Rosacea: Symptoms, Triggers and Treatment Options

What is rosacea?

Rosacea is a long-term, inflammatory skin disease that mostly affects the central part of the face (cheeks, nose, forehead, chin). It usually starts after the age of 30 and is recognised more often in people with fair skin; however, it can occur in all skin tones. Because redness is harder to notice on darker skin, diagnosis may be delayed.

Its exact cause is not known. Genetic predisposition, the immune system, changes in the skin's blood vessels and certain microorganisms on the skin are thought to play a role. Rosacea is not contagious and is not caused by poor hygiene.

What are the symptoms?

In the past, rosacea was divided into specific subtypes; today it is recommended to assess it according to which symptoms a person has. A person may have more than one symptom at the same time.

• Flushing: Short-lived reddening of the face together with a feeling of heat
• Persistent redness: Constant redness in the central part of the face
• Visible small blood vessels (telangiectasia): Fine red vessels on the nose and cheeks
• Acne-like bumps and small inflamed swellings: Unlike acne, there are usually no blackheads (comedones)
• Sensitivity, burning, stinging and dryness of the skin
• Thickening of the skin: In some people, more often in men, the skin can thicken, especially on the nose, and its shape can change
• Eye symptoms: Dry eyes, a gritty feeling, burning, redness and swelling of the eyelids

Factors that trigger flare-ups

Triggers differ from person to person. Keeping a diary to identify which situations cause flare-ups for you can help. Commonly reported triggers are:

• Sunlight
• Hot weather, hot showers or saunas; very cold and windy weather
• Alcohol, especially red wine
• Spicy food and very hot drinks
• Emotional stress
• Strenuous exercise
• Skincare products containing alcohol, perfume or abrasive ingredients
• Corticosteroid creams applied to the face (long-term use can worsen a rosacea-like condition)

When should you see a physician?

If you have persistent facial redness, frequent flushing or recurring bumps, it is advisable to see a dermatologist. Rosacea can be confused with acne, seborrhoeic dermatitis, an allergic reaction or some systemic diseases. A correct diagnosis is important for choosing the appropriate treatment.

Rosacea can also affect the eyes (ocular rosacea). If eye involvement is not treated, it can lead to damage to the front surface of the eye and vision problems. If you have eye symptoms, you also need to be assessed by an eye doctor.

Treatments a physician may suggest

Treatment is planned according to the symptoms that are most prominent for you, and more than one method is often used together. Because rosacea is a chronic disease, treatment is usually long-term; the aim is to reduce symptoms and prevent flare-ups.

• Creams and gels: For bumps and inflammation, products containing active ingredients such as azelaic acid, metronidazole or ivermectin; for persistent redness, the physician may suggest certain creams that temporarily narrow the blood vessels.
• Oral medicines: For more widespread bumps or bumps that do not respond to creams, the physician may prescribe medicines such as tetracycline-group antibiotics for set periods, usually at low doses intended to reduce inflammation. In selected cases, other medicines may also be considered.
• Eye involvement: Eyelid hygiene, warm compresses and, when needed, eye drops or oral medicines are planned together with an eye doctor.
• Skin thickening: For marked thickening of the nose, certain lasers or surgical methods may be considered.

Each of these medicines has side effects and situations in which it must not be used. If you are pregnant, planning a pregnancy or breastfeeding, be sure to tell your physician. Do not use prescription medicines for longer than recommended, and do not start them on your own.

Laser and IPL for redness and blood vessels

Persistent redness and visible blood vessels usually respond only to a limited extent to creams. For these symptoms, light-based treatments such as lasers that target blood vessels and IPL (intense pulsed light) can markedly reduce the redness and visible vessels. More than one session is usually needed, and repeat sessions may be needed from time to time to maintain the result.

Temporary redness and swelling are common after these procedures; rarely, bruising, crusting or colour change can occur. The risk of pigmentation is higher on darker skin. The treatment should be performed by an experienced physician who assesses your skin type.

Caution with cosmetic procedures

People with rosacea have more sensitive skin. Chemical peels, microneedling, some high-energy lasers and abrasive skincare procedures can trigger flare-ups, especially while the disease is active. Before having any aesthetic procedure, tell the physician that you have rosacea; if a procedure is needed, a period when the disease is under control is preferred.

For this reason, the suitability and timing of procedures such as fillers, botulinum toxin and peels in rosacea should be assessed individually. For general information about peels, see our article «Chemical Peels: What They Are, Who They Suit and What Recovery Involves».

Daily skincare

• Use a broad-spectrum sunscreen every day; for sensitive skin, products with mineral filters (containing zinc oxide or titanium dioxide) are usually better tolerated.
• Wash your face with lukewarm water and a gentle, fragrance-free cleanser; do not scrub.
• Use a fragrance-free moisturiser regularly.
• Avoid products containing alcohol, menthol, perfume and abrasive particles.
• Try a new product on a small area first.

Realistic expectations

Rosacea is a chronic disease, and it is usually not possible to eliminate it completely. However, with treatment and by avoiding triggers, symptoms often decrease markedly. The effect of creams is usually seen within a few weeks to a few months. Symptoms may return when treatment is stopped; your physician may therefore suggest a maintenance plan.