Rosacea is a long-term inflammatory skin condition that primarily affects the face, often resulting in redness and visible blood vessels. The symptoms usually show up on the cheeks and nose but can also extend to the forehead, chin, and even the neck and chest. In some cases, rosacea can impact the eyes. An estimated 14 million individuals in the United States live with this condition.

The exact cause of rosacea is unknown, though researchers believe a combination of environmental and genetic factors plays a role. Common triggers include stress, heat, and sun exposure. You’re more likely to develop rosacea if you are between the ages of 30 and 50, were assigned female at birth, or have a family history of the condition.

Although there is no cure, rosacea can be effectively managed through medications and lifestyle adjustments.

Types of Rosacea

Rosacea is categorized into several types based on how it affects the skin and which areas of the body are involved.

erythematotelangiectatic rosacea (ETR)
This is the most common form, also referred to as vascular rosacea. It appears as flushed, red patches on the face, and in more severe cases, you might notice visible blood vessels.

papulopustular rosacea
Also known as inflammatory rosacea, this type is characterized by facial redness along with small, pus-filled bumps that resemble acne. It often appears alongside or following ETR.

phymatous rosacea
This severe form of rosacea causes the skin to thicken and become bumpy, particularly around the nose, though it can also affect the chin, cheeks, forehead, and ears. In more advanced cases, it may lead to rhinophyma, where the nose becomes swollen and deformed due to overgrowth of connective tissue and oil glands.

ocular rosacea
This type affects the eyes and eyelids. It may occur with or without visible skin symptoms. Symptoms include:

  • Watery or bloodshot eyes

  • Dryness

  • Itching or burning

  • Sensitivity to light

  • Blurred vision

If untreated, ocular rosacea can impair vision and damage the eyes.

Common Symptoms of Rosacea

Rosacea symptoms vary by type and severity. Most commonly, individuals experience persistent redness on the face. The condition has flare-up periods when symptoms worsen and remission periods when symptoms ease. However, rosacea is chronic and can worsen over time if not treated.

Key symptoms include:

  • Flushing and facial redness

  • Burning or tingling skin

  • Rough or scaly red patches

  • Pimples or pus-filled bumps

  • Enlarged or visible blood vessels

In people with darker skin tones, rosacea may present as brown discoloration or yellow-brown bumps rather than redness. The central face (nose and cheeks) is most commonly affected, but symptoms can spread to the neck, ears, scalp, and chest.

More advanced symptoms may include:

  • Thickened skin, particularly around the nose

  • Eye redness, itchiness, or dryness

  • Swollen eyelids or irritation at the base of the eyelashes

Causes and Risk Factors

The exact cause of rosacea remains unknown. However, experts believe inflammation triggered by genetic and environmental factors is at the root of the condition.

genetic predisposition
Rosacea often runs in families, suggesting a hereditary link. Some people may have an abnormal response to a protein called cathelicidin, which is meant to protect the skin from infections but can instead cause redness and swelling in rosacea patients.

environmental triggers
People with rosacea often have sensitive skin that overreacts to sunlight, heat, and wind.

microbes and skin mites
Research has found that individuals with rosacea may have higher populations of Demodex mites, microscopic organisms living near hair follicles. While these mites are common on all human skin, their overgrowth could irritate those prone to rosacea.

bacterial involvement
Some studies link rosacea to the presence of H. pylori, a bacterium found in the stomach. This bacterium could contribute to systemic inflammation, but it’s still unclear if it plays a direct role in rosacea.

higher risk groups
You're more likely to develop rosacea if you:

  • Are between 30 and 50 years old

  • Were assigned female at birth

  • Have fair skin, particularly of Northern European descent

  • Have family members with rosacea

  • Have a history of acne cysts or nodules

Interestingly, while rosacea is more common in people assigned female at birth, those assigned male are at greater risk for severe forms, including ocular and phymatous rosacea.

How Rosacea Is Diagnosed

Dermatologists typically diagnose rosacea by visually examining the skin and discussing your medical history. No specific lab test exists for rosacea, but your provider might conduct tests to rule out other conditions like lupus or allergic reactions that mimic rosacea.

If ocular symptoms are present, a referral to an ophthalmologist may be necessary for further evaluation.

Rosacea Treatment Options

Treatment focuses on reducing flare-ups and preventing complications such as skin thickening or eye damage.

medications
Topical and oral drugs can help reduce inflammation and redness. For ocular rosacea, treatment often includes:

  • Warm compresses

  • Gentle eye cleansers

  • Prescription eye drops

Topical medications for skin symptoms include:

  • Antibiotics such as metronidazole to reduce inflammation

  • Antiparasitics like ivermectin (Soolantra)

  • Vasoconstrictors such as oxymetazoline (Rhofade) and brimonidine (Mirvaso) to temporarily reduce redness

For acne-like rosacea, options include:

  • Sodium sulfacetamide with sulfur

  • Retinoids (with caution, due to sensitivity)

  • Oral isotretinoin (brands like Absorica, Claravis, Zenatane), especially for thickened skin

laser and light therapies
These procedures reduce visible blood vessels and skin redness. Multiple sessions may be needed, and while results can be long-lasting, side effects like burns or discoloration may occur. These procedures are usually not covered by insurance.

surgical options
For advanced phymatous rosacea, surgical removal of thickened skin may be necessary. This could involve reshaping the nose or other affected areas to restore normal appearance.

Preventing Rosacea Flares

Rosacea can’t be cured, but you can manage it by avoiding common triggers and sticking to a dermatologist-approved care routine.

Tips for preventing flare-ups:

  • Use sunscreen daily and avoid intense sun exposure

  • Manage stress through techniques like yoga or meditation

  • Avoid hot baths, saunas, or overheating

  • Stay away from skincare ingredients like alcohol, menthol, camphor, or sodium lauryl sulfate

  • Limit spicy food and hot drinks

  • Drink alcohol in moderation

  • Cover your face during cold or windy weather

Associated Health Conditions

Research has shown that people with rosacea are more likely to experience other inflammatory or systemic conditions. These may include:

  • Depression and anxiety

  • Hypertension

  • Heart disease

  • Type 2 diabetes

  • Migraines

  • Rheumatoid arthritis

  • H. pylori infection

  • Ulcerative colitis

  • Dementia

These associations highlight the importance of holistic care for people with rosacea.

Living With Rosacea

Managing rosacea involves long-term commitment and personalized care. Since the condition can affect your appearance and emotional well-being, psychological support can also play a key role in treatment.

Untreated rosacea can lead to lasting skin changes or vision damage, particularly in ocular and phymatous forms. However, with the right treatment and lifestyle adjustments, many people successfully control their symptoms and maintain a good quality of life.