Rosacea (row-zay-sha) is a chronic skin condition that affects mainly the face.

The first signs of rosacea may be redness or blushing that comes and goes initially. Over time, the redness may become persistent and more visible.The most common sites for symptoms are the cheeks, nose, chin, and forehead. Sometimes, rosacea may involve the eyes as well, and include symptoms such as blood-shot eyes that feel gritty. Over half of rosacea sufferers may experience eye symptoms.

Bumps, tiny pus-filled pimples, and enlarged blood vessels can also appear, giving skin a rough, uneven appearance. Rosacea symptoms can vary from one person to another, and there is no predicting severity. There is no known cure for rosacea, although it can be managed with appropriate treatment and lifestyle changes.Rarely, rosacea symptoms can be severe enough that the skin tissue of the nose becomes thick, swollen, and bumpy (called rhinophyma). It is characterized by thick, red bumps around and on the nose, which develop when the oil-producing glands and the surrounding connective tissues becoming enlarged. This is a more severe form of rosacea that occurs mostly when it remains untreated. Rhinophyma develops in some men who have rosacea, and very rarely in women with rosacea.

Who is at risk?

Rosacea usually develops in adults between ages 30 and 50. It affects both men and women, although it seems to affect more women and more severe cases seem to occur in men. It tends to affect people with fair skin, such as those of northern and eastern European descent (for example Celtic, English, and Scottish), although rosacea can develop in those of any skin type.

Signs and symptoms
  • Frequent flushing or blushing on cheeks, nose, chin, forehead
  • Persistent redness
  • Red lines, due to enlarged blood vessels becoming visible
  • Dry skin
  • Burning, stinging, or itching
  • Pimple-like bumps without blackheads or whiteheads
What causes it?

Experts are not certain about what specifically causes rosacea but they believe that it is due to a combination of genetic and environmental factors. There are several theories about a potential cause:

The immune system appears to be involved in rosacea’s development.

Being fair-skinned and of Irish, Scottish, English, or of Eastern or Northern European descent seems to increase the chances of developing rosacea.

family history of rosacea is considered a risk factor.

Chronic sun exposure is a known risk factor for rosacea.

skin mite called Demodex folliculorum may contribute to rosacea. The theory is that the mites block oil glands and cause the inflammation that underlies rosacea.

bacterium associated with gastrointestinal ulcers, called Helicobacter pylori, may play a role.

There are four forms of rosacea, which are defined by the following range of symptoms:

Mild (Erythematotelangiectatic) The main symptoms are facial flushing and redness, which may be present only sometimes. In addition, there may some swelling, burning and stinging, roughness, and visible red blood vessels.

Moderate (Papulopustular) This is a more advanced form of rosacea that is marked by persistent redness and pimplelike bumps (often mistaken for acne), as well as burning and stinging.

Severe (Phymatous) In some individuals, rosacea may affect the nose, causing the skin tissue to thicken (giving an enlarged appearance) and become bumpy. This advanced form of rosacea is called rhinophyma.

Ocular rosacea In addition to skin symptoms, rosacea may also affect the eyes and eyelids. It may cause redness to the surrounding skin tissue but also burning or stinging, dryness, light sensitivity, blurred vision, and watery, bloodshot eyes.

Rosacea can feel a lot worse than it looks. Like other chronic diseases, it is difficult psychologically to deal with a condition that persists for many years. Because of the physical symptoms, many patients with rosacea feel self-conscious and embarrassed about the redness and bumps that occur primarily on their face, making it more difficult to hide than clothed areas. In addition, they may be affected negatively by the common misconceptions about rosacea, such as the belief that it is a sign of alcohol abuse or poor hygiene.

Nearly three quarters of rosacea patients have reported low self-esteem. An equal proportion of patients have felt that rosacea adversely affects their career opportunities. Because of the social and psychological impact of rosacea, it is imperative to receive a diagnosis and treatment for this chronic skin condition. Successfully controlling symptoms through treatment has been shown to improve the mental and emotional well-being of rosacea patients.

Quick facts about rosacea
  • Rosacea affects over two million Canadians.
  • It is a chronic skin condition that does not go away but can be controlled.
  • It typically develops between ages 30 and 50.
  • It usually occurs more often in women than men.
  • It is often misdiagnosed as adult acne.
  • In about half of cases, rosacea symptoms involve the eyes.

A number of lifestyles factors can cause rosacea to flare up. Some common triggers thought to affect rosacea include hot and cold weather extremes, sun exposure, mental stress, and hot or spicy food and drinks. These triggers vary from person to person, so it is both important and helpful to find out which ones make your rosacea symptoms flare up. Knowing this can help you to better manage your condition because you will be able to avoid things that can potentially aggravate your skin. Keeping track of your symptoms and activities in a journal can help you to identify triggers, which you can discuss with your doctor.

Food and beverages

What you eat and drink can affect rosacea symptoms as well, especially spicy foods or hot soup and drinks. Here is a list of things to watch for in your diet – track when you eat these trigger foods and drinks to determine which ones affect your symptoms:

  • Thermally hot drinks, such as soup and hot chocolate
  • Caffeinated beverages, such as tea or coffee
  • Spicy seasonings such as white or black pepper, paprika, red pepper and cayenne
  • Alcohol, especially red wine

Sun exposure

UV exposure seems to make rosacea worse so it is recommended that rosacea sufferers wear sunscreen with an SPF value of 30 or more daily. A sunblock may be better tolerated than a sunscreen in people with sensitive skin. Also, it is best to avoid the sun at peak times, primarily between 11 a.m. and 4 p.m.

Temperature extremes

Extremely hot or cold weather conditions, very dry or humid, wind, and indoor heat exposure can act as triggers. So the key is to stay cool in hot weather, cover up skin and moisturize when it is cold outdoors, and avoid hot baths, saunas or other environmental factors that raise your body temperature.

Intense exercise

High-intensity workouts overheat the body, which can trigger flushing. Avoiding vigorous exercise or dividing it into shorter sessions may help. You can also find ways to stay cool while working out, such as exercising outdoors during cooler weather, and indoors in an air-conditioned space when it is hot outdoors.

Stress

Stress, or emotional upset, is one of the most common triggers associated with rosacea flare-ups. If this is a trigger for you, seek out ways to manage stress, such as getting enough sleep, exercising regularly, deep breathing and stretching, and eating a healthy diet. Keep in mind that too much caffeine and sugar, dehydration or skipping meals, can also increase stress levels.

Medications

Certain medications that cause flushing can cause flare-ups. Drugs that cause vasodilation (ones that cause your blood vessels to enlarge) such as ACE-inhibitors and some cholesterol-lowering drugs (i.e. niacin) may play a role. Extended use of prescription-strength cortisone creams on the face can worsen rosacea symptoms.

Cosmetic products

Products with fragrance, alcohols, abrasives or other irritating ingredients can aggravate rosacea symptoms. Remember that rosacea-prone skin is sensitive and dry, so choose only gentle products.

Good skin health tips for rosacea

The key to caring for skin affected by rosacea is to treat it gently.

  • Choose products that are non-drying, free of alcohol or astringents.
  • Use a mild cleanser and do not rub or scrub skin.
  • Make a habit of using sunscreen (SPF 30 or higher) every day.
  • Moisturize your skin, especially during the colder months when the air is dry.
Harmful myths about rosacea

Myth #1: It’s a form of acne.

Do not try acne creams because they may dry out and irritate your skin even more.

Myth #2: It’s because of a drinking problem.

Excess alcohol consumption does not cause rosacea. Alcohol is a known trigger so it can worsen symptoms in individuals with rosacea.

Myth #3: It’s due to high blood pressure.

It is a common misconception that high blood pressure produces facial flushing. Medications used to manage high blood pressure, however, can increase redness in rosacea sufferers.

Myth #4: It’s due to poor hygiene.

Rosacea does not result from not washing enough. In fact, because rosacea skin tends to be dry and sensitive, overcleansing it can actually make symptoms worse.

Myth #5: It’s actually a bad sunburn.

Because of the redness that characterizes rosacea, people may assume that you have sunburned skin.

Rosacea does not improve or resolve on its own, and untreated rosacea can worsen over time. Unlike acne, self-treating with over-the-counter products may not help and may even irritate skin more, causing more redness and bumps. Your family doctor or dermatologist can prescribe various forms of treatment and recommend which skin care products and cosmetics are appropriate.

Sticking with the treatment recommended by your doctor will improve symptoms within a few weeks.

Metronidazole

This topical agent, which has anti-inflammatory and antimicrobial effects, is considered a gold standard treatment for rosacea. It can be used long term and is available in a gel, cream and lotion formulation.

Antibiotics (topical, oral)

Rosacea is often treated with antibiotics, either in a topical formulation that is applied directly to affected skin or in a pill form you swallow. They work mainly by providing an anti-inflammatory effect. Oral antibiotics include tetracycline, minocycline, erythromycin, clindamycin, and others.

Steroid creams

Rosacea may be treated with mild topical steroids that are either over-the-counter or prescription-strength. These can be used short-term to help to reduce skin redness and inflammation. They can make rosacea worse if used for longer periods.

Isotretinoin

This oral agent may be prescribed if rosacea is severe or if symptoms do not respond to antibiotics.

Tretinoin cream

This topical agent may be prescribed for mild rosacea.

Sodium sulfacetamide and sulphur

Sodium sulfacetamide and sulphur are typically used in combination to treat redness and inflammation.

Laser therapy and other cosmetic surgery

Laser therapy treatment involves using a pulsed dye laser or intense pulsed light (IPL) to treat visible red blood vessels. Laser resurfacing, dermabrasion or cosmetic surgery may be used to reduce the tissue overgrowth associated with rhinophyma.

Camouflage make-up

In addition to treating their rosacea symptoms, many patients feel better about their condition if they are able to cover the visible redness and bumps. Corrective camouflage is available to help conceal rosacea symptoms. This is a special kind of make-up with a green tint.