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Rosacea - symptoms, treatment, skin-care

Rosacea is a skin condition characterised by a red facial rash.  It most commonly affects the nose, cheeks, forehead and chin but some people can experience symptoms on their neck, back, scalp, arms and legs.  Antibiotics are the primary treatment, while changes to skin care regimes may help prevent reoccurences.

Rosacea can have a similar appearance to acne but the two conditions are unrelated.  Rosacea does not produce the blackheads, deep cysts or lumps that are symptomatic of acne.  It mostly affects fair-skinned Caucasians (especially those of Celtic origin) aged 30–60 years.   

Signs and symptoms  

The cause of rosacea is not known but it is thought that a variety of factors may trigger the overreaction of facial blood vessels to cause the skin’s flushing and inflammation.  Identifying the disease is the first step to controlling it.  Self-diagnosis and treatment is not recommended, especially as some over-the-counter skin applications may make the problem worse. 

Rosacea often begins with episodes of flushing of the skin. As the condition progresses the skin become persistently red and spider-like veins (telangiectasia) become visible on the skin. Other symptoms characteristic of rosacea include:  

  • Pimples that may be hard (papules) or pus filled (pustules).
  • Dry and flaky facial skin.
  • Burning and stinging of the skin.
  • Red, sore eyelids and a tendency to develop styes and conjunctivitis.
  • Swelling of the face and eyelids.
  • In advanced cases, the pores of the skin may become prominent and the nose may become enlarged and unshapely (rhinophyma).

A number of factors are known to irritate the condition, including:   

  • Excess alcohol  
  • Hot drinks and spicy foods. 
  • Smoking.
  • Application of topical steroids.
  • Excessive exposure to sunlight or extreme hot or cold temperatures.
  • Rubbing or massaging the face.
  • Some facial creams and cosmetics.  


The mainstay of treatment for rosacea is oral antibiotics. Most commonly, tetracycline based antibiotics, such as doxycycline and minocycline, are used. Other antibiotics that may be used include metronidazole and cotrimoxazole.  Antibiotic treatment usually lasts for between six and 12 weeks. It is not uncommon for repeat courses of antibiotics to be required.  It is believed that the antibiotics work by reducing inflammation in the small blood vessels and structures of the skin. Severe cases are treated with higher doses of antibiotics.

Once the symptoms are under control, an antibiotic ointment may be prescribed on a long-term basis.  Other treatments that may be used include:

  • Isotretinoin – a vitamin A derivative that may be recommended in cases of rosacea that have not responded to antibiotics, or where antibiotic treatment is not well tolerated.  Taken orally, isotretinoin can help to reduce the papules and pustules that occur with rosacea.  This medication must not be used by pregnant women however as it can cause birth defects
  • Azelaic acid – a topical cream or lotion, often used to treat acne, which has proven effective in treating rosacea
  • Vascular laser treatment – this can be effective in treating persistent telangiectasia
  • Other medications – Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, can help to reduce redness and discomfort of the skin. Medications, such as clonidine, can help to reduce flushing of the skin
  • Surgery – this can help to treat rhinophyma by reshaping the nose.
Usually an improvement in the condition should be noticed within three to four weeks of antibiotic treatment.  A referral to a dermatologist (skin specialist) may be recommended if the disease does not respond to the antibiotic treatment.

When treatment is followed correctly, there is gradual improvement.  In some cases rosacea can recur and in others it can clear up completely.  If left untreated, rosacea will worsen and become more difficult to treat. The success of treatment depends upon how early rosacea was diagnosed and if the full course of treatment is followed correctly.   

Skin care

To help prevent further irritation of rosacea and promote healthy skin, these general steps can be taken: 

  • Avoid smoking, alcohol, hot beverages and hot spicy food.
  • Do not massage or rub the face.
  • Avoid oil based cosmetic products.
  • Use alcohol free facial products.
  • Protect against exposure to extreme hot and cold temperatures e.g. hot baths or showers.
  • Use a non-irritating sunscreen with a sun protection factor (SPF) of 15+ to protect your skin from the sun. 


Anderson, K. N., Anderson, L. E. & Glanze, W. D. (Eds.) (2006) Mosby’s Medical, Nursing and Allied Health Dictionary. (6th ed.) St. Louis: The C.V. Mosby Company
Camer, R. H. (2006) Rosacea. The Gale Encyclopedia of Medicine, Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thomson Gale.
DermNet NZ (2013) Rosacea. New Zealand Dermatological Society Incorporated.
Last Reviewed – 11 July 2013
Go to our Medical Library Index Page to find information on other medical conditions.