Rosacea is a chronic, inflammatory skin condition that causes red patches and/or bumps on the face, often on the nose, cheeks, or chin. Initially, the redness may fade and reappear periodically. Over time, however, the redness typically remains, becoming more prominent. Ultimately, rosacea may lead to dilated blood vessels, flushing, facial swelling, thickened skin with prominent pores, and eye inflammation.
Rosacea is common, affecting an estimated 5% of the world’s population. Although men are diagnosed with rosacea less frequently and at an older age than women, they are at higher risk of developing thickened skin. The condition is most commonly diagnosed among people with fair skin.
Although there is no cure for rosacea, it can be well-managed. Lifestyle changes, medical treatment, laser treatment, and/or surgery may help the redness become less noticeable. It’s also possible to cover up the redness with cosmetics designed for sensitive skin.
What is rosacea?
Rosacea is a chronic inflammatory skin condition characterized by red spots on the face that arise during adulthood, usually on the nose, cheeks, or chin.
Certain risk factors are known to worsen rosacea in some people, including:
- Exposure to sunlight (ultraviolet light)
- Taking hot baths
- Spending time in environments with high temperatures
- Cold weather
- Exposure to wind
- Exercising strenuously
- Alcohol consumption
- Spicy food
- Hot food
- Hot beverages
Risk factor avoidance, along with medical, laser, and surgical treatments for rosacea, help to minimize the appearance of red spots on the skin and prevent flare-ups or complications, such as skin-thickening, from occurring.
What causes rosacea?
Although doctors aren’t sure exactly what causes rosacea, the following triggers are associated with the condition:
- Ultraviolet radiation and/or heat. Exposure to ultraviolet radiation and/or heat may be a trigger in susceptible people, leading to redness and swelling of the skin on the face.
- Skin barrier malfunction and/or microbiome alteration. Some people with rosacea have a disruption of their skin barrier, leading to water loss, dryness, and sensitivity to irritants. People with a disrupted skin barrier are prone to dryness, scaliness, burning, and physical sensitivity, which increases susceptibility to rosacea. Alteration of the microbiome, such as excess Demodex mites, may also increase susceptibility to rosacea.
- Family history. Some people may inherit a genetic mutation that makes them susceptible to rosacea. In those cases, the condition runs in their families.
- Overactive blood vessels. It’s also possible that overactive blood vessels in the face may dilate more easily than they should, allowing more blood to circulate, leading to facial redness and other symptoms.
What are the symptoms of rosacea?
People with rosacea have:
- Red patches and/or bumps on the face
- A tendency to get flushed or blush easily
- Blood vessels that appear beneath the skin of a reddened nose, chin, or cheeks
- Skin that stings, burns, itches, or feels tight
- Dry, scaly skin
- Pus-filled skin sores that resemble acne, which may crust or ooze
- Thickened skin with prominent pores, often affecting the nose
- Gritty, burning sensation in the eyes
- Bloodshot eyes
- Watery eyes
- Swollen eyelids
What are the risk factors for rosacea?
People who are at increased risk of rosacea:
- Are female
- Are fair-skinned
- Are in their 30s to 50s
- Have had ultraviolet radiation and/or heat exposure
- Have a skin barrier dysfunction and/or an altered microbiome
- Have a family history of rosacea
How is rosacea diagnosed?
It is possible to be diagnosed with rosacea after sharing your medical history with a doctor and undergoing a skin examination. Although there are no diagnostic tests to confirm rosacea, certain tests can help rule out other conditions. Diagnostic testing, such as a skin biopsy, is more likely to be used to rule out other conditions, including cancer, than to confirm the presence of rosacea.
If, as an adult, you begin to notice red spots on your face, let your doctor know when they began appearing, if they fade for periods of time, and whether certain triggers cause them to stand out. Also tell your doctor if you have a family history of rosacea or notice anything else, such as dry skin or a burning sensation where the skin appears red.
During a physical exam, your doctor will look for signs of rosacea, including red patches and/or bumps on your nose, cheeks, and chin, as well as for the presence of dilated blood vessels, flushing, facial swelling, thickened skin with prominent pores, and/or eye inflammation.
How is rosacea treated?
Appropriate facial skin care and photoprotection are first-line treatments for the management of rosacea.
Although there is no cure for the condition, a number of medications are available to help manage symptoms, including:
- Topical creams or gels, including azelaic acid, ivermectin, and metronidazole, to reduce redness, swelling, and other symptoms
- Antibiotics, such as doxycycline, to help reduce inflammation
- Isotretinoin to help minimize facial swelling
- Alpha-adrenergic agonists and beta blockers to reduce skin flushing
- Prescription eye drops and/or artificial tears to manage eye redness or burning
When medication isn’t effective, other treatments are available, including:
- Laser therapy, such as pulsed dye laser, or other light-based therapies, such as intense pulsed-light therapy, to reduce redness
- Surgery to reshape thickened skin and reduce the appearance of pores
Lifestyle changes may also help to minimize symptoms, such as:
- Wearing sunscreen (broad spectrum SPF 30 or higher)
- Washing your face with a pH-balanced soap-free cleanser in lukewarm water
- Applying a gentle moisturizer containing glycerin or petroleum jelly (petrolatum)
- Avoiding astringents, toners, abrasive exfoliators, cosmetics that contain irritants or are difficult to remove, and abrasive procedures
People with rosacea should also avoid triggers (mentioned above) that make symptoms worse.
What is the outlook for people with rosacea?
Untreated rosacea may advance over time, sometimes leading to dilated blood vessels, flushing, facial swelling, thickened skin with prominent pores, and eye inflammation. Although rosacea is incurable, people may manage the redness and inflammation by avoiding triggers and a combination of medical, laser, and/or surgical treatment options. Some people with rosacea may feel self-conscious about their appearance. Therapy or counseling may also be helpful, particularly if rosacea leads to anxiety or depression.
What makes Yale unique in its treatment of rosacea?
“The Yale Department of Dermatology is a regional center for expertise in the management of rosacea,” says Yale Medicine dermatologist Caroline Nelson, MD. “We offer holistic care that focuses on the physical and emotional impact of rosacea on the individual. In addition to medical therapies available through our outpatient dermatology clinics, pulsed dye laser and other state-of-the-art laser therapies are offered by the Yale Aesthetic Dermatology Program.”