Rosacea

What is rosacea?

Rosacea is a frequent, long-lasting skin condition centred on the middle of the face, namely the cheeks, nose, forehead and chin. It causes flushing, persistent redness, visible blood vessels and, in some people, acne-like spots. It tends to come and go, with flare-ups and calmer periods. Less often, it can affect the neck, chest, scalp or ears.

Who gets it?

Rosacea can start at any age, including in young adults, but it is most often diagnosed between the ages of 30 and 60. Although seen more often in fair skin, rosacea affects every skin type, and it is frequently missed in brown and black skin. It is more common in women, but men can have more severe disease, including thickening of the skin of the nose.

What causes it?

The cause is not fully understood. Changes in the blood vessels of the face, an overactive immune response, sensitivity of the nerves in the skin, and a tiny mite called Demodex that lives in hair follicles may all play a part. Genetics and sun damage also contribute.

Many people notice particular triggers that bring on flushing or flares. These commonly include alcohol, especially red wine, hot drinks, spicy food, hot or cold weather, wind, hot baths and saunas, exercise, sunlight, stress and some skincare products. Triggers vary from person to person.

Steroid creams used on the face can cause or worsen a rosacea-like rash.

Is it hereditary or contagious?

Rosacea seems to run in some families. It is not contagious.

What does it look and feel like?

Rosacea usually begins with a tendency to flush or blush easily. Over time, the central face can develop persistent redness, and small dilated blood vessels (telangiectasia) may become visible. Some people develop red bumps and pus spots that look similar to acne, but unlike acne, rosacea does not cause blackheads or whiteheads. In brown and black skin the redness may be subtle, and rosacea can instead show as a dusky or darker, sensitive area with bumps.

The skin is often sensitive, and may feel hot, stinging or burning, especially with skincare products. Some people get swelling of the face, particularly around the eyes.

In some people, especially men, the skin of the nose gradually thickens and becomes enlarged and bumpy. This is called rhinophyma.

Occular rosacea

Rosacea can affect the eyes in many people, sometimes before the skin. Ocular rosacea can cause gritty, dry, watery, red or burning eyes, sensitivity to light, inflamed eyelids (blepharitis) and recurrent styes. Rarely, it can affect the surface of the eye (the cornea) and cause blurred vision. Any eye pain, reduced vision or marked sensitivity to light should be assessed promptly.

The emotional impact

Facial redness and flushing can be embarrassing and can affect confidence, social life and work. Many people with rosacea experience anxiety or low mood, and it is worth discussing this.

How is it diagnosed?

Rosacea is diagnosed from its appearance and history. Tests are not usually required. Several conditions can look similar, including acne, seborrhoeic dermatitis, perioral dermatitis, contact dermatitis and, occasionally, lupus, so a careful assessment is helpful.

What are the treatment options?

Dr Mounsey will confirm the diagnosis, identify your triggers and look for eye involvement. Treatment depends on whether redness, spots or thickening are the main issue. Options include creams such as ivermectin, metronidazole or azelaic acid, and tablets such as low-dose doxycycline for more widespread spots. Persistent redness may respond to brimonidine gel or vascular laser treatment, and isotretinoin at low dose can help resistant cases. He will also advise on gentle skin care, sun protection and practical ways to reduce flushing.

What is the outlook?

Rosacea is a long-term condition and cannot be cured, but it can be well controlled. Identifying and avoiding personal triggers and protecting the skin from the sun can make a real difference.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/rosacea

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.