Rosacea: Symptoms, Causes, Diagnosis, Prevention & Treatments

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Rosacea is a long term and chronic condition of the skin. It causes inflammation of the skin and most frequently affects the face. The condition tends to worsen over time if it not treated properly. This condition might often be mistaken to be either acne, eczema or some allergic reaction on the skin.

This condition is benign inflammation of the skin which occurs mostly in adults and has a worldwide distribution. This disease has a more common occurrence in fair skinned people as compared to dark skinned people. Though it can affect anyone, it commonly occurs in middle aged women who are fair skinned.

The condition presents itself with redness of the skin on the face, red bumps on the skin which might contain pus, small and dilated blood vessels, cysts and irritation in the eyes. Most of the times people confuse this condition with the thought that their skin is sensitive and blushes or flushes easily. The flare ups of this condition happen in cycles which means that these signs can appear for periods ranging from week to months and then can disappear for some time. Most of the times the chin, nose, forehead and the cheeks are most affected.

There is no definite cause for the condition but individuals with a family history of the disease are at a higher risk than others. Some other factors that are known to aggravate the condition are alcohol, menopause, exercise, sunlight, heat, spicy food, steroid cream on the face, stress and cold. This is not an infectious disease. The condition waxes and wanes and is considered to be an auto-inflammatory condition of the skin. In contrast to acne that occurs during the teenage years on an individual, this condition does not go away.

The redness of the skin that occurs in this condition which is often exacerbated by flushing causes the small blood vessels present in the face to dilate and enlarge permanently which makes them more visible through the skin, looking like small red lines on the face. Episodes occurring repeatedly or in high frequency aggravate the inflammation and cause red bumps which look like acne to appear on the skin. This is the reason that this condition is also known as acne rosacea. One unpleasant effect of rosacea on the skin is the overgrowing of dermal tissues which leads to the production of phymatous changes in the skin appearing as permanent swelling and thickening of tissues of the face. An example of this is a bulbous nose which is known as rhinophyma.

Though rosacea and acne are two different skin conditions, they show certain similarities. Rosacea is often called as adult acne. As opposed to acne, rosacea does not have blackheads, occurs mostly in adults and does not go away after puberty. This condition happens frequently in women but the severity is more in men. This condition affects around one and ten percent of the people worldwide.

Types of Rosacea:

–  Subtype one also known as erythematotelangiectatic rosacea or ETR causes redness on the face, flushing and is associated with visible blood vessels.

–  Subtype two also known as papulopustular or acne rosacea causes breakouts as experienced in acne, swelling, redness and breakouts and occurs mostly in middle aged women.

–  Subtype three also known as phymatous rosacea or rhinophyma is a rare type of rosacea which causes the skin on the nose to thicken. The skin resembles a bumpy texture. It mostly affects men and occurs with another subtype of rosacea.

–  Subtype 4 also known as o cular rosacea affects the eye area. It makes the eyes red and swollen and causes irritation in the eyes.

–  Another form of rosacea known as steroid rosacea occurs due to the use of corticosteroids, more so if used for the treatment of vitiligo and dermatitis.

Risk Factors and Triggers of Rosacea:

The risk of developing rosacea is more if the individual is a woman, is over the age of 30, has a family history of the condition, indulge in smoking or is fair skinned and the skin has been damaged by the sun.

Some triggers of rosacea include caffeine, dairy products, spicy food, sunlight, wind, humidity, vigorous exercise, hot foods or drinks, acute medical conditions like cold, cough or a fever, chronic conditions like hypertension, hot baths or saunas, medicines used for treating conditions like high blood pressure, extremes of temperature etc. Alcohol can also be a trigger for some people.

Signs and Symptoms of Rosacea:

The signs and symptoms of this condition vary from person to person. The most common signs and symptoms include:

Facial skin hyper reactivity:

The sensitive blood vessels very easily dilate on being touched. This can also happen because of other physical stimuli like sunlight. Many a times this is mistaken for sensitive skin, but it is caused by the sensitivity of the blood cells and not because of sensitive skin.

Pimples, papules and pustules:

This is in case of inflammatory rosacea. Small spots, papules and pustules occur on the face in this condition. The misdiagnosis of this condition is easy because of its resemblance to acne, however there are no blackheads associated with this condition which might make it easier to identify.


The episodes related to flushing can last for as long as five minutes. This condition of easy blushing can start from the face and spread to the neck and chest. The skin might feel hot and unpleasant during the episode.

Persistent redness:

Episodes of flushing might be followed by episodes of redness. The redness which appears is difficult to get rid of. This occurs because of the dilation of the many blood vessels on the face.

Inflamed blood vessels:

This is known as vascular rosacea. When the symptoms progress, the blood vessels on the cheeks and nose start becoming visible and might appear like spider webs. The facial skin also tends to become blotchy.

Facial Swelling:

Fluid build-up might happen in the facial skin because of leakage of excessive fluids and proteins from the blood vessels. This leakage is not drained promptly out of the system by the lymphatic symptom.

Excess facial skin around the nose:

The facial skin around the nose might thicken. This is known as rhinophyma. This is rare and happens more often in males than females. The nose can also become enlarged.

Ocular rosacea:

Conjunctivitis might be caused because of the inflammation of the inside of the eyelid. Sties can also develop in some people. Eyes appear bloodshot because of a burning sensation in the eyes. In some rare occurrences, vision might become blurred.

Causes of Rosacea:

Light skin colour: People with light skin are more prone to develop rosacea.

Family history: Genes play a role in the development of the condition. It is more common in people who have a close relative suffering from this condition.

Abnormalities in facial blood vessels: Abnormalities present in the blood vessels of the face can lead to redness, flushing and visibility of the blood vessels. The exact cause of the inflammation of the blood vessels is still not known.

Demodex folliculorum (microscopic mite): These creatures reside on the human skin and generally are harmless. But people suffering from rosacea are found to have a higher number of these mites living on their skin. It is not exactly known if the mites cause the condition or is it an effect because of the condition.

Intestinal bacteria: The H. pylori bacteria which is found in the gut of humans is known to stimulate the production of bradykinin, which causes the blood vessels to dilate. This bacterium has been associated with the development of the condition.

Diagnosis of Rosacea:

Rosacea can be easily diagnosed by the doctors just by looking at the patient’s skin. There are no particular tests for rosacea. The doctors will examine the patient’s skin and how long ago the symptoms surfaced. The doctors will differentiate the skin infection from other skin diseases because of the enlarged blood vessels. Timely treatment and diagnosis of rosacea is important to curb rosacea and stop it from progressing. Most people would not discuss the infection in cases of mild rosacea, but it is important to see a doctor if you have developed it as it is indistinguishable from some other diseases.

It is important to visit a doctor to confirm the cause and the severity of the skin disease. It is also important to see a doctor if the skin disease starts affecting your eyes, it can lead to itchy, painful, dry and bloodshot eyes. It even affects the eyelids. If the infection is not treated it can also result in serious damage to the eyes. The doctors will conduct tests to rule out chances of any other skin condition such as psoriasis, lupus or eczema as these conditions cause symptoms similar to the symptoms caused by rosacea.

Treatment of Rosacea:

The treatment for rosacea focuses on controlling the symptoms and signs. This is often done using a combination of prescribed treatments and personal skin care. The duration and the type of treatment is determined by the severity of the condition. Mild rosacea might not require any treatment. One should take doctor’s advice for treatments of the skin condition include:

Topical Medications:

Topical medications can help control the symptoms caused by the skin condition effectively. Topical medication is prescribed by the doctor to apply once or twice each day. Applying topical anti-biotic medication like metronidazole (Metrogel) once or twice every day after cleansing yourself can improve the condition significantly.  Another effective treatment for the patients of the skin condition is azelaic acid (Azelex cream, Finacea gel 15%). Both these medications work to control bumps and redness caused by rosacea.

Many may even choose a combination therapy and alternate between the use of metronidazole and azelaic acid, applying one in the morning and the other in the night to notice significant improvements. Other topical creams include clindamycin (Cleocin) and erythromycin. Newer topical gels and creams such as oxymetazoline hydrochloride cream (RHOFADE) and brimonidine gel (Mirvaso) help in relieving the redness caused by the skin condition. Sodium sulfacetamide (Klaron lotion) is prescribed by the doctors to reduce the inflammation of the skin.

Oral Antibiotics:

Patients with mild rosacea are usually prescribed oral antibiotics. Many oral antibiotics are thought to work such as tetracycline (Sumycin), minocycline (Dynacin, Monacin) and doxycycline (Oracea, Vibramycin, Atridox, Adoxa). These oral antibiotics work by reducing the inflammation of the skin. Potential risks and other common side effects should be taken into account before taking oral antibiotics and other such medications and drugs.


Skin cleansers can provide control and relief from the symptoms as well. These skin cleansers can be both over the counter ones and the prescribed ones. The doctors suggest the patients to avoid harsh lotions, soaps, face washes and body washes. Less irritating skin products such as Purpose gentle skin cleansers are suggested by the doctors to the patients. Benzoyl peroxide washes such as Clearasil and sulfa-based washes such as Rosanil are also suggested by the doctors or the skin specialists. Many patients even opt for a combination therapy, which means that they use these skin cleansers along with the medications prescribed by the doctors.

Laser therapy:

Intense pulses from a laser light are used to treat the continuous redness on the face, chest and the neck. Multiple treatments are required and during the treatment the patient is required to avoid the sunlight. Risks and other alternatives should be considered first before choosing laser therapy or intense light pulse therapy for rosacea. Laser therapy is a safe alternative and the improvement to the complexion and the condition of the skin is noticeable very quickly.

Other treatments:

Other treatments include glycolic-acid peels, these peels may help in improve and control the skin conditions. They can be applied professionally for two to five minutes every two or four weeks. Not everyone is able to handle such treatments and therefore it is advised to take caution in this treatment.

Sun protection using masks, hats and sun-blocks creams or sunscreens is also suggested as exposure to sunlight is the cause for rosacea in many patients. Use of an at least SPF 50 sunscreen is suggested every day.


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