Rosacea

What is rosacea

Rosacea is a chronic, inflammatory skin condition that causes redness over the areas of the face, chin and nose.

Rosacea causes the small blood vessels in the affected areas of the face (and sometimes the eyes) to become larger and show up through the skin, appearing as tiny little red lines all over the face which can become quite prominent over time.

In addition to the blood vessel visibility, small pimples can also occur in the affected area of the face (and eyes). While rosacea can cause pimples, it is not an acne condition because it does not cause any blackheads or whiteheads to form and the pimples are of a different type to those in acne.

Facts about rosacea

• Rosacea affects women more than men
• Rosacea is a common, yet chronic skin disorder
• People with rosacea can look as though they are constantly blushing
• Rosacea is also known as acne rosacea, which can be misleading, as rosacea is not a type of acne
• Up to 50% of people who have rosacea of the face also have rosacea of the eyes
• Identifying individual triggers of rosacea can help with avoiding them and so avoiding flare-ups of symptoms
• Triggers that flare up symptoms of rosacea may be different in each person
• Always try to use sunscreen whenever outside
• Always use skin care products for sensitive skin, that do not contain any harsh ingredients, in order not to irritate the skin and make symptoms worse
• Minimise stress and stressful triggers to avoid aggravating symptoms
• Always use a good moisturiser in winter
• Protect your facial skin from the cold and wind in winter when outside
• Never rub, pull or drag the skin on the face, always be gentle especially when washing it or applying skin care products
• Try to limit stress as much as possible, as that is a certain trigger for rosacea for many people

Symptoms of rosacea

The symptoms of rosacea normally start off quite mild and if not treated, can produce quite pronounced symptoms on the face:

• Burning, itching or stinging sensation of the affected areas
• Redness and appearance of “blushing” or “flushing” of the skin – these area are warmer than other parts of the face
• Skin becomes thicker
• Small, red, lumpy pimples, which can become large nodules if left untreated
• Tiny red veins on the face, chin and nose

Further symptoms

If the rosacea does not settle down and get better, then it can cause further symptoms such as:

• Conjunctivitis of the eyes
• Dry, red and irritated eyes (rosacea can cause serious eye problems if not treated
• Nose that becomes enlarged, red/purple and bumpy (especially in men)
• Swelling of the face, especially the affected areas

Causes of rosacea

The exact cause of rosacea is not known, but scientists believe it could be due to a combination of genetic and environmental factors. The following are the possible causes of rosacea.

Alcoholism

People who drink a lot of alcohol will experience a reddening of the face (flushing) and an enlargement of the blood vessels in their face from this. If the blood vessels continue to enlarge often enough the effect of the reddened face and flushing symptoms can be permanent and result in rosacea.

Gastrointestinal disorders

A factor that may cause rosacea in some people is low gastric acid output (common to many gastrointestinal disorders), which can prevent appropriate digestion and this can cause rosacea symptoms.

Genetics

Some experts believe that rosacea may have a genetic component, so people who have parents and other close relatives with rosacea, they are more likely to develop this condition as well.

Local infection

An uncommon cause of rosacea is a local infection on the face which may cause an enlargement of the blood vessels and may initiate rosacea symptoms beyond the infection.

Menopausal flushing

Women who are menopausal have a much higher incidence of rosacea due to the hormonal changes which occur at this time especially due to the hot flushes that many women experience during this time.

Severe seborrhoea

Experts believe that most people with severe rosacea have moderate to severe seborrhoea, where there is an excessive flow of sebum in the face, which causes the symptoms associated with rosacea.

Vitamin B deficiency

A severe lack of the B vitamins is associated with abnormal sebum production (it becomes excessive and causes seborrhoea) which can cause rosacea symptoms.

Prevention of rosacea

Non-preventable risk factors

Rosacea may be unpreventable in certain circumstances:

• Age – an unpreventable factor of developing rosacea is age. People who are between 30-50 are the ones who mostly develop rosacea
• Being fair skinned – people who are fair skinned are also much more likely to develop rosacea than people with darker skin
• Blushing – some people’s faces just blush a lot more, which means their blood vessels are constantly expanding and for this reason, they become more likely to develop rosacea and it is not easily preventable
• Female – there are about three females to every one male that are diagnosed with rosacea, so this risk factor is not one which is preventable
• Genetics – if other immediate family members (parents, grandparents or siblings) have rosacea then the likelihood of getting it are increased as this shows a genetic predisposition to this condition which is not preventable in this instance

Preventable risk factors

There are ways to prevent rosacea from occurring:

• Alcohol – people who drink a lot of alcohol will have reddening or flushing of the face as the alcohol moves through the bloodstream and warms up the body and enlarges the blood vessels. To prevent rosacea from this cause, drink less alcohol
• Cold, blustering winds – always cover your face when you are outside in cold, blustering windy days, as the cold winds will cause flushing and reddening of the face (by enlarging the blood vessels) and the best way to prevent this is to keep the face well covered or stay inside in this type of weather
• Exposure to strong sunlight – people who have a higher likelihood to developing rosacea should stay inside (or keep their face protected with a wide-brimmed hat) when it is really hot outside, as the strong sunlight will cause further reddening of the skin and worsening of symptoms
• Spicy foods – extremely hot, spicy foods can cause extremely flushing of the face (and enlarging the blood vessels), especially if you are not used to eating these types of foods. The heat in the spicy foods warms up the body too quickly and causes flushing and reddening in the face. To avoid this effect, do not eat highly spiced, hot foods
• Stress and strong emotions – stress and strong emotions can cause reddening and flushing of the face through the enlargement of the blood vessels, so in order to prevent this cause of rosacea, try to calm down by taking a deep breath and another, until the stress and negative emotions have subsided

Complications of rosacea

Complications of rosacea are not common, but do occur, especially if it is untreated and severe:

• Conjunctivitis – if the rosacea reaches the eye, it can become red and inflamed and cause conjunctivitis, a condition where the membrane of the surface covering the eyeball can become inflamed too, from the irritation of rosacea. A severe form of conjunctivitis caused by rosacea is known as rosacea keratitis, which may cause enough inflammation in the eye to impair vision
• Psychological damage – the reddened skin and other physical symptoms of rosacea can be difficult to disguise and people with this condition can develop psychological damage due to the perception of their facial disfigurement from the rosacea. This can especially occur in people who have severe symptoms or for people whose symptoms occur over a long period
• Rhinophyma – this condition occurs when the rosacea remains untreated and is characterised by enlarged, red and bulbous nose and the cheeks may become puffy. Rhinophyma can also cause thick bumps to appear on the lower portion of the nose (the end of the nose) and the cheeks may be similarly affected with bumps and lumps. The symptoms of this complication of rosacea is often permanent in people and is not easily treated other than with surgery

When to see a doctor about rosacea

People who have any of the symptoms of rosacea need to make an appointment to see their doctor who can diagnose this condition (or rule it out) and prescribe appropriate treatment to relieve symptoms.

People who have been diagnosed with rosacea need to see their doctor if:

• Their symptoms suddenly get worse and none of the medications or other strategies to alleviate symptoms are effective
• They experience different symptoms to the ones they normally experience

Diagnosis of rosacea

Initial diagnosis of rosacea is done through the following tests:

• Medical history of symptoms – the doctor will ask a series of questions about your symptoms (especially the duration and severity), your family medical history (if anyone else has similar symptoms), onset of symptoms and location of symptoms
• Physical examination – the doctor will examine various the parts of the face that are affected by the rosacea to determine if the condition is caused by rosacea

Ruling out other conditions

The doctor will also need to rule out other conditions that mimic the symptoms of rosacea (acne, side effects to medications, lupus, skin inflammation from other conditions). This is especially necessary if the symptoms of rosacea presented are ambiguous and difficult to diagnose quickly.

Conventional treatment of rosacea

The conventional treatment for rosacea depends on the part of the face (or eye) affected and how severely they are affected.

Skin symptoms

Various treatment methods are advised depending on the symptom type and severity:

• Antibiotics – these help reduce the skin bumps and pimples, but they do not seem to have any effect on the redness or flushing
• Laser surgery – this surgery can greatly improve the skin be reducing the little red lines on the face and is usually recommended for more serious rosacea symptoms
• Retinoid face creams – these contain a type of vitamin A derivative which help the symptoms of rosacea when other treatments have failed and must be prescribed and monitored by a doctor as they can cause severe side effects
• Skin creams – specially medicated skin creams are prescribed by a doctor to reduce bumps, redness and other symptoms
• Surgery – if the bumpiness on the nose becomes too unsightly, surgery can be performed to remove some of the bumps to make it look more like it was before rosacea. This is a last resort and only recommended for very severe types of rosacea

Eye symptoms

Various treatment methods are advised depending on the symptom type and severity:

• Antibiotics – these medication normally clear up eye symptoms very quickly
• Cleaning the eyes – doctors recommend cleaning the eyes often with a saline (tepid water with fine rock salt) to help reduce symptoms
• Eye drops – medicated eye drops are normally prescribed by the doctor to help clear up the eye symptoms. The eye drops contain steroid drugs which are the active ingredient that help reduce symptoms

Alternative / complementary treatment of rosacea

There are a number of alternative / complementary treatment strategies which can be used for mild to moderate rosacea and as a first step for treatment before trying medication.

People taking any type of medication for rosacea (or any other health condition) need to check with their doctor that these alternative / complementary treatment strategies are safe to try.

Herbs

There are no herbs recommended to treat the symptoms of rosacea.

Vitamins

Certain vitamins may assist with reducing symptoms of rosacea:

• Betacarotene – the precursor to vitamin A, the antioxidant vitamin betacarotene also has the same properties to ensure skin is healthy
• Bioflavonoids – the bioflavonoids work together with vitamin C to ensure blood vessels are healthy and strong and may reduce symptoms associated with rosacea
• Vitamin A – various studies show that the potent antioxidant vitamin A works to keep the skin and dermal layers healthy and may stop rosacea symptoms from getting worse or actually even prevent aggravation of symptoms in the first place
• Vitamin B3 – studies show vitamin B3 (niacin), together with zinc may play an important role in helping to reduce symptoms as much as just using antibiotics alone
• Vitamin C – studies show that the potent antioxidant vitamin C keeps all the blood vessels smooth and elastic and ensuring they work properly, which may reduce symptoms associated with rosacea
• Vitamin E – the antioxidant vitamin E helps prevent free radical damage and promote healthy skin, with many studies showing that it reduces skin inflammation and this may help to reduce rosacea symptoms

Minerals

Certain minerals help to reduce duration and severity of symptoms:

• Zinc – many studies show that the antioxidant mineral zinc, either alone or together with vitamin B3 (niacin), may play an important role in helping to reduce symptoms of rosacea as much as just using antibiotics alone

Other nutrients

Certain other nutrients may help with reducing severity and duration of symptoms:

• Digestive enzymes – the digestive enzymes pancreatin and lipase may be useful in helping an improperly functioning digestive system to work better. Studies have shown that people supplemented with these digestive enzymes have a decrease in symptoms
• Hydrochloric acid – if low stomach acid is an underlying problem, it may be beneficial to use hydrochloric acid to increase stomach acidity and help digest foods properly
• Omega 3 fatty acids – the omega-3 fatty acids help stop inflammation in any part of the body and could be useful for helping reduce the inflammation associated with rosacea symptoms

Dietary modifications

These include avoiding all the foods that trigger the rosacea:

• Avoid alcohol – while it may not directly be responsible for causing the rosacea, drinking lots of alcohol certainly makes symptoms much worse
• Drink enough water – it is important to drink an adequate supply of water, as it is vital to hydrate the skin and allow skin to be healthy
• Limit caffeine – while it may not cause rosacea, high caffeine intake makes symptoms much worse
• Limit hot, spicy foods – these foods tend to make symptoms worse, especially flushing of the face and should be strictly limited, especially when symptoms are flaring up

Lifestyle modifications

These can help reduce severity and duration of symptoms:

• Protect the skin in the sun – always use sun protection when going outside; makes sure to wear a hat, sunglasses and use natural, preferably organic sunscreen as it is less likely to irritate the facial skin more
• Relaxation strategies – learn to really relax to help reduce exacerbation of symptoms. Some good relaxation strategies include: meditation, tai chi, yoga
• Stop smoking – people who smoke need to stop, not only is it harmful to the lungs, but it also harms the skin and makes rosacea symptoms worse. It is also important not to be exposed to other people’s second hand smoke

Alternative treatments

There are no other alternative treatment recommended for rosacea.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with rosacea

There are a number of strategies which are recommended to help deal with rosacea:

• Avoid alcohol – any type of alcohol intake will cause the face to flush and become red, which means it will only exacerbate symptoms. This means you need to avoid drinking any alcohol when you have rosacea, especially when symptoms are at their worst
• Don’t smoke or be exposed to smoke – cigarette smoke can exacerbate symptoms of rosacea in some people, so make sure you limit your smoking habit, or better still, give it up, when rosacea symptoms are at their worst. Also, do not be exposed to other people’s second hand smoke as it will have the same debilitating effect
• Drink enough water – an adequate intake of water is necessary to keep the face and body well hydrated and prevent dehydration which can cause an increase in sebum and worsening of symptoms
• Limit caffeine – it may also be necessary to limit caffeine intake, because caffeine has a diuretic effect on the body and can exacerbate symptoms in some people. This means coffee, tea, chocolate and energy drinks needs to be strictly limited to avoid worsening of symptoms
• Limit intake of hot, spicy foods – any type of hot (heat or spice) and spicy foods can make the skin flush and become red, enlarging the blood vessels and cause a worsening of symptoms, so avoid them as much as possible. Eat your food when it is slightly cooled and order the very mild curries, but try to limit your intake
• Relaxation strategies – it is useful to try to find some sort of strategies to help you relax and reduce stress and tension in your life, because stress can aggravate symptoms of rosacea. Some useful relaxation strategies include: meditation, tai chi and yoga
• Supplements – if the rosacea is mild and you are not taking any other medications, ask your doctor about using supplements to help your skin heal. The best ones to use for rosacea are: vitamin A, vitamin C and vitamin E (for the skin in general), all the B vitamins, especially vitamin B3 (niacin) (for the immune system), zinc (for healing the skin) as well as the omega-3 fatty acids
• Use sun protection – whenever you go outside, always wear a wide brimmed hat, use sunglasses that wrap around your face and wear a natural sunscreen on the face. The best sunscreens to use are those which are organic and have no chemicals that may irritate the skin further

Caring for someone with rosacea

Partner

There are a number of useful strategies that you can use to help a partner with rosacea:

• Avoid alcohol – it’s beneficial for your partner not to drink any alcohol as it will aggravate their symptoms, so try to limit your alcohol intake with your partner
• Don’t smoke around your partner – it is really important for your partner’s well being if they are not exposed to your second-hand cigarette smoke, either at home or in the car because it can exacerbate their symptoms

Family

There are a number of useful strategies that you can use to help a family member with rosacea:

• Avoid alcohol – it’s beneficial for your family member not to drink any alcohol as it will aggravate their symptoms, so try to limit your alcohol intake with your partner
• Don’t smoke around your family member – it is really important for your family member’s well being if they are not exposed to your second-hand cigarette smoke because it can exacerbate their symptoms

Friends

There are a number of useful strategies that you can use to help a friend with rosacea:

• Avoid alcohol – it’s beneficial for your friend not to drink any alcohol as it will aggravate their symptoms, so try to organise meetings with your friend that do not involve alcohol
• Don’t smoke around your friend – it is really important for your friend’s well being if they are not exposed to your second-hand cigarette smoke because it can exacerbate their symptoms

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Last reviewed and updated: 14 May 2024