Rosacea is a chronic inflammation of the skin that leads to a rash in the central part of the face. The inflammation stimulates the blood vessels in the facial skin, resulting in increased redness, flushing, and small dilated blood vessels.
The condition is common in Northern Europe, particularly among women between the ages of 30 and 60. Approximately 5% of all adults develop rosacea. The condition is not contagious.
There are various subtypes of rosacea, and some patients may have overlapping symptoms consistent with multiple subtypes.
Rosacea is characterized by a wide range of skin changes in the face, including redness (erythema), flushing, dilated blood vessels (telangiectasia), and pimple-like rash (papules and pustules). Common areas of involvement are the forehead, nose, and cheeks. There is typically a clear zone around the eyes and mouth.
The condition typically starts with intermittent flushing in early adulthood. Over time, more chronic and established skin changes develop. Accompanying skin issues may include a burning, stinging, and sometimes tender sensation. Many patients also report increased sensitivity to light.
In some individuals, particularly older men, there may be a thickening of the sebaceous glands and skin on the nose. This is called rhinophyma or "potato nose." You can read more about rhinophyma here (LINK).
Rosacea can also involve the eyes, known as ocular rosacea. This subtype of rosacea can cause eyelid inflammation (blepharitis), a sensation of having foreign bodies in the eyes, and light sensitivity. In severe cases, there is a risk of serious eye complications, including corneal inflammation (keratitis). In rare cases, a biopsy (tissue sample) and blood tests may be necessary to exclude similar conditions.
The exact cause of rosacea is unknown, but there is evidence suggesting a combination of genetic and environmental factors. It has been observed that 15-40% of affected individuals have first-degree relatives with the condition.
The development of the disease may be linked to altered functioning of the blood vessels in facial skin. Sun damage also appears to be a contributing factor. Some publications have shown that bacteria and mites that normally reside in the sebaceous glands of the skin can contribute to the inflammation.
Patients with rosacea typically describe a range of factors that exacerbate the rash and accompanying skin issues. Common aggravating factors include intense sunlight, hot food and beverages (coffee and tea), spicy foods, alcohol, and stress. The use of corticosteroid creams can also worsen the condition.
The treatment of rosacea focuses on alleviating symptoms and involves a range of prescription medications. These can include topical treatments and/or oral medications.
Different types of rosacea require slightly different approaches: For primarily facial redness, redness-reducing topical treatments can be attempted. Creams with a green base can also partially camouflage the redness. Intense pulsed light (IPL), laser treatments, and medications may also be options.
For more pimple-like rash, various topical treatments and oral medications are available. Low-dose oral antibiotics taken over several weeks can be helpful. In more rare cases, there may be an indication for low-dose vitamin A-like medications taken over several months to years.
Relapse rates after treatment cessation are high in rosacea. In one study, 40% of individuals experienced a relapse six months after discontinuing treatment. Therefore, it is important to be aware of aggravating factors and try to avoid them as much as possible. The use of sunscreen with high sun protection factor (SPF) is essential, and there are specific sunscreens suitable for rosacea.
There are several similar conditions, including acne and perioral dermatitis. Unlike acne, rosacea patients do not have comedones (blackheads and whiteheads). Unlike perioral dermatitis, rosacea rarely presents with a rash around the mouth or scaly skin changes. Systemic lupus erythematosus is a rare condition that can cause a similar redness over the bridge of the nose and cheeks (known as "butterfly rash"). This diagnosis should always be considered in cases of increased redness in the central part of the face.
