Published Jun 8, 2023

Rosacea causes, symptoms and treatment

Dr. Sudip Bose
Medically reviewed by
Dr. Sudip Bose
Two young white friends pose in their underwear while having fun in the sun. They have dark hair, are smiling, are not wearing makeup and are wearing neutral colors.
Published Jun 8, 2023

More than 16 million Americans live with rosacea. Symptoms of rosacea can look like redness, flushing, pimples and red bumps. In advanced cases, it can cause skin disfigurement or vision problems. With effective treatments and good skin care practices, these can usually be managed.

What is rosacea?

Rosacea is an inflammatory skin condition that causes redness or flushing on the skin of the face. Without treatment, it can lead to solid red bumps or pus-filled pimples. As the condition advances, it can cause skin thickening or disfigurement.

There are four main types of rosacea—and it’s possible to have more than one at a time.

  • Erythematotelangiectatic: The mildest form, this causes redness or flushing in the central part of the face (across the inner part of the cheeks, the nose and middle forehead). Small visible blood vessels on the face may be visible under the skin.
  • Papulopustular: As the condition advances, it can lead to swelling, pustules (pus-filled pimples) or papules (small, solid bumps).
  • Phymatous: This type causes thickened skin, large pores and possibly skin deformities. It’s most common on the nose (rhinophyma), which can appear bulbous or swollen. But it can also occur on the ears, chin or forehead.
  • Ocular: It’s very common for people with other types to also have it in their eyes. The eyes may appear watery or bloodshot. Eyes can feel irritated, including burning, stinging or feeling like there’s something in the eye. Without treatment, it can lead to vision problems.

Who gets rosacea?

Rosacea typically affects people between the ages of 30 and 50. It’s most common in middle-aged women with fair skin—but it can happen to anyone. Research suggests that about 1 in 10 fair-skinned people develop it. With rosacea, men are less likely to have it—but they have more severe cases.

Famous people with rosacea include Lena Dunham, Princess Diana, Prince William and Bill Clinton. Also, historical figures like Rembrandt and J.P. Morgan.

What does rosacea look like?

Rosacea causes redness on many areas of the face. It usually begins in the center part of the face like the nose, inner part of the cheeks and middle part of the forehead. It can also occur on the scalp, eyes, back and chest. In the early stages, it might look like a deep blush or a sunburn that doesn’t go away. You might see small broken blood vessels under the skin.

It’s more common in people with fair skin. But it can occur in people with all skin tones. People with darker skin tones may not notice redness right away or think it’s related to another condition, like acne. This sometimes means that it’s not diagnosed in people with dark skin until it’s advanced or caused significant skin damage.

Signs of rosacea include:

  • Feeling warm or flushed most of the time
  • Dry, tight skin with patches of redness (in people with pale skin) or areas of darker skin (in people with dark skin tones)
  • Visible blood vessels under the skin
  • An all-over flush (for people with light skin tones) or dusky brown coloring (for people with dark skin tones)
  • Breakouts that don’t respond to usual acne treatments
  • Red, yellowish or brown hard bumps around the mouth or eyes
  • Burning or stinging—especially when you apply skin care products or wash your face
  • Swelling on the face
  • Thickened skin on the nose, cheeks, chin or forehead

It also commonly affects the eyes, causing watery and bloodshot eyes that might sting or burn. If you notice these symptoms, talk to your medical provider immediately. Without treatment, this can lead to vision problems, skin disfigurement or scarring.

What are some causes of rosacea?

Researchers don’t know exactly why rosacea happens. But several systems and triggers play a role.

  • Innate immune system: The innate immune system is the body’s first line of defense. Because it quickly responds to threats and treats all threats the same way, it’s known as the general or nonspecific immune system. Research has found that people with skin inflammation may have an overactive response to potential invaders.
  • Neurovascular system: The skin has sensory receptors that control how blood vessels dilate in response to environmental triggers. These triggers include UV rays, temperature changes or strong emotions. People with this condition may have problems with this system and so react strongly to environmental stimuli.
  • Mites and microbes: Researchers have found that people with rosacea have an abundance of a kind of mite on their skin called Demodex folliculorum. All people have this mite on their skin. But high levels may trigger an immune response. Other researchers believe a kind of bacteria (Bacillus oleronius) associated with the mite may be at play. Some research has also found that high levels of certain kinds of bacteria (including gut bacteria) may trigger skin inflammation.
  • Genetics: There is good evidence that rosacea runs in families. New research also links it to certain changes in DNA. This suggests that some people are genetically predisposed to it.
  • Environmental triggers: Rosacea may be triggered by environmental factors like UV rays, temperature extremes, wind, stress, spicy foods, hot beverages and alcohol consumption.

Is rosacea an autoimmune disease?

An autoimmune disease occurs when the body mistakenly attacks its own healthy cells and tissues. (Like an allergic reaction.) Rosacea occurs when the body identifies and overreacts to a threat or trigger. So rosacea is not an autoimmune disease.

But new research shows that it may link to other autoimmune diseases like type 1 diabetes, celiac disease, multiple sclerosis and rheumatoid arthritis.

Skin care with rosacea

A good skin care routine can help you prevent rosacea flares, manage symptoms and help skin look and feel better. Proper skin care can also help rosacea medicine work better.

  • Wash twice a day with a gentle, non-soap cleanser. This will remove bacteria, dirt and oil from the affected areas that can make the condition worse.
  • Moisturize after cleansing. Even a thin layer traps water in the skin.
  • Use SPF 30+ sunscreen every day. Sun exposure is one of the most common triggers. Look for sunscreens that contain zinc oxide, titanium dioxide or both.
  • Choose skin care products for your skin type: Try products labeled as “gentle” or those for sensitive skin. Make sure they don’t have any added fragrance. And skip astringents, toners or exfoliators.

There are a few ingredients that can make symptoms worse. Avoid products that contain:

  • Camphor
  • Menthol
  • Alcohol
  • Urea
  • Astringent toners
  • Lactic acid
  • Sodium laurel sulfate
  • Fragrances
  • Glycolic acid

Will rosacea ever go away?

Rosacea is a relapsing-remitting condition. This means it gets better and then flares again over the long term. It cannot be cured. But managing triggers and working with a dermatologist can help keep symptoms under control.

Who diagnoses rosacea?

A dermatologist can diagnose your skin condition. Similar conditions include:

  • Acne vulgaris (a type of acne most common in teens and young adults)
  • Lupus
  • Folliculitis
  • Seborrheic dermatitis
  • Perioral dermatitis

Proper rosacea treatment can improve symptoms and prevent flares. If you experience changes in your skin—including new redness or flushing—talk to a medical provider or dermatologist. It’s especially important to seek help if you notice eye symptoms, as the condition can affect your vision.

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Sources:

Alexis, A. F., et al. (2019). Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience. Journal of the American Academy of Dermatology. 80(6), 1722–1729.e7.

Banasikowska, A. K., et. al. (2021). Rosacea. Medscape. Retrieved April 6, 2023.

Buddenkotte, J., et al. (2018). Recent advances in understanding and managing rosacea. F1000Research, 7, F1000 Faculty Rev-1885.

Egeberg, A., et al. (2016). Clustering of autoimmune diseases in patients with rosacea. Journal of the American Academy of Dermatology. 74(4), 667–72.e1.

Farshchian, M., et al. (2022). Rosacea. StatPearls.

Kang, C. N., et al. (2021). Rosacea: An update in diagnosis, classification and management. Skin therapy letter, 26(4), 1–8.

Keri, J. E. (2022). Rosacea - Dermatologic Disorders. Merck Manuals Professional Edition. Retrieved April 5, 2023.

National Rosacea Society. (n.d.). Famous people affected by rosacea. Rosacea.org. Retrieved April 8, 2023.

National Rosacea Society. (2017). Rosacea through the ages: A timeline. Rosacea.org. Retrieved April 8, 2023.

Rainer, B. M., et al. (2017). Rosacea: Epidemiology, pathogenesis, and treatment. Dermato-endocrinology. 9(1), e1361574.

Rivero, A. L., et al. (2018). An update on the treatment of rosacea. Australian prescriber, 41(1), 20–24.

Zip C. (2017). The role of skin care in optimizing treatment of acne and rosacea. Skin therapy letter, 22(3), 5–7.

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