Rosacea

What is rosacea?

Rosacea is a chronic skin condition that affects more than 16 million Americans. It primarily affects the face, causing redness, visible blood vessels, and sometimes small red bumps filled with pus. In some cases, rosacea can cause eye problems, including dryness, irritation, and swollen eyelids.

The exact cause of rosacea is not known. However, it can often be controlled with medication, gentle skin care, and avoiding known triggers.

Types of rosacea

There are four types of rosacea. Each type has its own set of symptoms, and more than one type can occur at the same time:

  • Erythematotelangiectatic rosacea (ETR): Persistent facial redness and visible blood vessels.
  • Papulopustular rosacea: Red bumps or pus-filled pimples, often affecting middle-aged women.
  • Phymatous rosacea: Skin thickening, swelling, and bumpy texture, sometimes leading to a bulbous nose (rhinophyma); more common in men.
  • Ocular rosacea: Eye irritation, dryness, bloodshot appearance, sensitivity to light, and painful eyelid bumps.

What causes rosacea?

The cause of rosacea is not fully understood, but several factors appear to play a role:

  • Genetics: A family history of rosacea increases risk.
  • Blood vessel abnormalities: Issues with facial blood vessels may lead to flushing and redness.
  • Overactive immune system: Inflammation triggered by immune proteins.
  • Demodex mites: Higher numbers of these skin mites may contribute to inflammation.
  • Helicobacter pylori bacteria: Infection with this stomach bacterium has been linked to rosacea.

Risk factors

  • Age 30–50 years
  • Fair skin or tendency to sunburn
  • Blond hair and blue eyes
  • History of acne cysts or nodules
  • Women undergoing menopause

Triggers

These factors can provoke or worsen rosacea symptoms:

  • Sun exposure
  • Extreme temperatures or hot baths
  • Hot drinks and spicy foods
  • Alcohol, especially red wine
  • Stress and anxiety
  • Strenuous exercise
  • Certain medications and topical irritants

Symptoms of rosacea

Common signs and symptoms vary by type but may include:

  • Persistent facial redness, especially on cheeks, nose, chin, or forehead
  • Visible blood vessels (telangiectasia)
  • Small red bumps or pus-filled pimples
  • Dry, irritated, or bloodshot eyes
  • Swollen eyelids or gritty sensation in the eyes
  • Burning or stinging skin
  • Rough, dry, or scaly facial patches
  • Thickened skin, most often on the nose
  • Facial swelling

Diagnosis

Diagnosis is based on clinical evaluation by a dermatologist or healthcare provider. They look for characteristic blood vessels and bumps and rule out other skin conditions like acne, psoriasis, or lupus. Eye involvement may require an ophthalmologist’s assessment.

See a provider if you experience:

  • Persistent facial redness
  • Visible facial blood vessels
  • Acne-like bumps not responding to standard acne treatments
  • Dry, irritated, or red eyes

Treatment

Treatment aims to control flare-ups, reduce redness, and improve skin appearance. Options include:

Topical medications

  • Metronidazole (Metrogel, Noritate)
  • Azelaic acid (Finacea, Azelex)
  • Ivermectin cream (Soolantra)
  • Brimonidine gel (Mirvaso) or oxymetazoline cream (Rhofade)
  • Minocycline foam (Amzeeq, Zilxi)

Oral medications

  • Doxycycline (Oracea, Doryx)
  • Other tetracyclines (minocycline, tetracycline)
  • Isotretinoin (Accutane) for severe cases

Light and laser treatments

  • Vascular lasers or intense pulsed light to reduce redness and visible vessels
  • Laser resurfacing for thickened skin

Ocular rosacea care

  • Eyelid hygiene and warm compresses
  • Lubricating eye drops
  • Antibiotic eye drops if needed

Skin care and lifestyle

  • Avoid known triggers
  • Use broad-spectrum sunscreen (SPF 30+)
  • Gentle, fragrance-free cleansers and moisturizers
  • Stress management techniques (yoga, meditation)

Early diagnosis and a tailored treatment plan can greatly improve symptoms and quality of life. Consult a dermatologist for personalized care.

Sources

  • Gallo RL, Granstein RD, et al. “Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee.” J Am Acad Dermatol. 2018;78(1):148–155.
  • Van Zuuren EJ, Arents BWM, et al. Rosacea: New Concepts in Classification and Treatment. Am J Clin Dermatol. 2021;22:457–465.
  • National Rosacea Society. All About Rosacea: Signs, Symptoms, and Treatment.
  • American Academy of Dermatology Association. What is Rosacea?
  • StatPearls. Rosacea. National Library of Medicine.
  • National Institutes of Health. Rosacea.