What is rosacea?

Rosacea is a skin condition that affects the face. It is not contagious, but it is very common: in the United Kingdom, for example, about one in 10 adults are affected,[1] and according to recent statistics, over 16 million Americans are affected.[2]

Rosacea is not a type of acne, and the term “acne rosacea” is misleading. However, acne and rosacea may occur together. Unlike acne, rosacea is more common among older people, particularly those aged between 40 and 60 years of age.[3] It is somewhat more common among women than men, but tends to be more severe in men.[4] Also unlike acne, rosacea does not cause scarring.[3]

Rosacea usually affects the skin of the face, particularly the nose, cheeks and forehead.[1] More rarely, it can affect the skin of the neck, chest and ears. Rarely, rosacea can affect the eye. Rosacea is not always itchy or painful, but may cause a stinging or burning sensation. It can also be unsightly, and distressing to those affected by it.[1]

Its most prominent symptoms are facial redness and flushing. A rare effect of rosacea is rhinophyma, a thickening of the skin on and around the nose that leads to a characteristic red and bumpy appearance.[1] This is usually found in older male sufferers.

Types of rosacea

There are several subtypes of rosacea:[5][6]

  • Erythromatotelangiectactic, characterized by skin redness and visible small blood vessels.
  • Papulopustular, characterized by papules (small pimples) and pustules (small pimples containing pus).
  • Phymatous (both mild and severe subtypes), marked by thickened skin.
  • Ocular, affecting the eyes.

Treatment depends on which sort of rosacea is present. People suspected of having rosacea, particularly those who suffer from ocular rosacea or from symptoms that are resistant to treatment, should generally be treated by a specialist such as a dermatologist or ophthalmologist.

Symptoms of rosacea

Because rosacea is common, most competent medical practitioners will be able to diagnose it based on the patient’s history and the appearance of their skin. In some cases, doctors may recommend that blood tests are done, in order to rule out other conditions that cause skin redness, such as systemic lupus erythematosus.[1]

The symptoms of rosacea are distinctive. They include:[1][3][4]

  • A tendency to blush or flush easily, leading to transient redness, also known as erythema
  • Dilated and visible blood vessels under the surface of the skin, known as telangiectasia
  • Red bumps, known as papules, and pustules, slightly resembling mild acne
  • Thickened skin, known as phymatous changes
  • Eye problems, such as sore eyelids and dry eyes

The symptoms of rosacea tend to begin mildly but worsen with time. People affected will first notice an increased tendency to blush or flush, with skin redness taking longer and longer to fade. Over time, the redness will become permanent. The intensity of facial flushing can be affected by emotion, hydration, chemicals and stress.[7]

In some cases of rosacea, small blood vessels under the skin become more prominent. Itching is sometimes present, and redness is often accompanied by a burning sensation. Affected people may find that their skin is hot to the touch during a flushing episode.

Symptoms of ocular rosacea

Ocular rosacea is a complication of the condition. Symptoms include:[3][5][8]

  • Itchy, burning or stinging eyes.
  • Dry, scratchy eyes.
  • A feeling of grit or a foreign body in the eye.
  • Photosensitivity (sensitivity to light).
  • Inflammation of the eyelid (blepharitis), styes, or cysts.
  • Chalazions, which are small, usually painless lumps on the eyelid, caused by blocked oil or meibomian glands. (Not to be confused with styes, which result from infection. Styes are painful and tend to occur near the eyelashes.)

Inflammation of the cornea (the transparent front covering of the eye) is rare but serious, and can affect vision. If corneal inflammation, also known as rosacea keratitis, occurs, seek medical help as soon as possible.[3]

Causes of rosacea

The exact cause of rosacea has not yet been established. It is possible that it is an autoimmune response, a reaction to high skin pH, a response to undiagnosed food sensitivity, or the result of a high number of demodex folliculorum mites on the face.[1][7] There may also be a genetic component.

According to present knowledge, there is no way to prevent rosacea from beginning and there is currently no way to entirely eliminate the condition.[1]

There is some evidence that rosacea’s facial flushing is caused by the body’s sympathetic nervous system becoming stimulated.[7] The sympathetic nervous system is the part of the nervous system that is involved in activating the fight or flight response. It is activated by strong emotion or physical stress.

Research has shown that rosacea can be triggered by various physical and environmental factors such as weather conditions, exercise, cosmetics, or certain foods. Many people with rosacea find it helpful to keep a diary of their outbreaks in order to narrow down what their particular triggers are.

Some common triggers are:[1][7][9]

  • Emotional stress
  • Strenuous exercise
  • Exposure to strong sunlight
  • Hot weather
  • Cold weather
  • Wind
  • High humidity
  • Hot baths/showers
  • Exfoliant, abrasive or astringent facial products
  • Makeup containing oils
  • Perfumed sunblocks
  • Sunblock or skin preparations containing insect repellents
  • Consumption of alcohol
  • Very sugary foods
  • Spicy foods, such as those containing chili
  • Smoking
  • Calcium-channel blockers, also known as calcium antagonists, such as dihydropyridine

Not all rosacea sufferers are vulnerable to all of these triggers.

Many of these triggers, such as exercise, alcohol and calcium antagonists, cause the dilation of the blood vessels (vasodilation), which increases blood flow. Increased blood flow to the skin causes a distinctive appearance of redness. Some of these triggers, for example exposure to sunlight, wind, smoking and cold weather, cause inflammation of the skin, which also causes redness.

  1. “Rosacea”. 4 June 2015. Accessed 27 March 2018.

  2. National Rosacea Society. “If you have rosacea, you are not alone”. Accessed 29 March 2018.

  3. British Association for Dermatologists. “Rosacea”. December 2014. Accessed 27 March 2018.

  4. British Skin Foundation. “Rosacea”. Accessed 27 March 2018.

  5. BMJ Best Practice. “Rosacea”. February 2018. Accessed 28 March 2018.

  6. MD Edge Cutis. “Standard Management Options for Rosacea, Part 2: Options According to Subtype”. August 2008. Accessed 29 March 2018.

  7. International Rosacea Foundation. “Rosacea Symptoms”. Accessed 29 March 2018.

  8. “Blepharitis”. December 2014. Accessed 29 March 2018.

  9. National Rosacea Society. “What to do now”. Accessed 29 March 2018.