-allergic, antibacterial, or anti-parasitic properties." 

Some of the most common rosacea treatment methods are:

  • Topical Medications: Mild-to-moderate rosacea can often be treated with prescription topical medications. "Examples include topical metronidazole, ivermectin, niacinamide, azelaic acid, and sulfur," Dr. Faloloa says. 
  • Oral Medications: Your dermatologist may include oral medication in your treatment plan. "Prescription oral medications include oral antibiotics, specifically the tetracycline class," Dr. Kim says. "Low-dose doxycycline is used because of its anti-inflammatory benefits, and it is a first-line therapy for ocular rosacea as well." 
  • Avoidance of Triggers: "Several environmental factors may contribute to rosacea flare-ups," Dr. Kim says. These include sunlight, stress, heat, exercise, alcohol, spicy foods, cold temperatures, and topical steroids.
  • Laser and Light Therapy: "Vascular lasers and intense pulsed light devices have been a mainstay in the treatment of rosacea in my practice," Dr. Kim notes. "They work by targeting hemoglobin in the blood vessels that are responsible for the flushing and blushing phenomenon, thereby reducing redness and telangiectasias."
  • Gentle Skincare Products: Using non-irritating products in your skincare routine is key. "One example is Rodan + Fields Soothe Sensitive Skin Treatment ($90)," Dr. Kim says. "Formulated for sensitive, visibly red, itchy, and dry skin, this product is well-suited for rosacea patients. [Use this with] a soap-free cleanser, gentle moisturizer, and mineral sunscreen, and you have a complete regimen."

How to Calm a Rosacea Flare Up

While rosacea flare-upsare often calmed by avoiding the aforementioned triggers, the following tips can also provide relief, according to Medical News Today:

  • Gentle, fragrance-free moisturizer can help soothe irritation.
  • A humidifier helps moisture circulate and prevents dry skin.
  • Staying hydrated with water helps prevent the skin from drying.
  • A towel dipped in cold water can be placed around the neck to stay cool.
  • Stress relief techniques, such as yoga and meditation.

When to See The Doctor 

If over-the-counter products and the avoidance of triggers are not controlling your symptoms, Dr. Kim recommends seeking help from a board-certified dermatologist. "Other conditions like contact dermatitis or autoimmune [diseases] can also cause a red, sensitive face, so a dermatologist can properly diagnose your skin condition and set you on the right path for treatment," she says. "If your rosacea is cystic, painful, or you are starting to see granulomatous textural changes to your skin, you may benefit from prescription medications in conjunction with laser treatments. Severe thickening and granulomatous changes of the skin in rhinophyma may require surgical intervention. If you are experiencing dry eyes or a foreign body sensation in your eyes, you should see an ophthalmologist to be evaluated for ocular rosacea." 

The Final Takeaway

Rosacea is one of the most common skin conditions. While it is a chronic inflammatory disorder, there are various ways to treat and reduce symptoms (from topical prescription medication to laser therapy). If you are dealing with rosacea, it is best to visit a dermatologist so they can help you figure out the best course of action.

Article Sources
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  1. Farshchian M, Daveluy S. Rosacea. In: StatPearls. StatPearls Publishing; 2021.

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