Rosacea

What is rosacea?

Rosacea is a chronic inflammatory skin condition that causes patches of redness on the body, most commonly on the face or eyes. For some, rosacea also forms pus-filled bumps resembling acne. There is no cure for rosacea, but there are effective lifestyle changes and treatment options that help with symptom management. 

The appearance of rosacea may come and go during flare ups, and certain environmental triggers may make symptoms worse or more noticeable. The best treatment option depends on the type of rosacea and how the symptoms manifest on the skin.

What are the types of rosacea?

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There are four main types of rosacea. A person may only experience symptoms of one type, or they may experience a couple of types. Distinguishing what type of rosacea you have is the primary step in deciding on the best treatment options. 

 

The four different types of rosacea include:

Erythematotelangiectatic: This type is characterized by persistent redness with visible and enlarged blood vessels. The appearance of the redness comes and goes unexpectedly during flares. 

Papulopustular: Papulopustular rosacea consists of pus-filled pimples and red, swollen bumps. These bumps often resemble acne and do appear most commonly on the face. 

Phymatous: Symptoms of phymatous rosacea include the swelling and thickening of the skin. In addition, your skin could form discolored bumps. The bumps typically form on the nose. 

Ocular: This type of rosacea affects the eyes. Symptoms include eyes that feel irritated and appear bloodshot or watery. The eyes can become sensitive to light and form painful styes on the eyelids. 

What causes rosacea?

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The cause of rosacea remains unknown. However, there are key theories about why rosacea develops. Several studies have tried to understand what aspects of a person’s immune system, genetic makeup, or external environment have a potential link to rosacea to narrow the potential cause. Scientists do know that rosacea is not a result of poor hygiene, and the condition is not contagious. 

What triggers rosacea?

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Triggers can make your rosacea appear or worsen. Knowing what can trigger your rosacea can help you avoid those triggers can develop mechanisms to minimize their impact. 

Rosacea flare-ups might be triggered by:

  • Drinking hot beverages or spicy foods
  • Exercise 
  • Wind, sunlight, or cold temperatures
  • Medications that dilate blood vessels 
  • Alcohol, especially red wine 
  • Makeup, skin, or hair products
  • Stress or emotional distress

These factors may not trigger rosacea for everyone, and each person may have unique triggers. Monitoring your activities and environmental conditions when you have a rosacea flare up can help you pinpoint triggers and do your best to avoid them.

What are symptoms of rosacea?

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The appearance and duration of rosacea symptoms will vary from person to person. Since the condition is chronic, individuals may experience cycles of symptoms with flare ups and periods of remission that can be unpredictable. 

 

The symptoms of rosacea include:

  • Facial redness: Rosacea can cause the central parts of the face to flush or blush for longer periods of time. For some with darker skin tones, the blushing can be hard to detect. 
  • Skin thickening: In more severe cases, the skin may thicken on the nose, causing the nose to become enlarged and appear bulbous. 
  • Rash: A rash may result from rosacea that consists of pus-filled bumps and pimples. 
  • Eye irritation: A symptom of ocular rosacea is that the eyes become red, itchy, watery, and irritated. This irritation can spread to the eyelids and at the base of the eyelashes where painful styes may develop. Symptoms of ocular rosacea need medical attention to prevent damage to or loss of vision. 
  • Visible blood vessels: Blood vessels may become visible as thin red lines on the cheeks and nose. 
  • Swelling: The skin may swell on the face along with other symptoms of rosacea. 
  • Burning sensation: Rosacea can cause a burning or stinging feeling on the face. These areas may feel hot and sensitive to the touch.
  • Dryness: The facial skin may start to feel rough and appear dry.

The symptoms of rosacea can start by being temporary occurrences but can become longer lasting over time. New symptoms may appear with each flare up. It is important to track your symptoms to stay on top of treatments to ensure your symptoms do not worsen or become problematic. Symptoms most commonly appear on the center of the face, but some rarer cases of rosacea extend to the neck, scalp, or chest.

Are there any risk factors or groups for rosacea?

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Key demographic and genetic factors can make someone more likely to develop rosacea. Anyone can get rosacea, but there are groups predisposed to rosacea. Middle-aged and older adults are at a higher risk. While women tend to develop rosacea more than men, men who have rosacea often experience more severe symptoms. The condition is also more common for people who have blond hair and blue eyes. 

People with fair skin that burns easily in the sun develop the condition more often. Since rosacea is harder to detect on people with darker skin tones, the condition could be underdiagnosed for people with darker skin. Those with a family history of rosacea face a higher risk of developing the condition. 

How is rosacea diagnosed?

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There is no test that specifically detects rosacea. With the absence of a test, doctors rely on a physical examination of the impacted skin and questions about your medical history and symptoms to reach a diagnosis. Your primary care physician may refer you to a dermatologist who has more specialized knowledge about skin conditions. In addition, if the symptoms appear in your eyes, you may receive a referral to an ophthalmologist for further evaluation. 

The doctor may begin the examination with a review of your medical history and confirming information. They will take a closer look at the affected skin or eyes and listen to any symptoms you describe. Since rosacea does not present as clearly on people of color, be sure to communicate with your doctor if you sense symptoms developing. 

In the event that your doctor cannot confirm a diagnosis with a physical examination alone, they may order tests to rule out the presence of other conditions that resemble rosacea. Conditions like psoriasis or lupus can resemble the symptoms of rosacea. If your doctor assesses your condition and thinks the supposed rosacea is actually another condition, skin tests or blood tests can help confirm what condition is causing the symptoms.

How is rosacea treated?

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There is no cure for rosacea, but there are a variety of treatment options to help with the symptoms. The right treatment option depends on the person. The goals of any treatment are to manage the symptoms, prevent the rosacea from worsening, and improve your quality of life. 

Topical Medications: Topical medications that you apply to the skin like creams or ointments contain antibiotics, antiparasitics, or vasoconstrictors, which treat flushing, redness, and rashes. 

For rosacea in the eye, drops or ointments help with eye irritation. 

Oral Medications: Common oral medications are antibiotics that treat severe rashes and serious eye symptoms. 

Laser Therapy: These therapies help by shrinking blood vessels to make them less noticeable. Light and laser therapy typically takes multiple sessions for results and does have side effects of swelling and bruising. 

Surgery: To remove excess or thickened skin, your doctor may recommend a surgical procedure. 

Should you see a doctor for rosacea?

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You should see a doctor for rosacea when you notice symptoms start. The sooner you receive medical attention, the better you can begin to manage flare ups and prevent any severe symptoms. If any of the signs or symptoms of rosacea become painful or cause discomfort, you should schedule an appointment as soon as you can. 

When you visit with your doctor, you can ask questions about preventing flares, what skincare products to use, what medication options you have, and what lifestyle changes help with your rosacea symptoms. Be prepared for a referral to a dermatologist or ophthalmologist in the event that you need a specialist for further diagnosis and treatment. You may need follow-up appointments to track the progression of symptoms and assess how well your at-home treatments or prescribed medicines are working. 

 

What is the outlook for people living with rosacea?

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Rosacea is not a life-threatening condition and is harmless with the right lifestyle adjustments and treatments. The condition is chronic, but you can take an active role in managing flare ups and symptoms as they occur. 

You can improve your outlook by recognizing your rosacea triggers and taking measures to avoid them. Keeping a journal of your flare ups can help you pinpoint the more precise triggers. When you have doctor’s appointments, you can share your journal entries and triggers to get advice on how to adapt. Staying on top of your skin treatments and any medications will help your symptoms be mild and under control. All of these actions can make your life more comfortable and your skin well-kept. 

If you notice rosacea impacting your social and emotional wellbeing, try seeking support from friends, family, or support groups. Mental health professionals can help you practice coping mechanisms to make living with this chronic condition easier and more sustainable. 

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