Rosacea

Rosacea: Left untreated, rosacea can get worse.

Rosacea: Overview

Rosacea (rose-AY-sha) is a common skin disease. It often begins with a tendency to blush or flush more easily than other people.

The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be red all the time.

Rosacea can cause more than redness. There are so many signs and symptoms that rosacea has four subtypes:

1. Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels.
2. Papulopustular rosacea: Redness, swelling, and acne-like breakouts.
3. Phymatous rosacea: Skin thickens and has a bumpy texture.
4. Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty.

With time, people who have rosacea often see permanent redness in the center of their face.

Famous faces of rosacea

If you are living with rosacea, you are in good company. Some famous people have struggled with rosacea:

• Bill Clinton.
• Diana, Princess of Wales.
• W.C. Fields (a film star in the 1920s and 1930s). 

Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Rosacea: Signs and symptoms

Rosacea causes more than a red face. There are many signs (what you can see) and symptoms (what a person feels) of rosacea.

Because rosacea has so many signs and symptoms, scientists created 4 subtypes of rosacea. Some people have more than one rosacea subtype at the same time. Each subtype requires different treatment.

Rosacea: People with this subtype of rosacea, also called ETR, often have very sensitive skin.

Subtype 1: Facial redness, flushing, visible blood vessels

Signs and symptoms

• Flushing and redness in the center of the face.
• Visible broken blood vessels (spider veins).
• Swollen skin.
• Skin may be very sensitive.
• Skin may sting and burn.
• Dry skin, roughness or scaling.
• Have a tendency to flush or blush more easily than other people.

Acne rosacea: This subtype of rosacea is most common in middle-aged women.

Subtype 2: Acne-like breakouts

Signs and symptoms

• Acne-like breakouts, usually where the skin is very red.
• Acne-like breakouts tend to come and go.
• Oily skin.
• Skin may be very sensitive.
• Skin may burn and sting.
• Visible broken blood vessels (spider veins).
• Raised patches of skin called plaques 

Subtype 3: Thickening skin

Signs and symptoms

Rhinophyma: Although rare, rosacea can cause the skin to thicken and have a bumpy texture. When this happens, it is called rhinophyma.

This subtype is rare. When it does occur, the person often has signs and symptoms of another subtype of rosacea first. The signs of this subtype are:

• Bumpy texture to the skin.
• Skin begins to thicken, especially common on the nose. When the skin thickens on the nose, it is called rhinophyma (rye-NO-fie-ma).
• Skin may thicken on the chin, forehead, cheeks, and ears.
• Visible broken blood vessels appear.
• Pores look large.
• Oily skin.

Subtype 4: In the eyes

Signs and symptoms

Ocular rosacea: When rosacea affects the eye, it is called ocular rosacea. If rosacea affects your eye, you may need to see an ophthalmologist (doctor who specializes in treating eye diseases).

Some people get rosacea in their eyes. The eyes may have one or more of the following:

• Watery or bloodshot appearance.
• Feel gritty, often feels like sand in the eyes.
• Eyes burn or sting.
• Eyes are very dry.
• Eyes itch.
• Eyes sensitive to light.
• Blurry vision.
• Visible broken blood vessels on an eyelid.
• Cyst on the eyelid.
• Person cannot see as well as before. 

Rosacea can affect quality of life

Rosacea can affect more than the skin and eyes. Because rosacea is a chronic (long-lasting) skin disease, it can reduce a person’s quality of life. Many people report problems at work, in their marriage, and with meeting new people. Surveys and studies report that living with rosacea can cause:
 

• Feelings of frustration and embarrassment: In surveys conducted by the National Rosacea Society, 41 percent said their rosacea caused them to avoid public contact or cancel social engagements.
   
• Worry: People worry that their rosacea will get worse or cause scars. People worry about side effects from medicine used to treat rosacea.
   
• Low self-esteem: Surveys conducted by the National Rosacea Society found that almost 70 percent of people living with rosacea said that the condition lowered their self-confidence and self-esteem.
   
• Work-related problems: Surveys conducted by the National Rosacea Society find that when rosacea is severe, 70 percent of people say the disease affects their interactions at work. Nearly 30 percent say that rosacea causes them to miss work.
   
• Anxiety and depression: Living with a skin condition that flares unexpectedly can cause people to believe you have a drinking problem. This can cause anxiety and depression.

Treatment seems to improve a person’s quality of life. Studies show that when people have fewer signs and symptoms of rosacea, their quality of life improves.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Rosacea: Who gets and causes

Who gets rosacea?

Rosacea is common. According to the U.S. government, more than 14 million people are living with rosacea. Most people who get rosacea are:

• Between 30 and 50 years of age.
• Fair-skinned, and often have blonde hair and blue eyes.
• From Celtic or Scandinavian ancestry.
• Likely to have someone in their family tree with rosacea or severe acne.
• Likely to have had lots of acne — or acne cysts and/or nodules.

Women are a bit more likely than men to get rosacea. Women, however, are not as likely as men to get severe rosacea. Some people are more likely to get rosacea, but anyone can get this skin disease. People of all colors get rosacea. Children get rosacea.

What causes rosacea?

Scientists are still trying to find out what causes rosacea. By studying rosacea, scientists have found some important clues:

• Rosacea runs in families. Many people who get rosacea have family members who have rosacea. It is possible that people inherit genes for rosacea.
   
• The immune system may play a role. Scientists found that most people with acne-like rosacea react to a bacterium (singular for bacteria) called bacillus oleronius. This reaction causes their immune system to overreact. Scientists still do not know whether this can cause rosacea.
   
• A bug that causes infections in the intestines may play a role. This bug, H pylori, is common in people who have rosacea. Scientists cannot prove that H pylori can cause rosacea. Many people who do not have rosacea have an H pylori infection.
   
• A mite that lives on everyone’s skin, demodex, may play a role. This mite likes to live on the nose and cheeks, and this is where rosacea often appears. Many studies found that people with rosacea have large numbers of this mite on their skin. The problem is some people who do not have rosacea also have large numbers of this mite on their skin.
   
• A protein that normally protects the skin from infection, cathelicidin, may cause the redness and swelling. How the body processes this protein may determine whether a person gets rosacea.

Rosacea: Diagnosis and treatment

How do dermatologists diagnose rosacea?

To diagnose rosacea, a dermatologist examines the skin and eyes. Your dermatologist also will ask questions.

How do dermatologists treat rosacea?

To treat rosacea, a dermatologist first finds all of the patient’s signs and symptoms of rosacea. This is crucial because different signs and symptoms need different treatment.

Treatment for the skin includes:

• Medicine that is applied to the rosacea.
• Sunscreen (wearing it every day can help prevent flare-ups).
• An emollient to help repair the skin.
• Lasers and other light treatments.
• Antibiotics (applied to the skin and pills).

Dermatologists can remove the thickening skin that appears on the nose and other parts of the face with:
 

• Lasers.
• Dermabrasion (procedure that removes skin).
• Electrocautery (procedure that sends electric current into the skin to treat it).

When rosacea affects the eyes, a dermatologist may give you instructions for washing the eyelids several times a day and a prescription for eye medicine. 

Outcome

There is no cure for rosacea. People often have rosacea for years.

In one study, researchers asked 48 people who had seen a dermatologist for rosacea about their rosacea. More than half (52 percent) had rosacea that came and went. These people had had rosacea for an average of 13 years. The rest of the people (48 percent) had seen their rosacea clear. People who saw their rosacea clear had rosacea for an average of 9 years.

Some people have rosacea flare-ups for life. Treatment can prevent the rosacea from getting worse. Treatment also can reduce the acne-like breakouts, redness, and the number of flare-ups.

To get the best results, people with rosacea also should learn what triggers their rosacea, try to avoid these triggers, and follow a rosacea skin-care plan.

Rosacea: Tips for managing

Learn how keeping a journal and other lifestyle tips can help reduce rosacea flares.

If you believe that you might have rosacea or have been diagnosed with rosacea, the following tips can help:

• See a dermatologist. This is important for the following reasons:

• Learn what triggers your rosacea. Many everyday things can cause rosacea to flare. These include sunlight, stress, and many foods and beverages.
  
  What causes one person’s rosacea to flare may not trigger a flare-up for another person. This is why dermatologists recommend that patients with rosacea learn what triggers their flare-ups. Avoiding these triggers can reduce flare-ups.
   
• Follow a rosacea skin-care plan. Skin care plays an important role in keeping rosacea under control. Many skin care products are too harsh. This can make rosacea worse.

Related resources:

Learning to control rosacea and getting support helps many people live more comfortably.

Rosacea Support Group
Free, moderated, online community that offers support.
National Institutes of Health, Department of Health and Human Services
Provides Q&A about rosacea.
National Rosacea Society
Quarterly newsletter, booklet to help people identify and avoid triggers, and other resources.
RosaceaNet
Website from the American Academy of Dermatology.