Rosacea – spot the signs and calm your skin

Skin redness and sensitivity could be signs of rosacea, making you feel embarrassed and self-conscious. Find relief plus skincare tips 

What are the symptoms?

Who gets rosacea?

What causes it? 

When to see a doctor

How is rosacea diagnosed?

What’s the treatment for rosacea?

Self-care strategies  

Do you blush easily? Perhaps you have redness, warm skin, spots with broken blood vessels or find your skin stings after applying products or water? These could be signs of the skin condition rosacea. Read on for the facts plus treatment tips.

Rosacea is a long-term (chronic) inflammatory skin condition that’s thought to affect about 5% of adults worldwide. It’s more common in women but tends to be more severe in men. 

The condition 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.

Rosacea 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.	

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


## What are the symptoms?

Symptoms of rosacea can vary from person to person, and over time. They 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 that comes and goes – your face may feel warm or painful
- redness, particularly on your cheeks and nose that lasts – if you have white skin
- darker patches, or a dusky brown discoloration that lasts – 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
- slightly raised patches of skin, known as ‘plaques’.

In some cases, you may also develop thickened skin – usually on your nose, but it can also happen on your cheeks, chin, forehead or ears.

Many people get eye symptoms (ocular rosacea) too – either on their 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 
- broken blood vessels on your eyelids
- other eye conditions, such as [conjunctivitis](/health-library/conditions/conjunctivitis-infective), a [stye](/health-library/conditions/stye), [blepharitis](/health-library/conditions/blepharitis) or a [chalazion](https://www.livehealthily.com/health-library/conditions/chalazion).

Less commonly, ocular rosacea can lead to more serious problems with the surface of your eye (cornea), such as [keratitis](https://www.livehealthily.com/health-library/conditions/keratitis), which can cause eye pain, blurred vision and sensitivity to light.

If you think you have symptoms of rosacea, [see a doctor](https://www.livehealthily.com/health-library/conditions/rosacea#when-to-see-a-doctor) for a diagnosis.


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## Who gets rosacea?

Rosacea usually starts between the ages of 30 and 60. 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
- __you have pale skin and blue eyes__ – 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. 


## What causes it? 

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

- most people who get acne-like breakouts with rosacea react to a bacterium called Bacillus oleronius. This causes the immune system to overreact (though we don’t know if this is what causes 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, but more research is needed
- 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.

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

- sun exposure
- stress
- hot or cold temperatures – from hot baths to cold winds
- spicy food
- hot drinks 
- alcohol
- aerobic exercise 
- some medications.


## When to see a doctor

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

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

- you have a red eye
- your eye is painful or feels gritty
- you have blurred vision
- you’re sensitive to light.

These can be signs of [keratitis](https://www.livehealthily.com/health-library/conditions/keratitis), which can be serious if it isn’t treated. 

## How is rosacea diagnosed?

In most cases, your healthcare professional can make a diagnosis by looking at your skin and asking about your symptoms. 

You may need tests to check for conditions such as lupus, as this can also cause color change in the face. 

In some causes a skin biopsy – where a small amount of your skin is removed to be examined under a microscope – is done to test for a rare type of rosacea called granulomatous rosacea. 


## What’s the treatment for rosacea?

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

- prescription creams and gels – one type is those containing ingredients such as azelaic acid and ivermectin to help control inflammation
- antibiotics – in cream or tablet form to be taken for 6 to 16 weeks to help relieve bumps and pimples
- laser therapy to help improve the appearance of long-term redness.

Alongside these treatments, follow self-care steps to help manage your symptoms.


## Self-care strategies  

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__ – keep a diary to see if you notice any patterns in flare-ups so you can help limit them
- __[protect your skin](https://www.livehealthily.com/self-care/safety-in-the-sun-how-to-get-the-health-benefits-without-the-risks)__ – by staying out of the sun during the hottest parts of the day and use a sun protection factor (SPF) of at least 30 (mineral or ‘barrier’ sunscreens that contain zinc or titanium dioxide can be less irritating for skin)
- __go for mild skincare products__, in the form of foams, powders or creams and avoid toners, astringents and chemical exfoliators such as alpha hydroxy acids (AHAs), as these can irritate it 
- __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 
- __don’t forget to moisturize__ – particularly if your skin is dry or sensitive. This strengthens your skin’s barrier, which could help manage your rosacea. Choose a non-perfumed product
- __try green-tinted primers or foundations__ (that tone down redness), and mineral make-up that contains fewer ingredients that might irritate your skin
- __manage stress__ – it can trigger flare ups. Try [breathing exercises](https://www.livehealthily.com/self-care/5-new-years-resolutions-to-boost-family-health#video-box-breathing) when you’re feeling tense and make time for activities that help you relax, such as reading.

### Get support from others

Having rosacea can affect the way you feel about yourself – and the way other people see you. It can feel lonely and upsetting. But there is help out there. 

The UK charity Changing Faces has an [online chat forum](https://www.changingfaces.org.uk/services-support/online-community/), where you can speak to people with rosacea. You could also try the US online forum [Rosacea Support Community](https://rosacea-support.org/community/).


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References

 Christina Quaine

Rosa Bowden

Jo Wheatley

Dr Maria Reza

Dr Ann Nainan

Dr Adiele Hoffman

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