Rosacea: how to spot the signs and calm your skin

20th June, 2022 • 14 min read

It probably started when you noticed you were blushing more easily. Now you have redness or a feeling of warmth that comes and goes. Maybe you also have some spots or tiny broken blood vessels, and your skin often stings when you use beauty products or water on it?

This is rosacea (pronounced ‘roh-ZAY-sha’). It’s a skin condition that’s thought to affect about 5% of adults worldwide, and it’s more common in women. It used to be called ‘acne rosacea’, but these 2 conditions aren’t linked (although you can have both at the same time).

Because it’s often very visible, rosacea may affect the way you feel about yourself, and how others see you. But there are things you can try to help.

“There’s no cure for rosacea, but early diagnosis and the right treatment and self-care strategies can keep it under control and may stop it progressing,” says Dr Ann Nainan, Healthily GP. And more than 70% of the people in the National Rosacea Society survey said treatment had improved their emotional and social wellbeing. So read on to get the information – and treatment – you need.

What is rosacea?

Rosacea is a long-term (chronic) inflammatory skin condition that mostly affects your face.

At first, it often causes temporary facial ‘flushing’ – when your skin turns red and/or feels warm (though some people get other symptoms, without flushing). Eventually, your skin may be red or feel warm most or all the time.

This is caused by widened blood vessels. You may also have small broken blood vessels that don’t go away, and possibly bumps and pus-filled spots that can look similar to acne. Some people develop thickened areas of skin over time, too.

Rosacea mainly affects areas of your face such as your cheeks, forehead, chin and nose. In rare cases, it can spread to your neck, chest, ears or scalp.

It can often affect your eyes, too, leaving them bloodshot and irritated. This is called ‘ocular rosacea’, and up to 75% of people with rosacea get it.

Who gets rosacea?

Rosacea usually starts between the ages of 30 and 60 (it’s less common in children, although they can get it).

You’re more likely to be diagnosed with it if:

  • you’re a woman – figures show that about 5.4% of women have rosacea, compared with 3.9% of men. But when men get rosacea, it can be more severe
  • you have pale skin and blue eyes – and are of North European or Celtic origin. You can also get rosacea if you have dark skin, but symptoms can be harder to spot, so it may be under-diagnosed
  • someone else in your family has it – while scientists don’t understand exactly how genetics play a part in rosacea, it does seem to run in families. And new research is showing this may be more common than previously thought
  • you’ve had severe acne with cysts – in the past, rosacea was sometimes called ‘acne rosacea’. But the 2 conditions are different, even though this kind of acne is linked to rosacea

Rosacea symptoms

As well as facial flushing, there are several other signs and symptoms of rosacea. These can vary from person to person, and over time.

It’s what’s known as a ‘relapsing’ condition. This is because your symptoms can get worse – or ‘flare up’ – during certain periods, and be milder and less obvious at other times.

Common rosacea symptoms include:

  • facial blushing or flushing, with a warm feeling
  • redness, particularly on your cheeks and nose – if you have white skin
  • darker patches, or a dusky brown discolouration – if you have brown or black skin
  • visible broken blood vessels
  • sensitive skin that may sting and burn
  • dry, rough or scaly skin
  • breakouts of spots that look similar to acne – often where your skin is very red
  • oily skin
  • slightly raised patches of skin, known as ‘plaques’

In some cases, you may also develop other symptoms over time, including:

  • a bumpy texture to your skin
  • thickened skin – usually on your nose, but it can also happen on your cheeks, chin, forehead or ears
  • enlarged pores on your skin

As mentioned above, many people get eye symptoms (ocular rosacea) as well as skin symptoms. It’s also possible to get ocular rosacea on its own. Or in some cases, eye symptoms appear first, then your skin is affected later.

Ocular rosacea symptoms include:

  • red and irritated eyes – they may feel gritty or dry
  • burning, stinging or watery eyes
  • bloodshot eyes
  • broken blood vessels on your eyelids
  • other eye conditions, such as
    conjunctivitis
    , a
    stye
    ,
    blepharitis
    or a
    chalazion

Less commonly, ocular rosacea can lead to more serious problems with the surface of your eye (cornea), such as

keratitis
, which can cause blurred vision and sensitivity to light.

If you think you have symptoms of rosacea, use our

Smart Symptom Checker
to get more information, and see a doctor for a diagnosis.

What does it feel like to have rosacea?

Having rosacea can chip away at your confidence. Surveys by the National Rosacea Society in the US show that almost 90% of people with rosacea feel it has lowered their self-confidence and self-esteem. And 41% say they’ve cancelled social plans because of it.

You may even find that people wrongly believe you drink too much alcohol (or you worry that this is what people think). Or maybe you feel it makes people think that you’re embarrassed or shy, when you’re not – and this undercuts their faith in you at work.

Plus, because there are various things that can cause rosacea to get worse, you may start to avoid your ‘triggers’. All of which means rosacea can have a big effect on your day-to-day life.

What causes rosacea?

We don’t know exactly what causes rosacea. But scientists have uncovered some links, which might help us understand more in the future.

The latest research has found that:

  • most people who get acne-like breakouts with rosacea react to a bacterium called Bacillus oleronius. This causes their immune system to overreact (though we don’t know if this is what cause rosacea)
  • a microscopic mite called Demodex folliculorum – which lives on human skin – is often found in high numbers on people with rosacea. It’s thought that these mites could trigger an immune response, or play a part in causing inflammation
  • how your body processes a protein called cathelicidin – which normally protects your skin from infection – may affect whether you get rosacea
  • bacteria called Helicobacter pylori – which can cause stomach infections – are common in people with rosacea. But lots of people have an H. pylori infection without rosacea, so the connection isn’t clear

Rosacea triggers

While we don’t know what causes rosacea, we do know that certain things about your lifestyle and environment can trigger rosacea flare-ups.

Over time, these flare-ups can make your condition worse overall. Your skin can stay flushed for longer each time they happen, and may eventually stay red permanently. It can also lead to other symptoms, such as broken blood vessels and skin thickening.

It’s important to know what your triggers are, so you can avoid them or take steps to manage them. These can vary a lot between people, but common triggers include:

  • sun exposure – this was the most common trigger in a National Rosacea Society survey, reported by 81% of people
  • stress – this was the second most common trigger in the survey
  • heat
  • cold, windy conditions
  • certain foods – including spicy food, mustard, pepper and vinegar
  • hot drinks
  • hot baths
  • alcohol – while research shows drinking alcohol can increase your risk of rosacea, it isn’t a sign that you drink too much, and people who never drink can still get it
  • exercise
  • certain household cleaning products and detergents – such as aerosols, laundry cleaners and window cleaners
  • menopausal hot flushes
  • using
    steroid creams
    on your face
  • certain medications – such as calcium channel blockers, used for
    high blood pressure

There’s also some evidence that mask-wearing – such as because of COVID-19 – can trigger rosacea in some people. It’s thought this could be due to irritation caused by having the mask resting on your skin and the warm, humid environment this creates.

What DOESN’T cause rosacea

There are a few common misconceptions about rosacea triggers. It’s NOT caused by:

  • poor hygiene
  • catching it from someone else – rosacea isn’t infectious, and you can’t pass it on
  • caffeine – it’s the heat from tea or coffee that can trigger flare-ups, not the caffeine

Self-care strategies to manage your rosacea

While you can’t get rid of rosacea, there are several things you can do to help you cope with it and prevent flare-ups.

Avoid your triggers

Not sure what triggers your flare-ups? Try keeping a diary of your daily activities and events, to see if you notice any patterns. Once you do, you can then try to avoid these triggers as much as possible.

Boost your sun protection

Sun exposure is a common trigger for rosacea flare-ups, so it’s important to protect your skin:

  • wear sunscreen every day (even if it’s cloudy), and reapply it regularly
  • use a product with a sun protection factor (SPF) of at least 30
  • look for mineral or ‘barrier’ sunscreens that contain zinc or titanium dioxide – these can be less irritating for rosacea than chemical and alcohol-based sunscreens
  • stay out of the sun during the hottest parts of the day

Read more about

staying safe in the sun
, and
sunscreen and how to use it
.

Find useful information on other areas of sun safety with our

complete Guide
.

Pay attention to your skincare routine

  • pick gentle products – avoid toners, astringents and chemical exfoliators such as alpha hydroxy acids (AHAs), as these can irritate your skin. The same goes for exfoliating with rough sponges or cloths. It’s better to go for mild skincare products, in the form of foams, powders or creams
  • ace your cleanse – clean your face gently with lukewarm water, using the tips of your fingers (avoid any harsh scrubbing). Choose a soap-substitute (emollient) or soap-free liquid cleanser or beauty bar without any perfume, which has a pH similar to the pH of your skin. If your skin is very sensitive, it may be best to cleanse only once, morning and night, to help avoid irritation – you may need to experiment a bit to see what works for you
  • don’t forget to moisturise – particularly if your skin is dry or sensitive. This strengthens your skin’s barrier, which could help manage your rosacea. (In 1 small study of people with rosacea, moisturising twice a day reduced skin sensitivity, dryness and discomfort.) Remember to choose a product without any perfume

Experiment with beauty products

Make-up doesn’t treat rosacea. But if you feel self-conscious about how your skin looks, it can help to minimise the appearance of it:

  • green-tinted primers or foundations can tone down redness and make your skin tone look more even
  • choose oil-free foundations and concealers
  • go for multi-purpose products, such as green-tinted base that also contains sunscreen – the more products you put on your skin, the higher the chance of irritation
  • mineral make-up usually contains fewer ingredients that might irritate your skin

Try simple stress-busters

If you find that stress triggers your flare-ups, work on techniques to help you manage it – such as:

  • trying
    breathing exercises
    when you’re feeling tense
  • making time for activities that make you feel good – such as reading or seeing friends

Read more about

stress relief
.

Get support from others

Having rosacea can affect the way you feel about yourself – and the way other people see you. If this happens, it can feel lonely and upsetting. But there is help out there. Support groups can be a brilliant way of connecting with other people going through the same thing.

The UK charity Changing Faces has an

online chat forum
, where you can speak to people with rosacea, or you can call its
support and information line
. You could also try the US online forum
Rosacea Support Community
.

Doctor’s tip

“Exercise can be a brilliant stress-buster, and it’s also important for your overall health,” says Dr Nainan. “So even if it triggers rosacea flare-ups, it’s important to stay active. Try to exercise in cooler temperatures (such as in the morning or evening), and choose low-impact activities. And break your exercise into chunks, rather than doing 1 long workout. Some people with rosacea say that aqua aerobics – where you work out in a swimming pool – is a good option for them.”

When to see a doctor about rosacea

If you think you have rosacea, make an appointment with your doctor. Getting the right diagnosis and treatment can help stop your symptoms getting worse.

How is rosacea diagnosed?

In most cases, your doctor will make a diagnosis by looking at your skin, so you won’t need any tests.

You can be diagnosed with rosacea if you have either of the following symptoms:

  • persistent redness
  • thickened skin

Or if you have at least 2 of these symptoms:

  • flushing
  • bumps and pimples
  • visible blood vessels
  • irritated eyes

Rosacea treatment

Your doctor may prescribe medicines that you swallow or apply to your skin – or a combination of these – or recommend other treatments.

What’s right for you will depend on your individual symptoms and preferences:

  • if you have persistent redness – you may be prescribed brimonidine gel, which you apply to your skin to temporarily reduce redness. Laser and light-based therapies may sometimes be recommended, which can help reduce redness and the appearance of broken blood vessels
  • for bumps and pimples – you may be prescribed a cream containing ivermectin. Experts think this helps because it’s anti-inflammatory, and it may also kill the mites that may be linked with rosacea
  • if flushing is a big problem – your doctor may suggest taking
    beta-blockers
    , such as propranolol or clonidine
  • for inflammation – creams containing metronidazole (an
    antibiotic
    ) or azelaic acid may be prescribed. Oral antibiotics can also help if you have moderate or severe rosacea. These include tetracycline, oxytetracycline, doxycycline, lymecycline, minocycline and erythromycin. How long you take them for depends on how you respond, but it’s usually for up to 3 months
  • if you have severe rosacea – you may be prescribed isotretinoin tablets, which are used by specialists to treat severe acne
  • for severe skin thickening – a type of laser therapy called CO2 laser ablation can help, particularly on your nose. In some cases, a procedure to shave off some of the extra tissue may be recommended

If self-care steps and treatments from your doctor aren’t helping, you might be referred to a skin specialist (dermatologist). This can also happen if your doctor isn’t sure whether you definitely have rosacea.

When to see a doctor urgently

You should see a doctor straight away or go to your nearest emergency department if you have rosacea and:

  • your eye is red and very painful or feels gritty
  • you have blurred vision
  • you’re sensitive to light

These can be signs of keratitis, which can be serious if it isn’t treated.

Your health questions answered

What is ‘acne rosacea’?

“Acne and rosacea are 2 separate conditions. Sometimes it can be hard to tell them apart, even for doctors – both can cause breakouts, pimples and bumps. But there are some key differences we look for. Blackheads are common signs of acne, but not rosacea. While flushing and broken blood vessels point to rosacea rather than acne. Other things that can give clues include your age – acne is more common in teens and young adults – and which part of your face is affected – rosacea can also affect your eyes and scalp. But they’re not foolproof. See your doctor, so they can help you work it out. It can be helpful to take photos of your skin, in case you're not having a flare-up when you see them.”

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.