Rosacea is a common but poorly understood chronic (long-term) skin condition that mainly affects the face. Symptoms begin with episodes of flushing (when the skin turns red). People with rosacea may experience spots and persistent redness of their skin. Small blood vessels in the skin can become visible. In the most severe cases, the skin can thicken and enlarge, usually on and around the nose. There is no cure for rosacea, but treatments are available to control the symptoms.
How common is rosacea?
Rosacea most commonly affects fair-skinned people from northern Europe and is estimated to affect up to 1 in 10 people. Rosacea affects twice as many women as men, although it is usually more serious in men. The symptoms usually begin between the ages of 30 and 50.
Triggers of rosaceaWhile the exact cause of rosacea is unknown, several triggers have been identified that make the symptoms worse in some people. These include:
- Exposure to sunlight
- Cold weather
- Hot drinks
- Eating certain foods, such as spicy foods
Identifying and avoiding the triggers of rosacea can be a useful way of controlling the symptoms.
As well as avoiding the triggers, you can control the symptoms of rosacea by using a number of different medicines. Rosacea is a relapsing condition, which means that it will keep returning. People with rosacea will have periods when their symptoms are particularly bad, followed by periods when the condition is less severe. However, most cases of rosacea can be effectively controlled with medication.
Symptoms of rosaceaThe symptoms of rosacea often vary from person to person. Although the condition has a number of common symptoms, not everyone will experience all of the possible symptoms. The common symptoms of rosacea include:
- Persistent redness
- Papules and pustules
- Visible blood vessels
- Thickened skin
- Eye irritation
These symptoms are explained below.
Flushing (when your skin turns red) is usually the first sign of rosacea. Episodes of flushing can last up for up to five minutes. The flush can spread to your neck and chest, and you may experience an unpleasant feeling of heat.
With rosacea, episodes of flushing are sometimes followed by episodes of persistent facial redness. This redness is like a flush or a patch of sunburn that does not go away.
Papules and pustules
If you have rosacea, you may develop: Papules: round red bumps that rise from your skin Pustules: pus-filled swellings These spots will appear on your face and are similar to teenage acne. However, unlike acne, your skin should remain free of blackheads (small, blocked pores).
Visible blood vessels
If you have rosacea, you may experience inflammation of the small blood vessels in the surface of your skin. This can cause your skin to appear red and swollen, producing the sort of blotchy skin that is often associated with excessive alcohol consumption. This can be upsetting for people with rosacea, as people often mistakenly assume that they are heavy drinkers. The medical name for visible blood vessels is telangiectasia.
In the most serious and developed cases of rosacea, the skin can thicken and form excess tissue, usually around the nose. This causes the nose to take on a large, bulbous appearance. This is known as rhinophyma. Rhinophyma is a rare symptom of rosacea. When it does occur, it is usually more common in men than women.
Eye irritationOver half of people with rosacea also experience symptoms that affect their eyes, such as:
- Feeling like there is something in your eyes
- Dry eyes
- Sensitivity to light (photophobia)
- Irritated and bloodshot eyes, which can often lead to related eye conditions such at blepharitis (inflammation of the eyelids)
Rosacea that affects the eyes is known as ocular rosacea.
Other symptomsOther symptoms associated with rosacea include:
- A burning or stinging sensation on your face
- Dry, rough skin
- Raised red patches, known as plaques, on your skin
- Facial swelling
- Not being able to use cosmetics because your skin is sensitive to them
Most people with rosacea have periods when their symptoms are particularly troublesome, followed by periods where their symptoms are less problematic. Permanent damage to the face, such as scarring, almost never occurs in rosacea. Rosacea is a common skin condition that mainly affects the face, causing redness and spots.
Causes of rosacea
The exact cause of rosacea is unknown. However, most experts believe it may be caused by a number of related factors. These are outlined below.
Blood vessel abnormalities
Many dermatologists (skin specialists) believe that abnormalities in the blood vessels of the face may be a major contributing factor for rosacea. This may explain the symptoms of flushing, persistent redness and visible blood vessels. However, it is not known what causes these abnormalities.
Demodox folliculorum is a microscopic mite (tiny insect) that may contribute to rosacea. These mites usually live harmlessly on human skin, but higher numbers of mites have been found on people with rosacea. However, it is uncertain whether the mite is a cause or an effect of rosacea.
Helicobacter pylori bacteria
Helicobacter pylori bacteria, which are found in the digestive system, have been suggested as a possible cause of rosacea, although the link is not proven. The bacteria may stimulate the production of protein called bradykinin, which is known to cause blood vessels to expand.
Rosacea seems to run in families. However, it is not known which genes are involved or how they are passed on.
Triggers of rosaceaMost people who have rosacea notice that certain triggers make their symptoms worse. Different people can have different triggers, but the most commonly reported ones include:
- Exposure to sunlight
- Hot weather
- Exposure to wind
- Strenuous exercise
- Hot baths
- Cold weather
- Spicy foods
- Caffeine (found in tea, coffee and cola)
- Dairy products
- Acute (short-term) medical conditions, such as a cold or fever (high temperature)
- Chronic (long-term) medical conditions, such as high blood pressure (hypertension)
- Vasodilatory medicines, which are often used to treat high blood pressure
Diagnosing rosaceaSee your GP as soon as possible if you think you have rosacea. The sooner treatment for rosacea begins, the less likely you will develop the more serious symptoms of the condition, such as thickened skin. There is no specific clinical test for rosacea. Your GP will make a diagnosis by:
- Examining your skin
- Asking you about your symptoms
- Asking you about any possible triggers you may have
- In some circumstances, your GP may recommend you have further tests, such as a blood test, to rule out other conditions that have similar symptoms, such as:
- Lupus, a condition where the immune system (the body’s natural defence against infection and illness) attacks healthy tissue
- The beginning of the menopause (when a woman’s monthly periods stop)
The symptoms of rosacea can be treated in a number of ways. These are described below.
Making lifestyle changes, such as avoiding possible triggers or wearing sunscreen, can be a good way of controlling the symptoms of facial flushing (when your skin turns red).
Creams and Gels
A number of treatments are effective in treating the spots and pimples caused by rosacea. Your GP can recommend a cream or gel as the first treatment option.
Complications of rosacea
Rosacea can cause complications that affect you physically and psychologically.
Eye problemsRosacea that affects your eyes (ocular rosacea) can lead to a number of eye conditions. Blepharitis (inflammation of the eyelids) is the most commonly reposted eye condition resulting from rosacea. It can usually be successfully treated by adopting a daily eye cleaning regime and by using antibiotic tablets and creams Up to 1 in 20 people with rosacea may experience symptoms that affect their cornea (the clear outer layer at the front of the eyeball). This can:
- Make your eyes bloodshot and watery
- Cause scarring of your cornea
In severe cases, if it is not treated, ocular rosacea can lead to vision loss. Your GP my refer you for treatment with an ophthalmologist (a doctor who specialises in eye conditions and their treatment or surgery).
Psychological and social effectsAny chronic (long-term) condition can have an adverse psychological effect, but rosacea can be particularly troublesome because it affects your appearance. This can change how you feel about yourself and also how you interact with other people. Many people with rosacea have reported feelings of:
- Low self-esteem
It is important to come to terms with the fact that you have a chronic condition which, although incurable, is controllable. Persevering with your treatment plan and avoiding your individual triggers are best ways of controlling your rosacea symptoms. As your physical symptoms begin to improve, you will start to feel better psychologically and emotionally. If you have rosacea, try to take comfort knowing that you are not alone. There are millions of people across the world who are living with the condition. Speak to your GP if you are feeling depressed as a result of your condition. They may recommend further treatment.
You can take steps to prevent your symptoms of rosacea from flaring up.
Avoiding known triggers can help reduce the severity and frequency of your rosacea symptoms. To establish what is triggering your symptoms, you could keep a diary of your daily activities to record their impact on your symptoms. Advice about how to avoid some of the common triggers of rosacea is explained below.
SunlightAs sunlight is the most commonly reported trigger of rosacea, it is recommended that you use sunscreen every day, even on overcast days. A sunscreen cream with a sun protection factor (SPF) of at least 30 is recommended. Using sunscreens specifically designed for children may help reduce any irritation to your skin. During the summer months, minimise your exposure to the sun, particularly in the middle of the day when the sun is at its hottest. However, remember that the sun can also be very strong in the morning and evening, so you will need to take adequate precautions at these times as well. To reduce your exposure to the sun:
- Regularly apply sunscreen to your skin
- Wear a wide-brimmed hat
StressAfter sunlight, stress is the second most reported trigger of rosacea. Successfully managing your stress levels can help control your rosacea symptoms. You can reduce stress by:
- Taking regular exercise
- Eating a healthy, balanced diet
- Getting the right amount of sleep
- Deep breathing exercises
Food and drink
The most commonly reported food – and drink – related triggers are alcohol and spicy foods. You may want to completely remove these from your diet to see if your rosacea improves. However, there are many other dietary triggers that can adversely affect some people with rocacea. Include information about how your diet affects your rosacea symptoms in your rosacea diary.
Covering your face and nose with a scarf can help protect your skin from cold temperatures and wind. If you need to spend considerable time outside during cold weather, you can protect your face with a balaclava.
Skin care techniquesThe advice below about skincare techniques may also help control your rosacea symptoms:
- Do not rub, scrub or massage your face. Doing so can irritate your skin.
- Use a moisturiser to soothe your skin if it feels sore.
- Do not use oil-based make-up, scented soaps, alcohol-based skin cleansers or other facial or hair products that contain ingredients that might irritate your skin, such as alcohol and fragrances.
- Look for products that are suitable for sensitive skin or non-comedogenic (will not block pores and cause spots)
- Gently clean your skin every morning and evening using a gentle, non-abrasive cleanser.
- Rinse your face with lukewarm water and allow your skin to dry thoroughly before you apply medication or make-up
- Men may find that using an electric razor, rather than a blade, helps reduce skin irritation
- Do not use steroid cream unless you are specifically instructed to by your GP. It may make your symptoms worse.