What Is Rosacea?

Rosacea is a chronic, inflammatory skin condition that most commonly affects the face. It leads to persistent redness, visible blood vessels, bumps that may resemble acne, and in some cases, thickened skin or eye irritation. The condition often starts as occasional flushing and progresses to more persistent symptoms if untreated.

It typically appears on the cheeks, nose, forehead, and chin, though it can also extend to the neck, chest, scalp, and ears. While not life-threatening, rosacea can have significant impacts on self-esteem and quality of life.

Types of Rosacea

Rosacea is categorized into several clinical subtypes:

  • Erythematotelangiectatic Rosacea (ETR): Characterized by facial redness, flushing, and visible blood vessels, especially on the cheeks and nose.

  • Papulopustular Rosacea: Features red bumps and pus-filled pimples, often mistaken for acne, along with redness and swelling.

  • Phymatous Rosacea: Leads to thickened, bumpy skin, commonly on the nose (rhinophyma), but also on the forehead, chin, and cheeks.

  • Ocular Rosacea: Affects the eyes, causing redness, burning, itching, dryness, and blurred vision.

Some individuals may experience a combination of these types over time.

Common Symptoms

The symptoms of rosacea can vary, but typical signs include:

  • Persistent facial redness or flushing

  • Small, red, pus-filled bumps

  • Visible blood vessels (telangiectasia)

  • Burning or stinging sensations

  • Rough or dry skin patches

  • Swollen eyelids or red eyes

  • Thickened skin on the nose (in phymatous rosacea)

In darker skin tones, rosacea may not appear as visibly red and may present as brown discoloration or bumps.

Causes and Risk Factors

The exact cause of rosacea is still unclear, but several factors may contribute:

  • Genetics: Rosacea tends to run in families.

  • Immune response: Abnormal processing of cathelicidin, a protein involved in immune defense, may cause inflammation.

  • Skin mites: Higher levels of Demodex mites have been found on rosacea-affected skin.

  • Bacterial factors: Helicobacter pylori, a gut bacterium, is linked to higher incidence in some studies.

  • Vascular issues: Blood vessel abnormalities may contribute to flushing and redness.

Risk factors include:

  • Age between 30–50

  • Fair skin and light eyes

  • Family history of rosacea

  • Being assigned female at birth (though men may experience more severe forms)

  • History of severe acne

  • Northern European or Celtic ancestry

Diagnosis

A dermatologist usually diagnoses rosacea by examining the skin and asking about symptoms. There are no specific laboratory tests for rosacea.

Your provider may perform tests to rule out other conditions that mimic rosacea, such as:

  • Lupus

  • Seborrheic dermatitis

  • Acne vulgaris

  • Allergic reactions

If you have ocular symptoms, referral to an eye specialist (ophthalmologist) may be needed.

Treatment Options

Rosacea cannot be cured, but effective treatments are available to manage symptoms and prevent progression.

Topical Medications

  • Metronidazole: An anti-inflammatory and antimicrobial cream or gel.

  • Ivermectin (Soolantra): Reduces inflammation and mite-related irritation.

  • Brimonidine (Mirvaso) or oxymetazoline (Rhofade): Vasoconstrictors that reduce redness temporarily.

Oral Medications

  • Tetracycline antibiotics: Such as doxycycline, used to reduce inflammation.

  • Isotretinoin: Reserved for severe cases, particularly for thickened skin.

Ocular Treatments

  • Warm compresses

  • Gentle eye cleansers

  • Prescription eye drops for dryness and inflammation

Laser and Light Therapy

Laser treatment (such as pulsed-dye laser or intense pulsed light) can help reduce visible blood vessels and persistent redness. These treatments are especially useful for ETR rosacea and phymatous thickened skin.

Potential side effects include swelling, blistering, and temporary discoloration. Several sessions may be required, and insurance often does not cover this option.

Surgical Options

For advanced phymatous rosacea, surgical reshaping of the nose or thickened areas using dermabrasion, electrosurgery, or CO2 lasers may be recommended. This is typically reserved for severe cases where the skin's appearance affects function or self-confidence.

Home Care Tips

Daily habits can make a significant difference:

  • Use a gentle, fragrance-free cleanser

  • Apply sunscreen (SPF 30+) daily

  • Keep your skin moisturized

  • Avoid triggers (see below)

  • Choose non-comedogenic, alcohol-free skincare and cosmetics

  • Limit or avoid exfoliation, which can irritate sensitive skin

Identifying Triggers

Rosacea flares are often triggered by specific lifestyle or environmental factors:

  • Sun exposure

  • Heat and hot beverages

  • Spicy foods

  • Alcohol (especially red wine)

  • Emotional stress

  • Wind and cold weather

  • Harsh skincare products

Keeping a journal to track flare-ups can help identify and avoid individual triggers.

Preventing Flare-Ups

Preventing rosacea flare-ups requires a proactive approach:

  • Use physical barriers like hats and scarves in harsh weather

  • Practice stress-reducing techniques like meditation or yoga

  • Limit alcohol and caffeine intake

  • Follow a consistent skincare routine

  • Stay hydrated

Always follow the regimen prescribed by your healthcare provider.

Related Conditions

Rosacea has been associated with a number of systemic diseases:

  • Depression and anxiety

  • Hypertension and cardiovascular disease

  • Migraines

  • Rheumatoid arthritis

  • Diabetes

  • H. pylori infection

  • Dementia and neurological conditions

Though the relationship isn’t fully understood, systemic inflammation may play a role in these associations.

Living With Rosacea

Rosacea can have a profound impact on mental and emotional health. The visibility of symptoms may affect self-image and lead to social withdrawal or psychological distress.

Support strategies include:

  • Joining a rosacea support group

  • Seeking counseling or mental health care

  • Being open with loved ones about your condition

Education, awareness, and consistent treatment can help individuals manage rosacea and live confidently.

When To Seek Help

Consult a dermatologist if:

  • You notice persistent redness or flushing

  • Bumps or pustules worsen

  • You experience eye discomfort or vision issues

  • Over-the-counter products cause burning or irritation

Early diagnosis can prevent progression and reduce long-term complications.