Rosacea Explained

If you’ve noticed persistent blushing and the odd bumps here and there on your face, you may have rosacea. Although it resembles other skin conditions, rosacea is a unique, common, and treatable condition. In this article, we help you understand the basics of this troublesome condition.

What Is Rosacea?

Rosacea is a skin condition that affects the face, including the forehead, nose, chin, and cheeks. Occasional skin flare ups characterize the condition. When you get a flareup, your skin becomes red and ruddier than the other parts of your skin. In advanced cases, bumps, pimples, skin thickening, and eye irritation may occur. Although there is no cure for this chronic condition, several treatments are available to manage and minimize your symptoms.

Types Of Rosacea

There are four types of this condition:

• Subtype one: Also known as erythematotelangiectatic (ETR) rosacea, subtype one is associated with flushing, facial redness, and visibility of blood vessels.
• Subtype two: Subtype two is also called ‘papulopustular rosacea’ or ‘rosacea acne’. It causes skin breakouts like those caused by acne.
• Subtype three: A rare type of the condition, rhinophyma causes the nose skin to thicken, making the nose look enlarged. It typically affects men.
• Subtype four: Subtype four affects the eyes, usually resulting in eye irritation and bloodshot eyes. It is also called ocular rosacea.

Symptoms

Your symptoms depend on the type of rosacea you have. However, it is common for different types to occur at once, leading to overlapping or combined symptoms.

Type I ETR rosacea symptoms

• Redness and flushing of facial skin
• Visible broken skin capillaries
• Skin sensitivity
• Facial skin swelling
• Burning or stinging sensation in inflamed areas
• Dry, scaly, and rough skin

Type II acne rosacea symptoms

• Acne-like skin breakouts
• Skin sensitivity
• Visible broken skin capillaries
• Skin patches
• Red skin
• Increased skin oiliness

Type III rhinophyma rosacea symptoms

• Skin bumps
• Thickening of nose skin
• Skin thickening on other areas like cheeks, forehead, ears, and chin.
• Enlarged pores
• Visible broken skin capillaries

Type IV ocular rosacea symptoms

• Bloodshot eyes
• Watery eyes
• Gritty feeling in the eyes
• Itchy and dry eyes
• Reduced vision
• Light sensitivity
• Stinging or burning sensation in the eyes
• Eye cysts
• Visible broken skin capillaries

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What Does Rosacea Look Like?

Rosacea looks like reddish blushing around the central parts of your face. It typically affects fair-skinned people more. However, anyone can get this condition. If you have such redness, the diagnosis is confirmed if the redness persists and you experience some level of skin thickening.

You can identify skin thickening by when you run your fingers on your skin and feel slightly raised bumps. Although such flare ups come and go, it is best to seek treatment when you first notice the redness to forestall any worsening of the condition.

What Is Rosacea Acne?

Rosacea acne, also called papulopustular rosacea or adult acne, is a type that causes acne-like skin breakouts. Such breakouts may have pus-filled pimples, cysts, and bumps. Although bearing the name of ‘acne’, it is not actually a type of acne. Instead, it gets its name from the similarity of its breakouts to those of acne.

Rosacea acne rarely occurs before other types of acne. Before the onset of this condition, milder types of rosacea may occur, which, if left untreated, then develop into rosacea acne. As such, early treatment may prevent rosacea acne from forming.

Who Gets It?

Anyone can get rosacea. According to the National Rosacea Society, this condition affects upwards of 16 million Americans. However, the majority do not know they have the condition and so do not seek treatment. Although studies have identified some risk factors, it is not entirely clear why some people get it and others don’t (Abram).

Here are some of the most common risk factors doctors suspect may lead to this condition:

• Gender: This condition affects more women than it does men, although the men who get it tend to experience severe symptoms.
• Family history: A history of rosacea in the family is a major predictor.
• Age: This condition typically affects adults aged thirty to sixty.
• Fair skin: Fair-skinned individuals are more at risk.
• Ancestry: Individuals with Scandinavian, English, Scottish, or northern European descent are more affected.
• Sun exposure: Prolonged exposure can damage surface blood vessels, potentially leading to this condition.
• History of severe acne: Severe juvenile acne with cysts may be a precursor for rosacea later in life.

Is Rosacea Genetic?

Several studies link rosacea to genetic factors. The studies compared control subject DNA (people with no rosacea) to test subject DNA (people with rosacea). They found evidence of gene markers for the condition. The markers identified were in the same region as those found for other inflammation and autoimmune conditions like multiple sclerosis, sarcoidosis, diabetes, and IBD. These results suggest a strong link between rosacea and genes. A history of this condition in families in general further reinforces these findings.

Triggers

Triggers may influence rosacea flare-ups. Understanding triggers is one of the ways you can manage the condition.

Here are the most common triggers:

• Sun exposure
• Hot, cold, or humid weather
• Hot or spicy foods
• Hot showers
• Wind exposure
• Stress and anxiety
• Menopause
• Some skin products (e.g., with alcohol or menthol)
• Some medications (e.g., topical steroids)
• Alcohol (specifically red wine)
• Excessive exercise or exertion

Although it seems like a lot can cause a flare up, these factors tend to affect different people in different ways. For example, while one person may get a flare up from taking red wine, taking a hot shower may not affect them.

Does Rosacea Get Worse With Age?

It’s impossible to tell whether this condition gets worse with age. What starts as mild flushing and redness may or may not escalate into acne-like lesions and permanent scarring. However, rosacea can worsen with age if left untreated. If you catch and treat this condition early, it is possible to prevent it from worsening over time.

Is It Contagious?

The scientific community currently considers rosacea as non-infectious, non-pathogenic, and non-communicable. You cannot transmit it to someone else through touch or sharing clothes, food, or cosmetics.

If you are pregnant or nursing, you may wonder whether you might transfer rosacea to your baby. Scientific research has found no such link. The only way you might pass on this condition to your child is through your genes.

Is Rosacea Connected To Other Skin Conditions?

Although rosacea has no known links to other skin conditions, there are several that have lookalike symptoms. These include:

• Acne vulgaris
• Seborrheic dermatitis
• Staph infections
• Polymorphous light eruption
• Contact dermatitis
• Systemic lupus erythematosus
• Dermatomyositis

If you experience rosacea-like symptoms, contact your doctor to rule out any of these or other more-serious diseases with similar symptoms.

Does It Go Away With Time?

Rosacea is characterized by flare ups that come and go. However, it is highly unlikely that over time, these flare ups will go away for good.

Some studies have found that rosacea does get worse with age (Huynh). Additionally, if left untreated, each subsequent flare up may be worse than the last. Because of this, it is not recommended to wait out a flareup with no management or treatment intervention.

Can Allergies Cause Rosacea?

Scientific research is yet to establish a concrete link between allergies and rosacea. Current evidence seems to point to a correlation between allergies and rosacea rather than causation.

However, this connection remains a possibility. For instance, the antimicrobial peptide cathelicidin LL-37 is part of the body’s allergic response. It is known to cause a heightened immune response as well as vascularization in the skin, two factors consistent with rosacea.
If you suspect an allergy may be causing a flare up, it is worthwhile to mention this to your doctor for further investigation.

Can You Prevent It?

Rosacea is still a poorly understood condition. We are not sure what causes it or how to stop it. Because of this, it is not possible to completely prevent flare-ups. However, the American Academy of Dermatology recommends these steps to reduce flare ups:

• Protect your skin from the sun, wind, and cold
• Lower your stress levels to reduce stress-induced rosacea flare ups
• Maintain a cool skin temperature when exercising, taking a bath, or warming up before a fire or heater
• Simplify your skincare routine by choosing mild ingredients and products and avoiding harsh products like alcohol, menthol, and camphor
• Pick mild foods instead of spicy foods that may cause flare ups
• Drink cool beverages

References

• Abram K, Silm H, Maaroos H-I, Oona M. Risk factors associated with rosacea. Journal of the European Academy of Dermatology and Venereology : JEADV. https://www.ncbi.nlm.nih.gov/pubmed/19874433. Published May 2010.
• Awosika O, Oussedik E. Genetic Predisposition to Rosacea. Dermatologic clinics. https://www.ncbi.nlm.nih.gov/pubmed/29499803. Published April 2018.
• D’Ardenne K. Genetic basis of rosacea identified by researchers. News Center. https://med.stanford.edu/news/all-news/2015/03/genetic-basis-of-rosacea-identified-by-researchers.html.
• Huynh TT. Burden of Disease: The Psychosocial Impact of Rosacea on a Patient’s Quality of Life. Am Health Drug Benefits. 2013;6(6):348‐354. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031723/.

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.