Rosacea: Symptoms, Causes, Therapy & Treatment

Have you ever experienced facial redness, acne-like breakouts, or pustules? These could be signs of rosacea, a common skin condition. Wondering how to manage it effectively? While there’s no cure, a dermatologist or skin specialist can help manage symptoms and prevent worsening. Additionally, mild rosacea can be managed by avoiding triggers and practising proper skincare. 

Keep reading to explore various rosacea treatment options, symptoms, therapies, and more.

What is Rosacea?

Rosacea is a common skin issue that mostly affects the face & eyes. It causes redness, pimples, and visible blood vessels. It usually starts between ages 30 and 60 and is more common in fair-skinned people and women in menopause. The cause of rosacea is unknown, but millions of people in the U.S. have it. Facial redness with swelling red lumps and little visible blood vessels are the main symptoms. Medications to treat acne or antibiotics help manage and lessen symptoms. If left untreated, it usually gets worse over time.

What are the Types of Rosacea?

There are four different types of rosacea:

1. Erythematotelangiectatic Rosacea:

It makes your face stay red all the time, and you can see big blood vessels. Sometimes, the redness worsens suddenly, and it’s hard to predict when it will happen.

2. Papulopustular Rosacea:

It causes pimples filled with pus or fluid to appear on your skin. Your skin might also swell, similar to what happens with acne. 

3. Phymatous Rosacea:

Symptoms involve skin swelling and thickening. It usually happens on your nose and makes it bumpy. Your nose might even look bigger and rounder than usual.

4. Ocular Rosacea:

It makes your eyes feel irritated and look red or watery. They might hurt when you’re in bright light. You could also get painful bumps on your eyelids.

What Are the Rosacea Symptoms?

Here are the main five types of Rosacea symptoms: 

1. Prerosacea

Marked by frequent episodes of blushing and flushing on the face and neck.

2. Vascular Rosacea

Identified by the swelling of blood vessels beneath the facial skin, which leads to warmth & skin swelling (commonly seen in women).

3. Inflammatory Rosacea 

Presents the appearance of pimples and dilated blood vessels on the face. 

4. Rhinophyma

Characterised by enlarged oil glands in the nose and cheeks, which leads to a swollen, bulbous red nose (primarily observed in men).

5. Eye Symptoms of Rosacea

Symptoms involving the eyes are common in rosacea, which affects both the eye itself and the eyelids. These symptoms can include redness, burning, tearing, inflamed eyelids, and a feeling of having something foreign in the eye. 

What are the Most Common Rosacea Triggers?

Know about the most common Rosacea triggers below:

• Exposure to sunlight
• Extreme temperatures (hot or cold)
• Alcohol consumption
• Spicy or hot foods
• Intense physical activity
• Stress
• Certain cosmetics, skincare, or hair products

Additionally, menopause and certain medications may lead to flushing. Keeping a symptom diary detailing symptom occurrences, activities, environmental conditions, and suspected triggers can help identify personal triggers.

What are the Causes of Rosacea?

The following are the main causes of rosacea:

1. Genetics:

Rosacea often appears in multiple family members, which suggests a genetic link.

2. Blood vessel issues:

The redness associated with rosacea may stem from blood vessel abnormalities in the face. Sun exposure could worsen these issues by causing blood vessels to dilate, which makes them more visible.

3. Mites:

They are very tiny insects you can’t see without a microscope. One type, called Demodex Folliculorum, normally lives on your skin without causing harm. However, some individuals may be more sensitive to these mites or have a higher than usual number of them. If there are too many mites, they might cause irritation to your skin.

4. Bacteria:

A type known as H. pylori usually live in your digestive system. According to some research, this bacterium may increase the production of a digestive hormone called gastrin, which could contribute to facial flushing. 

Rosacea Treatment – Medicines & Laser 

There are various types of Rosacea treatments & medications to address it effectively: 

1. Apply Rosacea Creams & Medicines To The Skin

Rosacea treatment comes in various forms, including creams and other medications applied directly to the skin. These topical drugs fight acne, inflammation, and bacterial growth, and they include:

• Azelaic Acid: A gel or foam that addresses bumps, swelling & redness while inhibiting bacterial growth.
• Brimonidine (Mirvaso): A gel that tightens blood vessels to reduce redness.
• Calcineurin Inhibitors: Pimecrolimus and tacrolimus.
• Clindamycin (Cleocin, Clindagel, ClindaMax): An antibiotic that eliminates skin bacteria.
• Erythromycin (Erygel): An antibiotic.
• Ivermectin (Soolantra): Reducing inflammation.
• Metronidazole (Flagyl) and doxycycline: Both antibiotics.
• Oxymetazoline (Rhofade): A cream.
• Sodium sulfacetamide and sulfur (Avar, Sulfacet, Clenia, Plexion): Antibiotic combinations.

2. Oral Medications

Isotretinoin (Amnesteem, Claravis, and others) is an acne medication that might also be prescribed for rosacea. Avoid it during pregnancy due to the risk of severe birth defects. Improvements in your skin may take several weeks or months with these medications.

3. Laser Therapy For Rosacea

In addition to medications, your doctor may recommend laser treatment. This involves using intense light to target & shrink enlarged blood vessels that reduce skin redness. Laser resurfacing can also be used to smooth thickened skin caused by rosacea.

How To Treat Rosacea Redness?

Here are some helpful strategies to treat Rosacea redness on the face:

• Azelaic acid and retinoids can be beneficial in reducing redness.
• Ensure to moisturise your skin daily to maintain its hydration.
• Confirming if you have rosacea is essential before starting treatment.

Rosacea Therapy

1. Persistent Redness

Redness that stays in the middle of the face, such as on the cheeks, nose, forehead, and chin, can come and go. In darker skin, the redness might look purple or brown.

Therapy: Strong evidence supports using FDA-approved creams like brimonidine and oxymetazoline to help with this redness. Doctors may also suggest light treatments such as intense pulsed light (IPL) or lasers like pulsed dye or potassium titanyl phosphate (KTP).

2. Thickened Skin

Changes in the skin’s texture can lead to enlarged pores, thickened or hardened skin, and larger oil glands, especially in the nose (rhinophyma). This thickening can also occur elsewhere on the face, either due to ongoing or previous inflammation.

Therapy: For active inflammation, doctors may suggest using creams alongside oral medications or laser treatments. Other options include surgical procedures like removing extra tissue with a scalpel, using electric current, or applying heat deep into the skin with radiofrequency waves. Doctors might also prescribe oral medications like isotretinoin or antibiotics alongside these treatments.

3. Red Bumps and Pimples

Raised red bumps (called papules) that might have pimples (pustules) with them are common in rosacea. They often show up in groups on the cheeks, nose, forehead, and chin, and sometimes there are raised areas called nodules.

Therapy: Creams that are very effective and approved by the FDA include ivermectin, azelaic acid, and metronidazole. Other creams like clindamycin, retinoids, and sulfacetamide sodium/sulfur are also used, even though they haven’t been studied as much for rosacea. Oral treatments may include different antibiotics, including a low-dose version of doxycycline approved by the FDA with less risk of resistance (called sub-antimicrobial doxycycline), as well as retinoids.

4. Visible Blood Vessels

Small dilated or broken blood vessels (called telangiectasia), often referred to as spider veins, can appear. These signs are more obvious in lighter skin, but they can also be seen in darker skin.

Therapy: Special light treatments like IPL, pulsed dye laser, and KTP laser are often used to reduce the appearance of these blood vessels on the skin. Sometimes, doctors may also prescribe creams with retinoids.

5. Red Face

Getting red in the face frequently and for a long time (sometimes blushing) is common, except in darker skin tones where it might not look as red.

Therapy: Doctors may suggest using creams like brimonidine and oxymetazoline to reduce redness. They might also recommend antibiotics, alpha- and beta-blockers, intense pulsed light (IPL), or, less often, KTP laser therapy.

Rosacea Skin Care Tips

Some of the best Rosacea skin care tips recommended by dermatologists are:

1. Go For Rosacea-friendly Skincare Items

With rosacea, many skincare items and makeup can make your skin feel worse. To avoid this, dermatologists advise staying away from products with these ingredients: alcohol, camphor, fragrance, glycolic acid, lactic acid, menthol, sodium lauryl sulfate (common in shampoos and toothpaste) & urea.

2. Try Out Skin Care Products  & Makeup

Must try products on a small area before using them on your face. Do you find that everything you put on your face causes discomfort? Testing can help you discover products that won’t irritate your skin. Remember to test products with guidance from certified dermatologists.

3. Clean Your Face Twice Daily

Washing helps remove oil and dirt that can make irritation worse. Do it very gently. To cleanse without making your skin more irritated, dermatologists suggest: picking a gentle cleanser suitable for rosacea (not soap), applying the cleanser softly with your fingertips in circular motions, rinsing off the cleanser with warm water, using only your fingertips, and patting your face gently with a clean, cotton towel afterwards.

4. Apply Moisturiser

If using rosacea medication, apply it first. Moisturising hydrates skin, reduces irritation & enhances comfort. Studies show that using a rosacea-friendly moisturiser can improve treatment outcomes.

5. Keep Your Skin Safe From The Sun

Sunlight can make rosacea worse, no matter the season. It’s one of the top reasons why rosacea acts up and affects people of all skin colours. To stop sun-triggered flare-ups, dermatologists advise staying in the shade when you can, wearing sun-blocking clothes, like wide hats and UV-protective sunglasses, and using sunscreen with SPF 30 or higher and water resistance. Remember to put it on any skin that’s not covered by clothes, even if it’s cloudy.

A Quick Recap

Treating rosacea involves various approaches, such as skin care routines, trigger avoidance, light or laser therapy, and medications. If you’ve attempted these methods independently without improvement, it may be beneficial to consult a skin specialist. They can assist in devising a personalised treatment plan curated to your individual requirements.

Want to know whether dermal fillers are safe for someone who has rosacea or not? There is no evidence to suggest that fillers will worsen rosacea. A common temporary side effect of hyaluronic acid fillers is a mild blush, which may be more noticeable in patients with rosacea but usually resolves within 24 hours or less. But, it is important to ensure you have an experienced injector.

Frequently Asked Questions Related To Rosacea

Q: Can rosacea be cured? 

A: While there is no cure for rosacea, various treatments can help minimise symptoms & flare-ups. Discuss your symptoms with your skin specialist for assistance in managing your condition & preventing symptom recurrence.

Q: What foods fight rosacea?

A: Prebiotics, a form of dietary fibre, might be beneficial in reducing rosacea symptoms. Foods rich in fibre include whole grains like oats, barley, brown rice, quinoa, and whole-grain breads.

Q: How long does rosacea last on the face?

A: It may take a few weeks to several months for your symptoms to improve. If your skin specialist prescribes medication, they will monitor your progress to ensure its effectiveness. As your symptoms begin to clear, your provider may gradually decrease the dosage.

Q: How do I heal my rosacea naturally?

A: There are a number of safe, natural alternative treatments to heal your rosacea such as undergoing testing for food allergies, decreasing stress levels, using apple cider vinegar, using aloe vera, and combining raw honey with a facial cleanser, or using it independently.