Last updated: April 2024
What is rosacea?
Rosacea is a common, chronic skin disorder affecting the central face. It is an episodic and variable condition but classically presents as acne-like bumps (papules and pustules), red or pink patches and broken capillaries.
Who gets rosacea?
It is estimated that rosacea affects around 5% of adults globally. 1
Rosacea is more common in women and typically presents between the ages of 30 to 50. The condition commonly affects individuals with fair skin and blue eyes who are of Celtic or English ancestry.
What causes rosacea?
The exact cause of rosacea is unknown. There could be a combination of factors involved including hereditary (genetic), environmental, vascular and inflammatory factors as well as reaction to the demodex mite (microscopic mite that lives on human skin, commonly called ‘eyelash mite’).
Several factors can trigger or aggravate rosacea by dilating blood vessels and therefore increasing blood flow to the surface of the skin, and may include:
- Hot food or beverages
- Spicy foods
- Alcohol
- Temperature extremes
- Sunlight
- Stress, anger or embarrassment
- Strenuous exercise
- Hot baths or saunas
- Oral and topical corticosteroids
- Drugs that dilate blood vessels such as blood pressure medications
- Inappropriate use of skin care products such as facial creams and oils.
What does rosacea look like?
Rosacea usually presents with blushing (facial flushing) which becomes more frequent and eventually leads to persistent facial redness which fluctuates in intensity. Small blood vessels dilate and become visible as telangiectasia (broken blood vessels) and the continual or episodic blushing may promote inflammation, causing red bumps to appear which can resemble teenage acne.
The cheeks, chin and nose are most commonly affected.
There are several types of rosacea which have their own distinctive features, including:
Erythematotelangiectatic rosacea
- Frequent blushing and flushing.
- Temporary or persistent facial redness in the central portion of the face.
- Telangiectasias on the nose, cheeks and chin.
Papulopustular rosacea
- Papules and pustules (swollen bumps) on the face that resemble acne.
- Sensitive skin
Swollen rosacea
- Lymphoedema (hot and swollen facial skin).
- Thickening ‘orange peel’ skin over the nose, cheeks, forehead and chin.
- Rhinophyma (enlarged bulbous nose with dilated pores which in severe cases can result in a deformed nose). Rhinophyma is more common in men.
Ocular rosacea
- Presents with red, sore or gritty eyelid margins or eyes. This can result in inflammation of the eyelids (blepharitis), conjunctivitis and inflammation of the white part of the eye (episcleritis).
- Untreated eye rosacea may result in permanent damage and impaired vision. An ophthalmologist should be seen if eye involvement is suspected.
How is rosacea diagnosed?
In most cases, rosacea is diagnosed based on history and clinical signs such as typical red or blushed facial appearance with associated papules and pustules (bumps) and telangiectasia.
In rare cases, a skin biopsy or blood test may be required to rule out other causes of facial flushing and facial redness such as systemic lupus and dermatomyositis.
How is rosacea treated?
Treatment options will vary depending on the individual and their needs.
General measures:
- Avoid the triggers of flushing.
- Avoid skincare products and make-up that cause stinging, burning or irritation. This may include products that include fragrances, waterproof cosmetics, toners and astringents, menthols and camphors or sodium laurel sulphate.
- Use a gentle cleanser and moisturiser.
- Use oil free topical products (non-comedogenic).
- Avoid applying topical steroid to rosacea.
- Protect your skin from the sun with sunscreen and by covering up with a hat.
- Keep your face cool to reduce flushing.
Treatment options may include:
- Topical treatments, such as topical metronidazole cream or gel, topical azelaic acid, topical erythromycin gel, topical sulphur in Cetaphil lotion, topical clindamycin, and topical tacrolimus 0.1%. Topical brimonidine may also be used to reduce redness.
- Oral treatments, such as oral tetracycline antibiotics (i.e., doxycycline) or other antibiotics (i.e., oral erythromycin) Isotretinoin, alpha 2 receptor agonists (i.e., clonidine) or beta-blockers (i.e., carvedilol) may also be suggested.
- Procedural therapies, such as vascular laser and rhinophyma.
What is the likely outcome of rosacea?
Rosacea tends to be a chronic condition. It can be persistent or it can fluctuate in severity. There can be periods of remission in some individuals but in others, it can progress and slowly worsen.
- Gether L, Overgaard LK, Egeberg A, Thyssen JP. Incidence and prevalence of rosacea: a systematic review and meta-analysis. Br J Dermatol. 2018 Aug;179(2):282-289. doi: 10.1111/bjd.16481. Epub 2018 May 31. PMID: 29478264.
- Hilbring, C., Augustin, M., Kirsten, N. and Mohr, N. (2022), Epidemiology of rosacea in a population-based study of 161,269 German employees. Int J Dermatol, 61: 570-576. https://doi.org/10.1111/ijd.15989
| Dr Antoinette Ciconte | April 2024 |
| Dr Antoinette Ciconte | April 2017 |