All about rosacea: Causes, triggers and treatment

If facial flushing and redness don't go away, you may have rosacea.

Written by
Kylie Saunder
Medically reviewed by
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Skin redness affects most of us from time to time. If you've just exercised, been in a heated environment, eaten a hot curry or had a glass of red wine, your face may flush and turn pink or red.

But, if the facial flushing and redness don't go away, you may have rosacea, a chronic inflammatory skin condition. If you have rosacea, you're not alone.

In 2018, the US-based National Rosacea Society estimated this common skin ailment affects over 415 million people worldwide. Mainly occurring in people over 30, the physical effects of rosacea can create adverse psychological effects.

Rosacea can be treated through various methods, including:

  • Laser therapy
  • Topical treatments
  • Oral medications
  • Avoidance of triggers
  • Reducing sun exposure, especially the midday sun
  • Gentle skincare

What is rosacea?

According to Dermnet NZ, "rosacea is a chronic inflammatory skin condition predominantly affecting the central face and most often starts between the age of 30–60 years."

It's characterised by:

  • Visible red blood vessels across your face
  • Persistent facial redness
  • Pimples or pustules on your face

Rosacea symptoms can flare up and then dissipate. While rosacea isn't contagious, it can make you feel embarrassed and less confident if untreated. 

What causes rosacea?

There can be multiple causes of rosacea that include:

  • Genetic susceptibility — if a family member has rosacea, you may be more prone to having it.
  • The altered microbiome of your gut and skin.
  • Triggers like UV light, temperature change, exercise, spicy food, psychological stress, air pollution, smoking and drinking alcohol.
  • Impaired skin barrier, which involves inflammation and bacteria.

Who gets rosacea?

In 2018, an estimated five per cent of adults worldwide had rosacea. Affecting both women and men, rosacea tends to present after the age of 30.

It can be more prevalent in people of Celtic or North European descent. 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases states, "Anyone can get rosacea, but it is more common among these groups:

  • Middle-aged and older adults.
  • Women, but it tends to be more severe when men get it.
  • People with fair skin, but it may be underdiagnosed in darker-skinned people because dark skin can mask facial redness."

What are the common symptoms of rosacea?

The pattern and number of symptoms will vary from person to person.

While rosacea is a chronic skin condition, it cycles between flare-ups, where you experience signs, and periods where you don't.

Common symptoms of rosacea include:

  • Eye irritation: Also called ocular rosacea, your eyes will become dry, watery, sore, red, and itchy. If you have these symptoms, it's essential to get them treated as they can result in eye damage and even loss of vision.
  • Facial redness: This can be a flush or blush that persists for extended periods. A burning or tingling sensation can also accompany it. In some people, this redness will become scaly and rough.
  • Rash: This rash may develop pus-filled bumps that resemble acne.
  • Skin thickening: This can occur on the nose, creating an enlarged and bulbous appearance. Skin thickening primarily affects men.
  • Visible blood vessels: These generally appear as thin red lines on your nose and cheeks.

Rosacea vs acne: What's the difference?

Rosacea is a chronic facial inflammatory condition characterised by flushing and a feeling of warmth on the face. Acne is "a common chronic skin disorder that affects the hair follicle and sebaceous gland, in which there is expansion and blockage of the follicle and inflammation."

2017 Australian study found acne "affects more than 90 per cent of Australian adolescents aged 16–18 years. It may have a significantly deleterious effect on their self-esteem and emotional state. Moderate-to-severe acne can lead to scarring."

Rosacea and acne have only one thing in common; an abnormal infiltration of immune cells that gather at skin sites with a high density of sebaceous glands. This includes the face, back, and chest. The primary therapeutic targets to treat acne surround inflammation and sebum alterations of the skin. 

Rosacea is treated differently from acne and includes controlling symptoms, avoiding triggers, topical treatments, and oral medications. 

What triggers rosacea?

The American Academy of Dermatology Association defines a trigger for rosacea as anything that causes it to flare up.

These triggers will differ from person to person but can include:

  • Alcohol
  • Exercise
  • Hair and skin products
  • Heat
  • Spicy foods
  • Stress
  • Sunlight
  • Wind and cold weather

While rosacea flare-ups are annoying, your skin can stay redder for longer each time they happen. This can result in permanently red and thickened skin where visible blood vessels appear in some people.

Understanding what triggers your rosacea flare-ups can help you:

  • Reduce your exposure to them
  • Improve the results from your treatment
  • Prevent your rosacea from progressing to severe rosacea.

Making a note of what you drink and eat, the products you use, your activity levels and the weather can help you identify what causes your rosacea to flare up.

How is rosacea diagnosed?

In 2017, a panel of seventeen dermatologists and three ophthalmologists decided to use a common approach to diagnosing rosacea.

The following two clinical features were independently considered diagnostic for rosacea: 

  • A flushed face, skin irritation, papules or pustules, telangiectasia and persistent facial erythema. This can include burning, stinging, dryness, and ocular changes.
  • Raised and thickened skin on the nose, forehead, chin, ears, or eyelids. This type of rosacea is called Phymatous rosacea.

Rosacea diagnosis and treatment should be based on clinical presentation. The consensus was achieved to support this approach for rosacea treatment strategies.

How is rosacea treated?

A 2021 clinical dermatology study advised, "the first step in the treatment of rosacea is to advise the patient to identify and then avoid triggers such as UV light, spices, weather changes, and alcoholic beverages."

Skincare recommendations to treat rosacea included:

Treating rosacea involves treating inflammation and the dilated blood vessels for people with erythema. Common treatments for rosacea include:

  • Topical or oral prescription medication, 
  • Light and laser treatment therapy
  • Using soothing skincare products.

Software's personalised prescription treatment for rosacea uses the superstar ingredient azelaic acid.

This topical treatment is gentle enough to use on sensitive skin and can help clear up rosacea and reduce redness on the skin thanks to the inflammation-reducing qualities of azelaic acid.

Our Australian-based health practitioners use proven, clinical strength ingredients to formulate your rosacea treatment customised for your skin goals. Simply take our online consult and a Software practitioner will be able to work with you to create a customised treatment plan.

What are the possible complications of rosacea?

Possible complications of rosacea include affecting your eyes and the skin around your nose. Rhinophyma is a skin condition where the sebaceous glands become larger, causing a red, swollen, and pulpy appearance.

Men can be more prone to this complication of rosacea than women.

Rosacea can also cause inflammation of the eye membrane, resulting in a red or pink appearance on your bottom eyelid.

Another complication of rosacea affecting the eyes is known as ocular rosacea.

Symptoms include:

  • Dry eyes
  • Bloodshot and irritated eyes
  • Feeling like you've got something in your eyes
  • Skin inflammation of your eyelids (also called blepharitis).

Ocular rosacea may also cause your cornea (the transparent layer at the front of your eyeballs) to become damaged and inflamed.

This condition is known as keratitis and has the potential to threaten your sight. 

If you suspect you've got issues with your corneas, please get in touch with your GP immediately or visit your local hospital, where an eye specialist can treat you and prevent permanent vision loss.

Photo credit: Getty Images

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  6. Rosacea, Mehdi Farshchian; Steven Daveluy, Last Update: December 30, 2021.
  8. Kurt Gebauer, Australian Family Physician,  Volume 46, Issue 12, December 2017
     > 2017 > December > Acne in adolescent
  9. American Academy of Dermatology Association, Triggers could be causing your Rosacea flare-ups.
  10. J Tan 1L M C Almeida 2A Bewley 3 4B Cribier 5N C Dlova 6R Gallo 7G Kautz 8M Mannis 9H H Oon 10M Rajagopalan 11M Steinhoff 12D Thiboutot 13P Troielli 14G Webster 15Y Wu 16E J van Zuuren 17M Schaller 18 Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel, British Journal of Dermatology, 2017 Feb;176(2):431-438.
  11. Overview of Rosacea, National Institute of Arthritis and Musculoskeletal and Skin Diseases.
  12. Crawford GH, Pelle MT, et al. “Rosacea: I. Etiology, pathogenesis, and subtype classification.” J Am Acad Dermatol2004;51:327-41.)
  13. Pelle MT. “Rosacea.” In: Wolff K, Goldsmith LA, et alFitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 703-9.
  14. Pelle MT, Glen H. Crawford GH, et al. “Rosacea: II. Therapy.” J Am Acad Dermatol 2004;51:499-512.
  15. Steinhoff M, Schmelz M, et al. “Facial erythema of rosacea — Aetiology, different pathophysiologies, and treatment options. Acta Derm Venereol. 2016 Jun 15;96(5):579-86.
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