Rosacea 101: Symptoms, Causes, and Treatments

Although many people crave a healthy, rosy-cheeked look, rosacea is much different than a youthful flush. It is also very different from what you might experience after an intense workout or a day at the beach. These are natural or temporary flushes caused by blood rushing to the cheeks after exertion or because of sun exposure, but rosacea is a different type of flush.

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Rosacea is a chronic type of skin inflammation that often causes pustules and permanent flushing of the skin due to enlarged capillaries, the small blood vessels closest to the skin’s surface. The origin of rosacea is still unknown, and there is still no lasting cure, but there are triggers to watch for, and treatment options that might help reduce the appearance of rosacea.

The onset of rosacea usually occurs between the ages of 30 and 50 years old, but like many other skin-related concerns, this condition worsens with age. The actual cause of rosacea has yet to be determined, but it is characterized by a permanent flush, usually on the cheeks, nose or neck area, and it is caused by enlarged capillaries. It is believed to be strongly affected by genetic indicators and is often accompanied by swelling, pimples, lumps under the skin, rash, or a stinging/burning sensation. Rosacea can include any variety of the above symptoms, and may include others as well, depending on your condition. Unlike acne, the pustules and lumps will not be tender. Persistent redness accompanied by bumps that don’t cause physical discomfort would be reason to consult your provider or dermatologist as rosacea may be the underlying cause.

Although the cause of rosacea still remains unknown, triggers have been known to include things such as nighttime overheating, consuming alcohol, drinking hot beverages, taking long, hot baths, eating spicy foods, having caffeine, prolonged sun exposure and/or sun damage, and experiencing emotional or mental stresses. It has also been suggested that rosacea could be the result of a sensitivity to a microscopic creature, known as the demodex folliculorum mite, which can live inside the pores of your skin. It is also interesting to note that there seems to be a connection between rosacea and systemic diseases such as gastroesophageal reflux disease, hyperlipidemia, hypertension, metabolic diseases, cardiovascular diseases, diabetes, celiac disease, multiple sclerosis, rheumatoid arthritis, and glioma. Having one of these diseases may make you more susceptible to rosacea, and it would be worth mentioning to your provider if you believe you might be at risk for developing rosacea. You are also at a higher risk for rosacea symptoms if you have fair skin, light skin, thin skin, or sensitive skin. A family history of rosacea patients or blood pressure issues could also be risk factors that indicate potential proclivities. Having this health information readily available will help your provider in determining your treatment plan.

You will need to see your provider or a dermatologist in order to know for sure whether or not you have rosacea. A provider may refer you to a dermatologist, but both will be able to examine your condition, compare that to your overall medical history, and determine the likelihood that you have, or may develop, rosacea. They may also need to do a blood test to rule out lupus erythematosus as lupus presents itself in a very similar way with a red pattern resembling a butterfly across the nose and cheeks. The National Rosacea Society points to the style or presence of rash development as indicating factors for differentiating between rosacea and lupus, but only a trained medical professional can make a definite distinction between the two.

Rosacea and Acne

Rosacea and acne are sometimes confused for one another, and while they can occur simultaneously, they are different dermatological conditions. Acne is related to sebum production, heightened keratin, and tender pustules, while rosacea deals more with the diameter of the blood vessels as well as the structure of the epidermis. It is possible, however, to experience both, a condition referred to as acne rosacea. Since acne and rosacea sometimes closely resemble one another, you will need to seek the advice of your provider before beginning any type of treatment as these two skin conditions require different skin care regimens.

Rosacea on the Face: Skin, Nose, and Eyelids

Rosacea most commonly occurs on the facial area, including the cheeks, nose and eyelids, but it can also appear on the scalp, ears and neck. It can also occur within the eyes. A manifestation in this area is referred to as ocular rosacea and may cause the eyes to become bloodshot, watery, or to develop styes (small, sometimes painful bumps in the eye area). If you notice these eye symptoms, do not hesitate to call your provider and seek their medical advice. Regardless of where your rosacea appears, it needs to be addressed in its early stages in order to prevent hardening of the skin, or a worsening of the condition. The symptoms of rosacea may vary from person-to-person. Therefore, if you believe you may be experiencing symptoms of rosacea, you should schedule an appointment with your provider or dermatologist as soon as possible.

Terminology and Definitions

  • Rosacea – a chronic type of skin inflammation often causing pustules and permanent flushing of the skin due to enlarged capillaries
  • Capillaries – the small blood vessels closest to the skin’s surface
  • Ocular – related to, happening in, or seen by the eye
  • Papules – red spots without pus
  • Pustule – pimple or blister-like spot on the skin that contains pus and has an inflamed base

If you notice that one or more of these signs or symptoms routinely characterizes the look of your skin, you should schedule an appointment with your provider. Catching and addressing rosacea early is pivotal in your ability to treat it, and in preventing your skin from hardening and becoming increasingly difficult to treat.

  • Persistent flushing – Those who flush easily, especially those with fair or pale skin, are the most susceptible to developing rosacea. Your flush may not be permanent, but your propensity for blushing may indicate a later development of rosacea.
  • Visible blood vessels – If you have (or are at risk for having) rosacea, you will notice minute blood vessels on the surface of your skin. It is particularly important for those with thin skin to keep an eye on their facial area in order to watch for early signs of rosacea, such as visible blood vessels.
  • Redness – Like flushing, if you begin to notice a redness that refuses to go away, contact your provider. It may look like sunburn, but unlike a sunburn, isn’t likely to cause discomfort.
  • Itchiness or stinging – Although rosacea doesn’t typically cause pain, you may experience an uncomfortable or prolonged tightness, itchiness or stinging, similar to the way it feels when your skin is overly dry.
  • Bumps – These will be pus-filled or red and solid. Usually they are not tender, but every person’s skin has the potential to react differently.
  • Styes and bloodshot eyes – If you believe you may have ocular rosacea, do not waste time consulting your provider. You could experience vision loss, corneal damage, or other eye problems if you fail to treat ocular rosacea in a timely manner.

Reasons and Causes of Rosacea

The cause of rosacea is still an unknown entity. Certain factors, such as fair or thin skin, a propensity towards blushing or overheating, genetic indicators, or already-present diseases may contribute to your development of rosacea. It is also helpful to avoid triggers if you believe you may be prone to the symptoms of rosacea. Triggers include: overheating, alcohol, hot beverages, spicy foods, caffeine, sun exposure and/or sun damage, and emotional or mental stressors.

Rosacea: Treatments, Medications, and Natural Remedies

There are only a few remedies available for those suffering from rosacea, however, these are good options, and they may make a significant difference in your overall skin appearance.

Laser Skin Resurfacing In general, laser skin resurfacing helps to reverse the appearance of skin damage. It is a cosmetic procedure known for its ability to effectively reduce facial wrinkles, scars and blemishes while providing skin rejuvenation and reveal smoother, more youthful looking facial skin. Laser skin resurfacing utilizes both ablative and non-ablative techniques, but the procedure used will be largely dependent on the severity of your rosacea. Severe rosacea, or rosacea with a rash or pustules, may become worsened by abrasive laser resurfacing. Otherwise, using laser resurfacing to ablate away capillaries could be helpful in diminishing redness. Because laser resurfacing techniques require a trained eye, you should consult a professional prior to treatment. This will ensure that you receive the best, most appropriate care for your skin.

Facials Facials are an excellent solution to a number of different skin concerns. They can be uniquely tailored to meet your specific skin needs and concerns, and can often be combined with one another to achieve your best results. Facials can be nourishing, healing, and cleansing, and can be formulated for all variations of skin types (sensitive, oily, combination, problematic, acne-prone, etc).

Facial methods can include masks, steam treatments, deep cleansing or exfoliating, massages, creams, lotions, gels, or a combination of all of the above. Facials benefit rosacea sufferers by matching the need to the type of facial. The effects of severe rosacea can be alleviated by gentle exfoliation and deep hydration while a less severe form of rosacea may benefit greatly from deeper exfoliation. Although there are many at-home or DIY facial options available, it is worth it to schedule skin treatments with professionals on a regular or semi-regular basis to reap the greatest benefit, especially when dealing with a skin condition such as rosacea. Doing this consistently will allow you to see the greatest overall benefit.

Creams and Skincare If you suffer from rosacea, you are not alone. Although what causes rosacea is unknown, it is a skin concern for many people, both male and female. The National Rosacea Society reported that roughly 16 million people have rosacea in the United States alone, and that it negatively affected their self-esteem, social life, and work life. The same survey results determined that 70% of rosacea suffers found that receiving treatment for their rosacea significantly improved their overall quality of life. Even using creams and proper skin care helped improve their outlook on the way rosacea negatively impacted their daily life.

The National Rosacea Society suggests using products with minimal skin irritants or harsh chemicals. Instead, they suggest rosacea sufferers use fragrance-free products, test products before using them regularly, and avoid using too many products.

Facial cleansing for rosacea should involve using the right product for your skin type (dry, oily, combination, etc.), and should include using gentle application and removal techniques. After appropriate cleansing, apply any topical medications, and follow with a moisture-rich lotion and sunscreen (or lotion/sunscreen combination). Many professionals believe that rosacea is related to a lack in the skin’s moisture barrier. Using a good moisturizer, especially during the dry, winter months, will be incredibly beneficial to your skin. It is also recommended that you use products designed for sensitive skin as these will be formulated with less skin irritants which will help reduce facial redness.

The following lists shows ingredients that you should look for and/or avoid in your skin care routine if you suffer from rosacea. As always, it is recommended that you consult your dermatologist and follow their advice for your skin. Remember that you are looking for non-irritating, moisture-rich products as you search for products to use in your daily routine.

  • Products that are fragrance-free, paraben-free, alcohol-free, non-comedogenic and hypoallergenic
  • Products containing niacinamide (Vitamin B-3) which helps improve the skin’s barrier
  • Products containing colloidal oatmeal which is known to calm irritated skin and reduce redness


The National Center for Biotechnology Information defines rosacea in stages. These include rosacea type 1 which refers to small, visible blood vessels and mild red areas, rosacea type 2 which adds papules and pustules, rosacea type 3 which includes thicker, bumpier skin, and rosacea type 4 which refers to rosacea that has reached the eyes. As you can see, the levels of rosacea build upon one another. Therefore, it is important that you do not let your rosacea go untreated.

There are several medications available to those dealing with rosacea. Of course, you will need to obtain these from your provider as they will know the best solution for your needs, but a few of the options mentioned by the U.S. National Library of Medicine are listed below:

  • Brimonidine tartrate gel – applied topically to treat mild forms of rosacea (rosacea type 1)
  • Azelaic acid (Skinoren, Finacea), ivermectin (Soolantra) or antibiotic metronidazole – ingredients used in creams, gels and lotions beneficial to those with type 2 rosacea (papules and pustules present). Ivermectin is particularly useful for those whose rosacea is related to hair mites (demodex mites).
  • Ciclosporin, Doxycycline – for rosacea type 4 (ocular rosacea)

Diet and Lifestyle

Evidence suggests that diet and lifestyle both play an important role in the effective management of rosacea. Keeping track of foods and activities that trigger your rosacea flare-ups could significantly help in reducing the severity of your condition. The National Institutes of Health also suggests following a healthy gut microbiome diet, which means ensuring you are eating enough prebiotic and fiber-rich foods. They contribute this suggestion to findings that indicate a strong connection between gut health and skin diseases. In other words, your typical American diet may need a strong overhaul.


Rosacea can play a significant role in the way you feel about yourself. Seeking medical attention and applying the different intervention methods discussed in this article will help you address your rosacea before it becomes invasive and extremely difficult to treat. Knowing that the majority of patients reported feeling a rise in their self-confidence and social interactions after seeking treatment for their rosacea, do not waste time in speaking with your provider if you suffer from rosacea. There are several treatment options available to fit your lifestyle, and seeking the proper treatment will be worth it to how you feel overall.

List of Sources

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