Rosacea

Overview

What is rosacea?

Rosacea is a common disorder that most usually affects facial skin. It causes redness on the nose, chin, cheeks and forehead. Over time, the redness may become more intense, taking on a ruddy appearance. Small blood vessels may become visible.

In some cases, rosacea can appear on the chest, ears, neck or scalp. If rosacea is not treated, red solid bumps and pus-filled pimples can develop. The disorder can cause the nose to take on a bulbous, swollen appearance called rhinophyma. Rosacea can affect the eyes, causing them to feel irritated and to appear bloodshot or watery. Styes may occur. This is called ocular rosacea.

Rosacea affects an estimated 14 million Americans. Most of them do not know they have this condition.

Who is likely to get rosacea?

People who have fair skin and who tend to blush easily might be at a higher risk for the disorder. Adults over the age of 30 are more likely to be affected, although rosacea occasionally occurs in adolescents and rarely in children. A family history of rosacea increases the likelihood of the disorder.

Rosacea appears more often among women, but men tend to have the more severe symptoms. A possible reason for this could be that men delay medical treatment until rosacea becomes advanced.

Symptoms and Causes

What causes rosacea?

The cause of rosacea is unknown; however, different theories exist regarding the cause. One theory is that rosacea might be a component of a more generalized disorder of the blood vessels. Other theories suggest that the condition is caused by microscopic skin mites, fungus, psychological factors or a malfunction of the connective tissue under the skin. Although no one knows for sure what causes rosacea, some circumstances and conditions can trigger it.

What are the signs and symptoms of rosacea?

Rosacea's appearance can vary greatly from one individual to another. Most of the time, not all of the potential signs and symptoms appear. Rosacea always includes at least one of the primary signs listed below. Various secondary signs and symptoms might also develop.

Primary signs of rosacea include:

  • Flushing: Many people who have rosacea have a history of frequent blushing or flushing. The facial redness, which might come and go, often is the earliest sign of the disorder.
  • Persistent redness: Persistent facial redness might resemble a blush or sunburn that does not go away.
  • Bumps and pimples: Small red solid bumps or pus-filled pimples often develop. Sometimes the bumps might resemble acne, but blackheads are absent. Burning or stinging might be present.
  • Visible blood vessels: Small blood vessels become visible on the skin of many people who have rosacea.

Other potential signs and symptoms of rosacea include:

  • Eye irritation: The eyes might be irritated, and appear watery or bloodshot in some people with rosacea. This condition, called ocular rosacea, can also involve styes as well as redness and swelling of the eyelids. Severe cases, if left untreated, can result in corneal damage and vision loss.
  • Burning or stinging: Burning or stinging sensations might occur on the face, and itchiness or a feeling of tightness might also develop.
  • Dry appearance: The central facial skin might be rough, and thus appear to be very dry.
  • Plaques: Raised red patches (plaques) might develop without changes in the surrounding skin.
  • Skin thickening: In some cases of rosacea, the skin might thicken and enlarge from excess tissue, resulting in a condition called rhinophyma. This condition often occurs on the nose, causing it to have a bulbous appearance.
  • Swelling: Facial swelling (edema) can occur independently or can accompany other signs of rosacea.
  • Signs beyond the face: Signs and symptoms might develop beyond the face, affecting areas including the neck, chest, scalp or ears.

Diagnosis and Tests

How is rosacea diagnosed?

Your doctor will conduct a thorough exam of your signs and symptoms, and will take a medical history. During your exam, you should tell your doctor about any problems you are having with your face (redness, bumps or pimples, burning, itching, etc.). There is no specific test to diagnose rosacea.

Management and Treatment

How is rosacea treated?

Treatment methods vary because the signs and symptoms of rosacea vary from person to person. The following are some treatments used for rosacea:

  • Medicines: Sometimes, doctors prescribe oral and topical medicines to treat the disorder's associated bumps, pimples and redness. Medicines can bring the condition under control and then maintain its state of remission.
  • Surgical procedures: Doctors can use lasers to remove visible blood vessels, limit the amount of extensive redness on the face, or correct nose disfigurement in some cases.

How do I cover rosacea with makeup?

Over-the-counter products can help cover rosacea. However, depending on the type of rosacea you have — and there are many — you may benefit from prescription medication or laser therapy. For example:

  • If you’re dealing primarily with a pink tint to your skin, then green-based, tinted moisturizer, which is available over the counter, can help minimize the redness.
  • If your skin redness is extensive, we can use the vascular laser to collapse the tiny blood vessels responsible for both the redness and the flushing that accompany rosacea.
  • If you’re dealing with skin redness accompanied by small, pimple-like lesions that flare with changes in the environment, spicy foods, hot beverages, etc., then you’ve got the papulopustular type of rosacea. For this type, the usual remedy is a topical antibacterial cream plus an oral antibiotic (similar to minocycline) to fight the underlying inflammation.

Everyone with rosacea should also apply sunscreen every day, because UV light aggravates this skin condition.

Prevention

Can you prevent rosacea?

As the cause of rosacea is not known, the condition cannot be prevented. However, rosacea sufferers can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors that aggravate individual conditions or trigger rosacea flare-ups. Some triggers include:

Outlook / Prognosis

Is there a cure for rosacea?

While there is no cure for rosacea and the cause is unknown, medical therapy is available to control or reverse its signs and symptoms. If you suspect that you might have rosacea, meet with your doctor.

Last reviewed by a Cleveland Clinic medical professional on 10/10/2019.

References

  • Habif TP. Acne, rosacea, and related disorders. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 7.
  • Lucas, JL, Tomecki KJ. Acne and rosacea. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010:section 3.
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. What is rosacea Accessed 8/10/2020.
  • · Abram, K. , Silm, H. , Maaroos, H. and Oona, M. (2010), Risk factors associated with rosacea. Journal of the European Academy of Dermatology and Venereology, 24: 565-571. doi:10.1111/j.1468-3083.2009.03472.x

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