• Image

You are here » Focus on the Skin » Rosacea

Rosacea

Rosacea is a chronic inflammatory disorder affecting the face. It is prevalent amongst fair-skinned individuals, especially of Celtic and northern European origin and is more common in women. The characteristic skin lesions (redness, visible blood vessels, papules and pustules) appear in the middle of the face (forehead, nose, cheeks) between the ages of 20 and 50. Flushing due to spicy food, alcohol, weather changes, sun, hot showers etc, often have a negative impact on the patients’ social life. Stinging, burning, sensitivity of the skin and intolerance to cosmetics are also very common and in some cases the eyes can become red, dry and itchy.  

Disease overview

Description

["roh-ZAY-sha "]

Rosacea is a common skin disorder that often begins as redness in the cheeks, nose, chin, or forehead in both men and women. Many patients find that this redness can be triggered by external factors such as temperature changes or certain foods and drinks. It can also be triggered by stress and is sometimes mistaken for blushing. Women may be more likely to experience rosacea, however men are more likely to have more severe forms of the disease.
People with rosacea often find that this redness appears and disappears at the beginning, but over time certain areas of the face may stay red. These areas sometimes have visible blood vessels or tiny pimples that may look similar to acne. As with acne, there are some microorganisms that seem to play a role in symptoms. However, it is important to realise that rosacea is not ‘infectious,’ and cannot be transmitted from one person to another. Some people also find their skin to be more sensitive to irritation and can experience burning or itching sensations.

Diagnosis

There is no specific test for rosacea. A dermatologist or other healthcare professional will usually make a diagnosis by examining the affected skin. However, your your healthcare professional may ask several questions that may help ensure a proper diagnosis or to rule out other skin disorders. These include questions about: 

  • Ancestry—people of Celtic or Northern European descent are more likely to have rosacea
  • Family history—you’re more likely to have rosacea if someone in your family has it as well
  • Medications—reactions to certain medications can cause symptoms similar to rosacea

Emotional Consequences

The effects of rosacea go beyond skin problems—there is an emotional side to the disease as well. Surveys have shown these emotional consequences often weigh heavily on people with rosacea. In a survey performed by the National Rosacea Society that include over 500 people with rosacea, 42% reported feeling sad or depressed by the appearance of their skin. In this survey, rosacea was second only to weight gain as the top age-related concern—making it a greater source of anxiety than many other common concerns, such as wrinkles, thinning hair and cellulite.

KEY MESSAGES:

IMPORTANT FACTS ABOUT ROSACEA

  • Rosacea is a skin disorder that occurs in both men and women, and is most common in people of Celtic or Northern European descent.
  • Rosacea typically begins as skin redness that can flare up in certain situations; over time the affected areas may stay red, and visible blood vessels and pimples may appear.
  • Your healthcare professional will typically diagnose rosacea by examining your skin, however they may ask questions about ancestry, family history, or other medications to confirm the diagnosis.
  • Rosacea carries a significant emotional burden, and can lead to anxiety.

Causes, Triggers, and Risk Factors

The exact cause of rosacea is not known, but researchers think that both genetic and environmental factors play a role. Almost one third of people with rosacea have a family history of the disease, which suggests that genetics are important in this disease. People with rosacea also find that there are several environmental factors that “trigger” their rosacea. You may notice that some of these factors in your daily life trigger your rosacea symptoms such as facial flushing. Triggers can be very different from one person to the next, and it is important for you to keep track of your triggers to help you avoid them and minimise flare-ups.

Factors that may trigger rosacea include: 

Trigger

Patients
Affected, %

Sun exposure

81

Emotional stress

79

Hot weather

75

Wind

57

Heavy exercise

56

Alcohol consumption

52

Hot baths

51

Cold weather

46

Spicy foods

45

Humidity

44

Indoor heat

41

Certain skin care products

41

Heated beverages

36

Certain cosmetics

27

Medications

15

Medical conditions

15

Certain fruits

13

Marinated meats

10

Certain vegetables

9

Dairy products

8

Data based on an unscientific survey by the National Rosacea Society of 1066 patients with rosacea.

There are also known risk factors for rosacea. While anyone can develop rosacea, these factors can alter your risk showing symptoms:

Family History

30% of patients with rosacea have a family history of the disease. This means that if rosacea runs in your family, you’re more likely to have it yourself.

Light Complexion

People with fair or light skin, especially those of Celtic or Northern European ancestry, are at greater risk.

Age

People between the ages of 30 and 60 are more likely to develop rosacea, especially women of this age going through menopause.

Flushing

People that experience frequent flushing or blushing are more likely to be diagnosed with rosacea.

 

Treatment & Practical Tips

There are several different types of rosacea and various treatments for these different types. Your healthcare professional may suggest prescription drugs and over the counter medications. Some of these will be applied directly to the skin (topical), whilst others are pills or capsules that are meant to be swallowed. In some cases laser treatments may be used to reduce the appearance of visible blood vessels. Any treatment will depend on the particular type of rosacea as well as the severity, consult with your healthcare professional for what may be suitable for you.

It’s important to always take rosacea treatments as prescribed by your healthcare professional. Rosacea treatment can be very effective at reducing pimples and improving the appearance of skin, but this does not happen overnight. Don’t be discouraged if your rosacea does not improve in a few days. There are several effective treatment options for rosacea. The aim of the treatment is to manage symptoms. Many rosacea medications are taken over long term periods because rosacea tends to recur.  Stopping treatment can result in disease relapse. In some cases, your healthcare professional may prescribe an initial treatment to get your rosacea under control, followed by another type of treatment that can help keep it from returning.

Treatment

How it works in rosacea

Topical preparations

 

Main mechanisms of action for topical treatments include;

  • Anti-inflammatory, antimicrobial used to treat papules and pustules of rosacea
  • Selective alpha2-adrenergic receptor agonist reduces erythema through direct cutaneous vasoconstriction.

Formulations include;

  • Creams
  • Gels
  • Lotions

Potential side effects include;

  • Application site irritation : dryness, stinging and burning, and redness and flushing. Care should be taken not to get these products into the eyes.

Oral Antibacterials 

Main mechanisms of action for oral treatments (e.g. Doxycycline/ Tetracyclines) include;

  • Anti-inflammatory, Antibacterial (antibiotic doses only) used to treat papules and pustules of rosacea

Formulations include;

  • Pills
  • Capsules
  • Tablets

Potential side effects include;

  • High doses of tetracyclines or doxcycylines can cause tooth changes in the fetus of pregnant women.
  • Typical side effects include nausea, diarrhea and other GI upsets, which can occur at all doses of these products, but are more frequent with the higher doses.
  • In addition, high doses of these products may result in organisms becoming antibiotic resistant.

Laser/IPL

Main mechanisms of action include;

  • Transmission of a special light that is absorbed by hemoglobin in the blood. The light destroys targeted blood vessels at the surface of the skin that cause the appearance of redness.

Treatment delivery includes;

  • Controlled exposure to laser treatments in short bursts administered by a healthcare professional

Potential side effects include;

Treatment with lasers and/or intense pulsed light may induce pain, redness, purple discoloration,or swelling, all being transient.

 

Your healthcare professional will help you to decide which treatment is best for you and the type of rosacea you have.  Also, your lifestyle and preferences should be taken into account when discussing treatment options with your healthcare professional:

  • First, the treatment should never be worse than the rosacea itself.
  • Consider your lifestyle, available time and the cost to help you decide among the options.
  • The treatment may need to be used for prolonged periods of time  in order to manage rosacea symptoms over the long term.
  • If you are pregnant or plan on becoming pregnant during rosacea treatment it is important to talk to your healthcare professional about what treatment options are appropriate for you.
  • Topical rosacea treatments may initially irritate the skin and cause rosacea flare-ups; these can resolve after continued use of the treatment.  If considered contact your prescribing healthcare professional for more advice.
  • Keep in mind: treatment adherence strongly influences treatment effectiveness (If you don’t use it, it won’t work!)

 

Cleansing

Cleansing is an important aspect of managing rosacea. The following tips may help soothe your skin and minimize symptoms like redness, stinging, burning, and tightness. These often involve minor modifications to your existing cleansing routine, and focus on treating your skin gently and avoiding potential triggers for exacerbating your rosacea.

Skin Care Tips

  • Use a gentle cleanser to thoroughly cleanse your skin each morning and evening, using your fingertips to apply it to your entire face.
  • Avoid ingredients that sting, burn or cause facial redness. Examples may include alcohol, witch hazel, menthol, peppermint, eucalyptus oil or clove oil.
  • Use fragrance-free products.
  • Rinse with lukewarm water to remove all dirt and soap, and use a thick cotton towel to gently blot the face dry.
  • Let your face thoroughly air dry before applying medication or skincare products, and wait a few minutes before applying topical medication. Then allow the medication to dry completely for 5 to 10 minutes before applying any moisturiser or makeup
  • Men should ideally use an electric shaver rather than a blade. If a blade must be used, never use a blunt blade, which might require extra scraping for a clean shave. Avoid shaving lotions and aftershaves that burn or sting.
  • Use makeup to hide blemishes and cover redness. Green-tinted prefoundations are available at many pharmacists that can mask general redness. These can be followed by a skin-tone foundation. Avoid powders, which can make dry, flaky skin look worse.

KEY MESSAGES:

HELPFUL HINT

Avoid hot water, hot tubs and saunas. These can trigger flushing and aggravate your rosacea.

CAUTION

Never pull, tug, scratch or treat your face harshly. Avoid any rough washcloths, loofahs, brushes or sponges.

Recording Symptoms or Triggers
Many patients find their rosacea easier to manage when using a diary or journal to record symptoms and triggers. Use the dairy from the Rosacea Awareness Program to identify the trigger factors and record important details of your rosacea. Over time this may help you to better understand your condition.

People with rosacea sometimes find that managing their lifestyle can help to keep symptoms under control.  Listed below are a few measures that may assist.  Consult with your healthcare professional on how to best manage your symptoms. 

Sun protection

  • Stay out of the sun (as well as tanning beds as much as possible) ; because it can trigger your rosacea.
  • Check with your healthcare professional to see if any medication you are taking makes you more sensitive to the sun.
  • Wear broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher to protect your face from the sun.

Winter protection

  • Protect your face in the winter with a scarf.

Avoid skin irritation

  • Avoid irritating your facial skin by rubbing or touching it too much.

Use a gentle cleanser

  • Wash your face with a gentle cleanser
  • When using moisturiser and a topical medication prescribed by your healthcare professional the general rule is to apply your medication first and allow this to dry before using moisturiser.  Check with your healthcare professional.
  • Stay away from certain ingredients (alcohol, menthol, astringents) and products (facial scrubs, masks) as they tend to irritate skin, which may make symptoms worse.

Use gentle skin care

  • Avoid oily or greasy cosmetics, hairstyling products or concealers
  • Use hydrating moisturisers

Avoid overheating

  • Avoid overheating - try to keep in a cool environment  

Make-up

  • If you wear make-up, consider using green- or yellow-tinted pre-foundation creams and powders.  These are designed to counter skin redness.

Avoid alcohol

  • Avoid drinking too much alcohol—it can trigger rosacea flare-ups

galderma.co.uk is focused on educating the public and patients about skin conditions and the different types of treatments that are available to treat and manage these diseases. This site is not intended as a substitute for medical advice from your doctor, dermatologist, or other healthcare professional and may include discussions about therapies or treatment options that are not suitable for your individual needs. We encourage you to use the information contained in this site to educate yourself about your disease and allow better communication between you and your healthcare professional.  Always consult a dermatologist or a healthcare professional for more information about your condition and the appropriate treatment / product that is right for your individual needs.

Corporate responsibility

Growing a responsible dermatological community

Discover some of the positive initiatives we are involved in across the world

Read

Video

We are committed

See all videos