Rosacea

What is rosacea?

Rosacea is an ongoing (chronic) skin condition that causes redness, pimples, and broken blood vessels. In severe cases it causes a misshapen nose. It most often affects the face and eyes. In some cases, it can also affect the neck, chest, or other areas of skin. Redness may become long-term (permanent) as the small blood vessels of the face widen (dilate). There may be small, red, pus-filled bumps (pustules).

It can look like adult acne. But it's not caused by the same things that cause acne.

Rosacea has flare-ups that come and go. This may happen every few weeks or every few months. If not treated, it tends to get worse over time. It may also be made worse by:

  • Sun
  • Heat
  • Spicy foods
  • Drinking alcohol
  • Blushing
  • Exercise
  • Stress, especially anger or embarrassment
  • Hot drinks
  • Irritation from skin products
  • Certain medicines

What causes rosacea?

Health experts don’t know what causes rosacea. Certain things may make it more likely. They include:

  • Family history of rosacea
  • Skin reaction to mites in the hair follicles or bacteria in the skin
  • Abnormal response by your immune system
  • Disorder of the blood vessels that increases blood flow in the skin of the face
  • Some medicines

Who is at risk for rosacea?

You are more at risk if you are:

  • Between ages 30 and 60
  • Of Celtic or Scandinavian background
  • Fair-skinned
  • A person in menopause
  • Someone who blushes easily

What are the symptoms of rosacea?

Rosacea symptoms may vary from person to person. They often begin with easy blushing and flushing of the facial skin. Then redness will last around the nose area. Over time, the red area spreads to the rest of the face.

These are the main symptoms:

  • Flushing. Flushing (or blushing) happens often and lasts a while. Areas affected are the cheeks, chin, forehead, nose, and neck. The flushing can come and go. It's made worse by triggers.
  • Long-term (chronic) redness. Redness of the face that won’t go away is the most common sign of rosacea. It looks like a sunburn.
  • Blood vessels you can see. The enlarged blood vessels (telangiectasias) appear under the facial skin, especially on the cheeks. The blood vessels may form a web-like pattern. This type is common in people assigned female at birth.
  • Skin bumps (papules and pustules). These are hard, red bumps or softer, liquid-filled pimples. They may look like acne. They tend to occur above the nose, on the cheeks, and on the chin. The bumps may come and go.
  • Thickened skin (phymatous rosacea). The skin thickens or creates extra skin tissue. It most often affects the nose, causing it to be enlarged and bulbous (rhinophyma). It can also occur on forehead, chin, and cheeks. This happens more often in people assigned male at birth.
  • Eye irritation. Rosacea also often affects the eyes and eyelids. Eye symptoms may include redness, burning, tearing, inflamed eyelids, and feeling like you have grit or sand in your eye. Symptoms may get worse or get better from day to day.

Other symptoms may occur. These can include:

  • Burning or stinging. Your face can feel like it is burning or stinging. Itching can also occur. But it's not common.
  • Swelling (edema). Your face may have swelling along with other symptoms of rosacea.
  • Dry skin. The skin in the center of your face may be dry, rough, and scaly.

The symptoms of rosacea can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is rosacea diagnosed?

Your healthcare provider will ask about your symptoms and health history. They may also ask about your family’s health history. They will give you a physical exam. This exam will include looking closely at your skin and eyes. There are no tests that can confirm a diagnosis of rosacea. But sometimes testing is done. This is to make sure you don't have another skin condition that may look similar.

How is rosacea treated?

There's no cure for rosacea, but treatment can help ease symptoms. Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. Treatment may include:

  • Changes in what you eat and drink, such as not having caffeine, spicy foods, or alcohol
  • Antibiotic medicine that you take by mouth (oral) or put on your skin (topical)
  • Prescription creams, washes, or lotions. Creams containing metronidazole, azelaic acid, sodium sulfacetamide, and ivermectin are commonly used. Newer creams, such as brimonidine and oxymetazoline, decrease redness by temporarily constricting blood vessels.
  • Glycolic acid peels
  • Prescription eye drops
  • Laser therapy or electrosurgery to shrink blood vessels
  • Surgery or scraping (dermabrasion) to treat scarring of the nose

Rosacea symptoms often get better with medicines. But they tend to get worse again if you stop taking the medicines. If your symptoms continue or get worse, ask about other treatment options. This includes combinations of treatments. Don’t use over-the-counter treatments unless told to by your healthcare provider. Some of these may make rosacea worse.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of rosacea?

Some people assigned male at birth who have a more severe form of rosacea develop a condition called rhinophyma. The oil glands on the skin of the nose become blocked. The nose gets bigger and can become large, bulbous, and red. The cheeks also become puffy. Alcohol may increase the flushing. But this condition is not caused by alcohol use. Ocular rosacea can cause eye problems such as corneal sores.

Can rosacea be prevented?

Researchers don’t know how to prevent rosacea other than staying away from things that trigger it.

How to manage rosacea

Rosacea is a chronic condition. But you can manage it with self-care.

Learn what your triggers are, such as:

  • Hot drinks
  • Spicy foods
  • Caffeine
  • Alcohol
  • Exercise
  • Stress
  • Sun
  • Extreme hot or cold weather

To manage your symptoms:

  • Stay away from things that trigger them.
  • Take your medicines as prescribed.
  • Wash your face twice a day with a gentle facial cleanser. Rinse your skin well with warm (not hot) water. Pat your skin dry with a cotton towel.
  • Don’t use sponges, brushes, loofahs, or other harsh tools.
  • Don’t use scrubs or astringents.
  • If you shave your face, use an electric razor.
  • Apply sunscreen with SPF 15 or more every day. Sun can make rosacea symptoms worse.
  • Choose skin care and cosmetics that don’t irritate the skin and are oil-free and fragrance-free.
  • Don’t put steroid cream on the skin sores. Steroid medicine may make rosacea worse.

When should I call my healthcare provider?

Call the healthcare provider if you have:

  • Symptoms that don’t get better with medicine, or that get worse
  • Redness, burning, or a gritty feeling in your eyes
  • Other new symptoms

Key points about rosacea

  • Rosacea is an ongoing (chronic) skin condition that causes redness, pimples, and broken blood vessels.
  • It most often affects the face and eyes. In some cases, it can also affect the neck, chest, or other areas of skin.
  • Rosacea has flare-ups that come and go. This may happen every few weeks or every few months. If not treated, it tends to get worse over time.
  • It may also be made worse by heat, spicy foods, alcohol, and other triggers.
  • There's no cure for rosacea, but treatment can help lessen symptoms.
  • You can manage it with self-care. Learn what your triggers are. Take steps to treat your skin gently.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.