Rosacea (roe-ZAY-she-uh) is a common skin condition that causes redness and visible blood vessels in your face. It may also produce small, red, pus-filled bumps. These signs and symptoms may flare up for a period of weeks to months and then diminish for a while. Rosacea can be mistaken for acne, an allergic reaction or other skin problems.
Rosacea can occur in anyone. But it most commonly affects middle-aged women who have fair skin. While there's no cure for rosacea, treatments can control and reduce the signs and symptoms. If you experience persistent redness of your face, see your doctor for a diagnosis and proper treatment.
Signs and symptoms of rosacea may include:
- Facial redness. Rosacea usually causes a persistent redness in the central part of your face. Small blood vessels on your nose and cheeks often swell and become visible.
- Swollen red bumps. Many people who have rosacea also develop pimples on their face that resemble acne. These bumps sometimes contain pus. Your skin may feel hot and tender.
- Eye problems. About half of the people who have rosacea also experience eye dryness, irritation and swollen, reddened eyelids. In some people, rosacea's eye symptoms precede the skin symptoms.
- Enlarged nose. Rarely, rosacea can thicken the skin on the nose, causing the nose to appear bulbous (rhinophyma). This occurs more often in men than in women.
When to see a doctor
If you experience persistent redness of your face, see your doctor or a skin specialist (dermatologist) for a diagnosis and proper treatment.
The cause of rosacea is unknown, but it could be due to a combination of hereditary and environmental factors. Rosacea is not caused by poor hygiene.
A number of factors can trigger or aggravate rosacea by increasing blood flow to the surface of your skin. Some of these factors include:
- Hot drinks and spicy foods
- Temperature extremes
- Sunlight or wind
- Drugs that dilate blood vessels, including some blood pressure medications
Anyone can develop rosacea. But you may be more likely to develop it if you:
- Are a woman
- Have fair skin, particularly if it has been damaged by the sun
- Are over age 30
- Have a family history of rosacea
In severe and rare cases, the oil glands (sebaceous glands) in your nose and sometimes your cheeks become enlarged, resulting in a buildup of tissue on and around your nose — a condition called rhinophyma (rie-no-FIE-muh). This complication is much more common in men and develops slowly over a period of years.
There's no specific test for rosacea. Instead, doctors rely on the history of your symptoms and a physical examination of your skin. In some cases, your doctor may have you undergo tests to rule out other conditions, such as other forms of acne, psoriasis, eczema or lupus. These conditions can sometimes cause signs and symptoms similar to those of rosacea.
If your eyes are involved, your doctor may refer you to an eye specialist (ophthalmologist).
Treatment for rosacea focuses on controlling signs and symptoms. Most often this requires a combination of skin care and prescription treatments.
The duration of your treatment depends on the type and severity of your symptoms. Recurrence is common.
The type of medication your doctor prescribes depends on what signs and symptoms you're experiencing. Prescription drugs for rosacea include:
Medications that reduce redness. Recent studies have shown the drug brimonidine (Mirvaso) to be effective in reducing redness. It is applied to the skin as a gel. It works by constricting blood vessels. You may see results within 12 hours after application. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to maintain any improvements seen.
Other topical products that have been shown to reduce redness and the pimples of mild rosacea are azelaic acid and metronidazole. With these drugs, improvements generally don't appear for three to six weeks.
- Oral antibiotics. Antibiotics help reduce some types of bacteria but likely mainly fight inflammation when used for this disease. Doxycycline is an antibiotic taken as a pill for moderate to severe rosacea with bumps and pustules. Other similar oral antibiotics are also sometimes used (tetracycline, minocycline, others), but their effectiveness isn't as well-supported by studies.
- Isotretinoin. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acne-like lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects.
Laser therapy may help reduce the redness of enlarged blood vessels. Other options for treating visible blood vessels and changes due to rhinophyma are dermabrasion, intense pulsed light therapy and electrosurgery.
Gentle daily facial massage may help reduce swelling and inflammation. Use a circular motion with your fingers starting on the central part of the face and work toward the ears.
Many other alternative therapies — including colloidal silver, emu oil, laurelwood and oregano oil — have been touted as possible ways to treat rosacea. But no conclusive evidence supports the idea that any of these substances are effective.
Talk with your doctor if you're considering dietary supplements or other alternative therapies to treat rosacea. He or she can help you weigh the pros and cons of specific alternative therapies.
You're likely to start by seeing your family doctor or a general practitioner. Or when you call to set up an appointment, you may be referred to a skin disease specialist (dermatologist). If your condition affects your eyes, you may be referred to an eye specialist (ophthalmologist).
It's a good idea to prepare for your appointment. Here's some information to help you.
What you can do
Preparing a list of questions will help you make the most of your appointment time. For rosacea, some basic questions to ask your doctor include:
- What might be causing the signs and symptoms?
- Do I need tests to confirm the diagnosis?
- What is the best treatment?
- Is this condition temporary or chronic?
- Is there a generic alternative to the medicine you're prescribing?
- I have other medical problems; how can I manage them together?
- Can I wait to see if the condition resolves on its own?
- What are the alternatives to the approach that you're suggesting?
- What skin care routines do you recommend I use?
Don't hesitate to ask any other questions that come up during your appointment.
What to expect from your doctor
Your doctor is likely to ask you several questions, including:
- When did you begin experiencing symptoms?
- How often do you experience these symptoms?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to trigger or worsen your symptoms?
These practices may help you reduce signs and symptoms or prevent flare-ups:
- Avoid triggers. Know what tends to cause flare-ups for you and avoid those triggers.
- Protect your face. Apply sunscreen daily. Use a broad-spectrum sunscreen with an SPF of 30 or higher. Take other steps to protect your skin, such as wearing hats and avoiding midday sun. In cold, windy weather, wear a scarf or ski mask.
- Treat your skin gently. Don't rub or touch your face too much. Use a nonsoap cleanser and moisturize frequently. Avoid products that contain alcohol or other skin irritants.
- Apply makeup. Some makeup products and techniques may help reduce the appearance of skin redness. For example, apply green-tinted makeup before a light liquid foundation. Or try a light dusting of green-tinted facial powder.
Rosacea can be distressing. You might feel embarrassed or anxious about your appearance and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions. Talking to a counselor about these feelings can be helpful.
A rosacea support group, either in person or online, can connect you with others facing the same types of problems — which can be comforting.