Topic Overview
What is rosacea?
Rosacea (say “roh-ZAY-sha”) is a
skin disease that causes redness and pimples on your nose, cheeks, chin, and
forehead. The redness may come and go. People sometimes call rosacea "adult
acne" because it can cause outbreaks that look like acne. It can also cause
burning and soreness in the eyes and eyelids.
Rosacea can be
embarrassing. And if it is untreated, it can get worse. If the symptoms bother
you, see your doctor and learn ways to control rosacea.
What causes rosacea?
Experts are not sure what
causes rosacea. It tends to affect people who have fair skin or blush easily,
and it seems to run in families.
Rosacea is not caused by alcohol
abuse, as people thought in the past. But in people who have rosacea, drinking
alcohol may cause symptoms to get worse (flare).
Rosacea often
flares when something causes the blood vessels in the face to expand, which
causes redness. Things that cause a flare-up are called triggers. Common
triggers are exercise, sun and wind exposure, hot weather, stress, spicy foods,
alcohol, and hot baths. Swings in temperature from hot to cold or cold to hot
can also cause a flare-up of rosacea.
What are the symptoms?
People with rosacea may
have:
- A flushed face and pimples or bumps on or
around the cheeks, nose, mouth, and forehead. Sometimes the flushing or redness
can last for days.
- Tiny red veins on the face that look like
spiderwebs.
- Burning or stinging facial skin, especially when they
apply lotions or medicines. The face may feel increasingly dry, sensitive, or
sunburned.
- Dry, red, irritated eyes. The eyelids may look red and
swollen, and vision may be blurry. If it is not treated, rosacea can cause
serious eye problems.
Without treatment, some cases of rosacea can cause knobby
bumps on the nose and cheeks that can multiply. This is advanced rosacea, known
as rhinophyma (say “ry-no-FY-muh”). Over time, it can
give the nose a swollen, waxy look. But most cases of rosacea don't progress
this far.
How is it treated?
Doctors can prescribe medicines
and other treatments for rosacea. There is no cure, but with treatment, most
people can control their symptoms and keep the disease from getting
worse.
- Antibiotic creams or pills may be used to
treat redness and pimples. Antibiotic pills may also help treat eye problems.
Women who are pregnant should not use some antibiotic creams or pills. If you
use antibiotics, be patient. It can take a month or two before you start to see
improvement.
- Stronger medicines may be tried if antibiotics don't
control your rosacea. Examples include isotretinoin (such as Sotret) or tretinoin
cream (Retin-A). You cannot use these if you are pregnant or might become
pregnant.
- Surgery or other treatments may help your skin look
better if you have advanced rosacea. Choices may include
dermabrasion,
cryosurgery, or
laser surgery.
How can you prevent rosacea flare-ups?
There are
some things you can do to reduce symptoms and keep rosacea from getting
worse.
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Find your triggers.
One of the most important things is to learn what triggers your flare-ups, and
then avoid them. It can help to keep a diary of what you were eating, drinking,
and doing on days that the rosacea appeared. Take the diary to your next doctor
visit, and discuss what you can do to help control the disease.
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Use sunscreen every day. Pick a sunscreen rated
SPF 15 or higher that blocks
ultraviolet light (UVA and UVB) and infrared rays.
During winter, use a moisturizer to prevent dryness caused by cold and
wind.
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Be gentle with your skin. Use skin
care products for sensitive skin, and avoid any products that scratch or
irritate your skin. Try not to rub or scrub your skin.
-
Take care of your eyes. Gently wash your eyelids with a
product made for the eyes. Apply a warm, wet cloth several times a day. Use
artificial tears if your eyes feel dry.
Frequently Asked Questions
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Learning about rosacea:
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Being diagnosed:
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Getting treatment:
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Living with rosacea:
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Cause
The exact cause of
rosacea is unknown. One theory is that it may result
from oversensitive blood vessels in the face. Because rosacea causes increased
warmth in the skin, bacteria may grow, causing the pimples and bumps.
Tiny mites (Demodex folliculorum) that normally
live on our skin may also play a role. People who have rosacea have more of
these mites on their faces than those who don't have the disease.
Flare-ups often start when certain triggers cause the blood vessels in
the face to dilate, which causes redness. Common triggers are sun, exercise,
hot weather, emotional stress, spicy foods, alcohol, and hot baths. Swings in
temperature from hot to cold or cold to hot can also trigger a flare-up of
rosacea.
Many people with this skin condition have a family
history of rosacea.1
There may be a link
between rosacea and Helicobacter pylori bacteria, which
causes an infection in the stomach, although studies are unclear.
Alcohol and poor hygiene do not cause rosacea, as was believed in the
past. But drinking alcohol may
trigger facial flushing and can cause symptoms to get
worse.
Symptoms
Some people may notice that their skin has
become very sensitive or that they blush easily before they notice other
symptoms of
rosacea. For example, facial products may burn their
skin.
As rosacea develops, redness on the cheeks lingers, like a
slight sunburn. This redness and other symptoms of rosacea come and go. The
main symptoms include:
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Facial redness/flushing
. Triggers, such
as sun exposure or alcohol, stimulate increased blood flow, which causes blood
vessels to expand and facial redness to appear. In women, the redness usually
appears on the cheeks, nose, chin, and forehead. The redness may appear in a
"butterfly" pattern across the cheeks and nose. Facial redness in men typically
appears on the nose, although symptoms can appear on other areas of the face.
In some cases, redness may also occur on the neck and upper
chest.
- Pimples on the face. Small pimples may occur on the red
areas of skin or on the edges. These
pimples—red, round bumps in the skin—are different
from acne pimples, which are
blackheads or whiteheads.
- Red lines on the
face (telangiectasia). These small, thin, red lines are tiny blood vessels that
look like spiderwebs. And they usually appear on the
cheeks.
- Swollen bumps on the nose. In severe cases, mostly in men,
the nose appears enlarged, bulbous, and red, a condition called
rhinophyma.
- Eye irritation. Symptoms
include redness, dryness, burning, crusted mucus, tearing, a gritty feeling
like that of sand in the eye, pinkeye (conjunctivitis), and swelling in the eyelid. The eyes
may not tolerate contact lenses, and
styes may develop. In some cases, vision may be
blurry, but only in severe cases is vision damaged. About half of the people
with rosacea have some eye irritation or symptoms.2
Rosacea may be mistaken for some
other conditions with similar symptoms, such as acne or lupus.
Some research suggests a link between rosacea and
migraine headaches.1 Blood
vessels may be the connection between these two conditions.
What Happens
Rosacea
develops in phases. The first sign may be the tendency to blush often. Rosy
cheeks or patches of red appear on the face. Facial skin may be more sensitive
and may react to skin products, such as lotions or soaps. Some people notice
eye irritation before they note any skin symptoms.
See a picture
of rosacea.
As rosacea progresses, facial
redness comes and goes on the cheeks, forehead, or chin. Facial flushing occurs
when there is a sudden increase of blood flowing through the blood vessels
under the skin. This causes the blood vessels to relax and get wider (dilate),
which results in skin redness. In time, ongoing dilation may cause blood
vessels to get larger and look like small red lines on the skin.
Tiny pimples may begin to appear on and around the area of redness. As
flare-ups continue, the redness increases, and flare-ups occur more often.
Later on, if rosacea is untreated, the redness and red lines may become
permanent.
Along with the redness and pimples of the face, rosacea
can also affect the eyes. Eye symptoms may develop before you notice facial
symptoms, and they include redness, dryness, infection, and burning (conjunctivitis). If eye problems are not treated, they
can lead to more serious complications. In some cases, vision may be blurry,
but vision is damaged only in severe cases.
Treatment can help
control rosacea symptoms and prevent the condition from getting worse. If
untreated, rosacea may lead to a condition called
rhinophyma, in which long-term (chronic) inflammation
causes the nose to appear enlarged and bulbous, red, and with thick bumps. This
is due to the oil-producing (sebaceous) glands and the tissues of the nose
getting larger. Rhinophyma is more common in men than women. It often takes
several years to develop. But most cases of rosacea do not progress this
far.
What Increases Your Risk
There are no known risk
factors for
rosacea. But many people with this skin condition have
family members with rosacea.1
Certain
triggers can cause flushing of the skin and a flare-up
of rosacea symptoms. These triggers include sun, stress, hot weather, alcohol,
caffeine, spicy food, exercise, hot baths, and cold weather. Triggers produce a
sudden increase in blood flow through the blood vessels in the face. This
causes the blood vessels to expand and the face to flush. A trigger that
affects one person may not affect another.
When To Call a Doctor
Call your doctor if you notice
symptoms that could be caused by
rosacea, such as:
- Red patches on your face that come and
go.
- Redness, pimples, and small, red lines on your
face.
- Eye redness and frequent eye irritation.
- Bulbous,
thick bumps and redness on your nose.
Watchful Waiting
If you notice any symptoms of rosacea, such as
redness, redness with pimples, eye irritation, or large, swollen bumps on your
nose, call your doctor. If you start treatment when you first notice symptoms,
it is likely that your symptoms will improve and your condition will not get
worse.
Who To See
The following health professionals can diagnose
and treat rosacea:
The following health professionals can treat moderate to
severe cases of rosacea that may require surgery:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Your doctor will diagnosis
rosacea after a physical exam. You probably will not
have medical tests unless the diagnosis is unclear. In that case, tests will
rule out other conditions, such as
lupus or a
fungal infection.
During an exam, your
doctor will check your eyes and the skin on your face, neck, and upper chest
for any symptoms of rosacea. Tell your doctor when you first noticed symptoms
and how often they occur. This information, along with your family history, is
usually enough for a diagnosis.
Treatment Overview
There is no cure for
rosacea. Treatment often helps keep symptoms under
control and prevents the disease from getting worse. If left untreated, rosacea
symptoms can get worse, can recur more often, and eventually may become
permanent.
Treatment for the four main forms of rosacea vary
depending on your symptoms:1
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Erythematotelangiectatic. Symptoms include flushing and often
thin, red lines (telangiectasias) on the face. Some people report stinging or
burning of the face. Treatment may include oral antibiotics. Your skin may be
too sensitive for you to use ointments on your face. In mild cases, you can
apply a gentle anti-inflammatory product and sunscreen in the morning. If
medicine does not clear up the thin, red lines, which are tiny blood vessels,
a form of laser surgery called pulsed dye laser therapy may help.
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Papulopustular. Symptoms include small
pimples (pustules). You can also have facial flushing and tiny, red lines on
your cheeks. Your doctor may prescribe ointments for your face or antibiotic
medicine. You may even use both at the same time. Skin tends to be less
sensitive with this form of rosacea.
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Phymatous. Symptoms include thick, bumpy skin and large pores.
The most common type affects the nose (rhinophyma). Other types affect the
chin, forehead, ears, and eyelids. You may also have flushing, pimples, and
visible blood veins. Your doctor may prescribe isotretinoin for phymatous
rosacea in its early stages. Surgery or
laser resurfacing can reshape the nose in severe cases
of rhinophyma.
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Ocular. Symptoms include red,
dry, and irritated eyes. You may feel like something is in your eye. Your
eyelids may swell or feel dry and flaky. In severe cases, a person may feel pain or
have blurred vision. You can try artificial tears for dry eyes. Ointments work
well for mild cases. Your doctor may prescribe antibiotic pills.
With treatment, symptoms usually improve in 2 to 4 weeks.
You'll see the best results in about 2 months.
Identifying and
avoiding
triggers that cause rosacea flare-ups is an important
part of treatment. Keep a list or diary of triggers to help you avoid those
foods, products, or activities that might cause flare-ups. Even people who are
using medicine to control rosacea benefit from avoiding triggers.
Prevention
The cause of
rosacea is unknown, and there is no way to prevent it.
But there are steps that you can take to prevent flare-ups of
rosacea, and this can help stop the condition from getting worse. You can find
out what
triggers your flare-ups by making a list of what you
were eating or doing around the time you had a breakout. Some triggers include
sun and wind, hot and cold temperatures, stress, spicy foods, skin care
products, and exercise.
Home Treatment
There are several things you can do to
reduce symptoms of
rosacea and prevent the condition from getting
worse.
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Skin care. Use soaps,
lotions, and cosmetics that are made for sensitive skin
and do not contain alcohol, are not abrasive, and will not
clog pores (noncomedogenic). Avoid rubbing or scrubbing your face. Cosmetics
with a green-colored base may help mask the redness of a flare-up. Your doctor
may be able to refer you to a clinic that specializes in the use of cosmetics
for people with rosacea.
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Use sunscreen. It is important to protect
your face from sun exposure. Every day, use a broad-spectrum sunscreen—one that
blocks UVA, UVB, and infrared rays—that is rated
SPF 15 or higher. It may be hard to find a sunscreen
with the right ingredients that does not sting your face. But it's important to
look for the right protection for your skin.
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Eye care. Apply warm compresses several times a day, and gently wash your
eyelids with a product made for the eyes. Use artificial tears if your eyes
feel dry.
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Identify triggers. Make a list or
keep a diary of potential triggers when you have a flare-up. The National
Rosacea Society has developed a rosacea diary checklist that you can use to
keep track of the factors that may be causing symptoms of rosacea. Use the
diary every day for several weeks. See the
rosacea diary checklist(What is a PDF document?).
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Avoid triggers. After you have identified
triggers that cause flare-ups, avoid these triggers to help reduce your
symptoms.
- Use sunscreen on your face every day. Avoid
the midday sun, and wear a wide-brimmed hat.
- Minimize stress in
your life. Take care of yourself, eat a balanced diet, and exercise
regularly.
- Stay cool on hot, humid days.
- Limit
consumption of alcohol, spicy foods, and hot drinks.
- Stay as cool
as possible when you exercise. Try to exercise for shorter, more frequent
intervals, and do low-intensity workouts. In the summer, exercise during the
cool morning hours.
- Use a moisturizer during the winter to protect
your face from dryness. Wear a scarf over your cheeks and nose to help protect
your skin from the cold and wind.
- Avoid excessive hot water, hot
tubs, and saunas.
- Use skin care products for sensitive skin. And
avoid any products that are abrasive or that irritate your skin.
Medications
You can use antibiotic creams to relieve
the redness on your face and help eye symptoms that result from
rosacea. Antibiotic pills may help clear the pimples,
and can reduce the swelling or irritation in your eyes. Mild cases often
respond to treatment with antibiotic creams. But symptoms usually improve
faster with antibiotics you take as pills or capsules. Long-term use of oral
antibiotics may cause side effects, such as stomach upset and vaginal yeast
infections. So oral medicine may be used first, then tapered off and
followed by antibiotic cream.
With antibiotic treatment, symptoms
usually improve in 3 to 4 weeks, with greater improvement in 2 months.
Swollen bumps on the nose (rhinophyma) do not respond well to
antibiotic treatment.
Medication Choices
Medicines used to treat rosacea include:
Doctors may prescribe other medicines, including
benzoyl peroxide or azelaic acid gel (such as
Finacea).
What To Think About
Medicines often work well to
help improve the symptoms of rosacea.
You may need to keep taking
medicine for rosacea if you have symptoms that are hard to control.
Surgery
Surgery may help for moderate to severe cases
of
rosacea to treat an enlarged nose (rhinophyma); small, red lines (telangiectasia); or
lingering redness.
Some types of skin problems respond better to
surgery than others. People with lighter skin who limit their time in the sun
and use sunscreen after the procedure tend to have better results than people
with sun-darkened skin and people who continue to spend lots of time in the
sun.
Surgery Choices
Surgery options include:
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Laser resurfacing. Laser surgery
removes layers of skin. This may help with an enlarged nose (rhinophyma);
small, red lines; or lingering redness.
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Dermabrasion. This procedure may smooth the rough skin
and bumps on the nose caused by rhinophyma.
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Cosmetic surgery.
Reconstructive surgery and plastic surgery may reshape or remove bumps from a
nose damaged by rhinophyma.
What To Think About
You may not be a good candidate
for surgery if you are using
isotretinoin or have used it within the last 6 to 12
months, because it may increase the risk of scarring after the
procedure.
Other Treatment
Cosmetic counseling is often
helpful for people with
rosacea. Ask your dermatologist to recommend someone
in your area.
Other Places To Get Help
Organizations
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American Academy of Dermatology
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| P.O. Box 4014 |
| Schaumburg, IL 60168 |
| Phone: |
1-866-503-SKIN (1-866-503-7546) toll-free
(847) 240-1280 |
| Fax: |
(847) 240-1859 |
| Web Address: |
www.aad.org |
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The American Academy of Dermatology provides information
about the care of skin, hair, and nails. You can find a dermatologist in your
area by calling 1-888-462-DERM (1-888-462-3376).
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National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health
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| 1 AMS Circle |
| Bethesda, MD 20892-3675 |
| Phone: |
1-877-22-NIAMS (1-877-226-4267) toll-free
(301) 495-4484 |
| Fax: |
(301) 718-6366 |
| TDD: |
(301) 565-2966 |
| Email: |
niamsinfo@mail.nih.gov |
| Web Address: |
www.niams.nih.gov |
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The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS Web site provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
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National Rosacea Society
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| 800 South Northwest Highway |
| Suite 200 |
| Barrington, IL 60010 |
| Phone: |
1-888-NO-BLUSH (1-888-662-5874) |
| Email: |
rosaceas@aol.com |
| Web Address: |
www.rosacea.org |
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The National Rosacea Society provides information about this
condition to the public and physicians. The society also publishes a
newsletter. Call the toll-free telephone number listed above to request
materials and services.
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References
Citations
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Powell FC (2005). Rosacea. New England Journal of Medicine, 352(8): 793–803.
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Blount BW, Pelletier AL (2002). Rosacea: A common, yet
commonly overlooked, condition. American Family Physician, 66(3): 435–440.
Other Works Consulted
- Habif TP, et al. (2005). Rosacea (acne rosacea). In
Skin Disease Diagnosis and Treatment, pp. 98–101. St.
Louis: Mosby.
- Van Zuuren EJ, et al. (2007). Systematic review of
rosacea treatments. Journal of the American Academy of Dermatology, 56(1): 107–115.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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Kathleen Romito, MD - Family Medicine |
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Specialist Medical Reviewer
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Alexander H. Murray, MD, FRCPC - Dermatology |
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Last Revised
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August 12, 2010 |