Rosacea

About

Rosacea

What is rosacea?

Rosacea (roe-ZAY-she-uh) is a common, chronic skin condition of unknown cause. More than 14 million Americans have it. Anyone can develop rosacea but it’s most common in fair-skinned people who have a tendency to blush easily. Rosacea causes redness on the face, visible blood vessels, swelling, acne-like bumps and thick skin. It can also develop in the eyes causing swelling and irritation. Symptoms can flare up for weeks or months and then stop for a while. Certain factors can trigger a flareup of symptoms. While there’s no cure, treatment with antibiotics and ache medications can control and reduce rosacea’s symptoms. If not treated, it will get worse over time. 

Do I need to worry about rosacea?

Rosacea is more than a cosmetic concern. You need an accurate diagnosis and treatment because it gets worse over time. A red, uncomfortable face can become permanent. Skin thickening can cause permanent disfigurement. Rosacea in the eyes, which occurs in about half of all patients, can decrease your ability to see.

Causes

What causes rosacea?

Although the cause of rosacea remains unknown, facial redness may be due to one or more of these potential causes:

In some people rosacea gets worse at certain times of the year (winter) or with certain activities -- your face feels hot and uncomfortable after drinking red wine, for example. 

Flare-ups of rosacea may be triggered by:

  • Spicy foods and hot beverages
  • Alcoholic beverages, especially red wine
  • Extremes in temperature
  • Sun or wind
  • Emotional upsets
  • Exercise
  • Drugs that dilate blood vessels, including some blood pressure medications
  • Certain cosmetics, or skin and hair products

Who’s at risk for rosacea?

You may be more likely to develop rosacea if you:

  • Have fair skin that burns easily in the sun
  • Blush easily
  • Are older than age 30
  • Have had a lot of acne
  • Smoke, or are around a lot of secondhand smoke
  • Have a family history of rosacea
  • Have Celtic or Scandinavian ancestry

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up

Symptoms

What are the symptoms of rosacea?

Rosacea symptoms vary from one person to another, and not everyone has all the symptoms. Symptoms are often more severe in men. The two most important symptoms, used to diagnose it, are: 

  • Persistent redness mainly on the face; can also affect the ears, chest and back
  • Thickening skin, especially on the nose (rhinophyma)

A diagnosis of rosacea can be made if you have two or more of these major signs of rosacea. The major signs of rosacea include:

  • Skin breakouts that can look like acne. Usually they are small, red, solid bumps or pus-filled pimples. 
  • Small blood vessels on the nose and cheeks that break and become visible on the skin. 
  • Eyes are more sensitive to light. Eyes are red, irritated, watering and bloodshot. Eyelids may swell; styes and pink eye are common. Crusts may accumulate around eyelids and eyelashes. The eyeballs can burn, itch or sting. Without treatment, severe ocular rosacea can cause cornea damage and a decrease in ability to see. The eyes are affected in about half of all rosacea patients. 

Secondary symptoms can include:

  • Face burns and stings if touched by water or a skin care product is applied
  • Itching or a feeling of skin tightness
  • Dry, rough-textured skin that can look scaly
  • Face blushing or flushing that includes feeling hot, or a burning sensation that comes and goes
  • Swelling of the face along with raised red patches (plaques) can develop without changes in the surrounding skin.
  • The same facial symptoms can also develop on the neck, chest, scalp or ears.
  • Quality of life issues are reported by almost 90% of rosacea patients; 70% said the condition has lowered their self-confidence and self-esteem.

Are there types of rosacea?

In an effort to better target treatment to individual types of cases, rosacea is divided into four types (subtypes). Each type has its own symptoms and treatment. It’s possible for a patient to have more than one type of rosacea at the same time. 

Subtype 1: Facial redness, flushing, visible blood vessels

Symptoms:

  • Very sensitive skin
  • Flushing and redness in the center of the face
  • Visible broken blood vessels (spider veins)
  • Swollen skin; may sting and burn
  • Dry skin, roughness or scaling
  • Tendency to blush more easily

Subtype 2: Acne-like breakouts (Acne rosacea)

Symptoms:

  • Acne-like breakouts on red skin
  • tends to come and go
  • Oily skin
  • Very sensitive skin
  • Skin may burn and sting
  • Visible broken blood vessels (spider veins)
  • Raised patches of skin (plaques)
  • Most common in middle-aged women

Subtype 3: Thickening skin (rhinophyma)

Symptoms:

  • Symptoms of another subtype usually happen first
  • Bumpy skin 
  • Skin begins to thicken on chin, forehead, cheeks and ears and especially the nose
  • Visible broken blood vessels 
  • Large pores 
  • Oily skin
  • Disfigurement 
  • Blocked nasal airflow if severe.

Subtype 4: Eyes (Ocular rosacea)

Symptoms of rosacea in the eyes:

  • Watery or bloodshot eyes
  • Eyes may burn, sting, itch, or feel very dry and gritty
  • Sensitivity to light
  • Blurry vision 
  • Visible broken blood vessels on eyelids
  • Cyst on the eyelid; stye in the eye
  • Decrease in ability to see

Diagnosis

How is rosacea diagnosed?

An accurate diagnosis is important because rosacea is often mistaken for ache, other skin problems, or a naturally ruddy complexion. There is no test to diagnose rosacea. Diagnosis requires at least one diagnostic sign or two major signs of rosacea (see Symptoms listed above). The secondary symptoms are not used to diagnose it.

Having either of these diagnostic signs indicates rosacea: Persistent facial redness and/or thickening skin, especially on the nose. 

The dermatologist will examine your skin and ask about your symptom history. You may have tests to rule out other conditions such as lupus or psoriasis. In people of color, rosacea is often misdiagnosed as an allergic reaction or seborrheic dermatitis. If your eyes are involved, you may be referred to an ophthalmologist (eye specialist).

Treatment

What are the treatment options for rosacea?

Treatment is important because, without it, flare-ups will continue, vision can be damaged and rosacea will get worse. 

Rosacea’s symptoms vary from patient to patient, and treatment plans must be tailored to each patient’s needs. Patient surveys revealed that medical treatment of rosacea improved emotional and social well-being for more than 70% of patients. 

Treatments may include:

Medications, both oral and topical (applied to skin), are often successful in reducing symptoms for many patients. Medications can target specific symptoms and may be used to both relieve immediate symptoms and maintain long-term remission. 

  • Mild to moderate rosacea flushing can be helped with a topical cream or gel that constricts blood vessels. Improvement can be seen in a few hours but it is temporary. The medication must be applied regularly to prevent flushing. 
  • Mild rosacea pimples can be helped with several topical medications that take several weeks to show improvement.  
  • Moderate to severe rosacea’s bumps and pimples may be treated with an oral antibiotic.
  • Severe rosacea that doesn’t respond to initial therapies may be treated with a powerful oral acne drug. It also helps clear rosacea’s lesions.

Lasers and pulsed-light sources can remove (or make less noticeable) visible blood vessels and correct disfigurement of the nose. Side effects of laser therapy include swelling and bruising that can last for several days. Applying ice packs to the area can help with recovery.

Home-care treatments can help. Adopt a gentle skin-care routine that’s approved by your dermatologist for your specific type of rosacea. Always use a mild, non-abrasive cleanser; rinse with lukewarm water, never hot; blot your face dry without rubbing. Moisturize liberally and use a UVA/UVB sunscreen every day, even in winter and on cloudy days. Use non-chemical sunscreens that contain zinc or titanium dioxide. Stop using any skin care product that stings, burns or makes 

Avoid lifestyle and environmental triggers to help keep your flare-ups at a minimum and maintain remission. You’ll need to track what causes your rosacea symptoms because every patient has different triggers. Keeping a diary of your daily activities and when you have flare-ups. 

References

National Rosacea Society (n.d.) All About Rosacea. Retrieved 9-29-21, {https://www.rosacea.org/patients/all-about-rosacea}
Mayo Clinic (Sept. 2021) Rosacea. Retrieved 9-29-21, {https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353815}
Mayo Clinic (Sept. 2021) Rosacea: Diagnosis and Treatment. Retrieved 9-29-21, {https://www.mayoclinic.org/diseases-conditions/rosacea/diagnosis-treatment/drc-20353820}
American Academy of Dermatology Association. (n.d.). Rosacea: Who Gets and Causes. Retrieved 9-29-21,({https://www.aad.org/public/diseases/rosacea/what-is/causes}
American Academy of Dermatology Association. (n.d.). Rosacea: Signs and Symptoms. Retrieved 9-29-21, {https://www.aad.org/public/diseases/rosacea/what-is/symptoms}
American Academy of Dermatology Association. (n.d.). People With Skin of Color Can Get Rosacea. Retrieved 9-29-21, {https://www.aad.org/public/diseases/rasacea/what-is/skin-color}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

Meet our doctors

TM2U Curve inverted

Affordable –
with or without insurance

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up