Rosacea: Symptoms, Causes & Treatments

Acne rosacea


What is Rosacea?

Rosacea is a skin condition that affects parts of your face. Symptoms can include facial flushing, facial redness, spots, thickening of your skin, and eye problems such as dry eyes and sore eyelids. Not all symptoms occur in all cases. Rosacea affects about 1 in 10 people in the UK, usually in middle age. Many cases are mild. Spots can usually be cleared with antibiotic treatment. Other treatments may be used for other symptoms. A complication that affects the front of the eye (the cornea) is uncommon but serious. See a doctor urgently if you develop any eye pain or visual problems.

Is rosacea like acne?

Rosacea is different than acne, although the two can coexist. It is occasionally called “adult acne.” Unlike common acne, rosacea occurs most often in adults (ages 30-50), especially in those with fair skin. As opposed to acne vulgaris, rosacea is devoid of blackheads. Furthermore, most teens eventually outgrow acne whereas patients with rosacea don’t generally outgrow it. Rosacea consists mostly of small red bumps. People with rosacea tend to have a rosy or pink color to their skin as opposed to acne patients, whose skin is usually less red.

Rosacea strikes both sexes and potentially all ages. It tends to be more frequent in women but more severe in men. It is very uncommon in children, and it is less frequent in people with dark skin.

Acne Rosacea Pictures

Erythematotelangiectatic rosacea

Figure 1


Papulopustular rosacea

Figure 2


Phymatous rosacea

Figure 3


Ocular rosacea

Figure 4

Rosacea is a skin condition that usually affects parts of your face such as your nose, cheeks and forehead. However, other areas, such as your neck, chest and ears can sometimes become involved.

Rosacea is sometimes called acne rosacea, as it can look similar to acne. However, it is a different condition to acne. Symptoms of rosacea include one or more of the following:

  • Frequent flushing of your face, similar to blushing. This is often the first symptom and may be the only symptom for months or years before anything else develops.
  • Redness (erythema) of parts of the face. This can look similar to sunburn.
  • Small lumpy red spots (papules) and small cysts (pustules) on your face. The spots and cysts look similar to acne. These may come and go in some cases but, in others, remain long-term unless treated.
  • Tiny blood vessels visible on your face. This is also called telangectasia. They can sometimes become quite prominent on your face.
  • Eye symptoms (also called ocular rosacea) occur in about half of cases but are often mild. They can include:
    • A feeling of something in your eye.
    • Burning, stinging or itchy eyes.
    • Dryness.
    • Sensitivity to light.
    • Eyelid problems such as cysts, styes or eyelid inflammation (blepharitis).

    Inflammation and infection of the front of your eye (the cornea) is an uncommon but serious complication that can affect your vision. See a doctor urgently if you develop eye pain or visual problems.

  • Thickening of the skin occurs in some cases. The most well-known example of this is an unsightly, bumpy nose (called a rhinophyma). This is uncommon and usually only occurs in men.

The symptoms are usually just on the central parts of your face – on your cheeks, forehead, nose, around your mouth and chin. Skin on other parts of your head is sometimes affected. Rarely, skin on your arms or back is affected. The first picture shows the typical pattern of redness in rosacea. The second picture shows telangiectasia on the nose and cheeks. Both pictures are of fairly severe rosacea. In many cases it is much milder than as shown.

Rosacea is not usually painful or itchy. However, in some cases there may be a burning feeling over the affected skin. You do not usually feel ill with rosacea and serious complications are uncommon. However, rosacea can be unsightly and distressing.

The symptoms can vary from case to case – for example:

  • Some people only ever get one or two of the symptoms. These may be just mild and not too troublesome. For example, some people just have facial flushing and/or mild redness of the face and never develop any other symptoms.
  • Some people may develop several symptoms but one symptom may dominate.
  • Spots are a prominent feature in some cases but not in all.
  • Rhinophyma is uncommon but may occur even without any other symptoms.
  • Eye symptoms occur in some people before any skin symptoms develop.

In short, the development and severity of symptoms of rosacea can vary greatly.

Causes of Rosacea

The exact cause of rosacea is still unknown and remains a mystery. The basic process seems to involve dilation of the small blood vessels of the face. Currently, it is believed that rosacea patients have a genetically mediated reduction in the ability to dampen facial inflammation that is incited by environmental factors such as sunburn, demodicosis (Demodex folliculorum in the hair follicles), flushing, and certain medications. Rosacea tends to affect the “blush” areas of the face and is more common in people who flush easily. Additionally, a variety of triggers are known to cause rosacea to flare.

There is no permanent cure for rosacea. There is nothing you can do to prevent rosacea from starting. However, treatments can ease the symptoms and can be really effective. The treatments used may vary, depending on what symptoms develop. Treatment may need to be adjusted over time, depending on your response to treatments and if you develop different symptoms.

Treatment for facial flushing

Some people find that certain things aggravate the skin and trigger flushing or make the flushing worse. The most common things reported that may trigger the skin to flush are:

  • Extremes of temperature (in particular, excessive heat).
  • Alcoholic drinks.
  • Strenuous exercise.
  • Stressful situations.
  • Sunlight.
  • Spicy food.
  • Hot drinks.

If any of these seem to trigger bouts of flushing or make the flushing worse then avoiding them is sensible and is therefore recommended.

Some medicines used for other conditions may also trigger flushing. If you suspect that a medicine is making the flushing worse then discuss this with your doctor. An alternative medicine may be available.

A new treatment called brimonidine gel has become available which works to reduce the redness associated with rosacea. Some people find this very effective and it can work very quickly.

Treatment for spots and cysts

Certain antibiotics are the usual treatment. They usually work well but it is not clear why they work, as there is no proven germ (bacterium) that causes rosacea. Some antibiotics reduce inflammation in the skin as well as killing bacteria and this may be why they work for rosacea. A rub-on (topical) antibiotic called metronidazole is the common treatment if you have just a few small spots. If you have many spots or cysts then antibiotic tablets such as a tetracycline or erythromycin may be used.

Some improvement may occur after 2-3 weeks of treatment. However, it commonly takes a 6- to 12-week course of antibiotics to clear spots and cysts. One reason why antibiotic treatment fails is that some people give up on treatment after a few weeks without completing the full course.

When a course of antibiotic treatment is finished, the spots or cysts commonly return at some point. Therefore, repeated courses of treatment may be needed from time to time. As an alternative, once the spots have cleared, some people take a regular maintenance dose of antibiotics or use a topical antibiotic (regularly or intermittently) long-term to prevent the spots and cysts from returning.

Topical azelaic acid is an alternative to topical antibiotics to treat mild-to-moderate spots. However, some people find that it can cause side-effects such as burning, stinging, itching, scaling and dry skin.

Ivermectin cream is used occasionally for people with rosacea. It works by killing the mite Demodex folliculorum and also works to reduce some of the inflammation in your skin.

If you do not respond to any of these treatments, other therapies are sometimes given in specialist clinics.

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