Rosacea

Rosacea is a long-term 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.

Rosacea mostly affects fair-skinned Caucasians (especially those of Celtic origin) aged 30–60 years and can be worse in men. Antibiotics are the primary treatment, while changes to a person’s skin care routine may help prevent recurrences.

Signs and symptoms

Identifying the disease and seeking a doctor's help are the first steps to controlling it. Self-diagnosis and self-treatment are 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 become visible on the skin. Other symptoms 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) due to skin thickening.

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.

Causes

The exact cause of rosacea is not known but may be due to a combination of genetic and environmental factors. It is known, however, that a variety of factors can trigger an overreaction of facial blood vessels and increased blood flow to the skin surface, causing skin flushing and inflammation.

Factors are known to trigger or aggravate the condition, include:

• Excess alcohol.

• Hot drinks and spicy foods.

• Smoking.

• Application of topical corticosteroids.

• Stress.

• Excessive exposure to sunlight or extreme hot or cold temperatures.

• Strong winds.

• Some facial creams, including sunscreens, and cosmetics.

Treatment

The mainstay of treatment for rosacea are oral antibiotics that are commonly used in a range of skin conditions. The course of treatment will usually last 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.

A range of other treatments may be used to reduce inflammation, facial redness and other visible symptoms.

When treatment is followed correctly, there should be a gradual improvement that should be noticeable within three to four weeks of starting antibiotics. A referral to a dermatologist (skin specialist) may be recommended if the disease does not respond to the antibiotic treatment.

Once the symptoms are under control, an antibiotic ointment may be prescribed on a long-term basis.

In some cases, rosacea can recur while 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.

In advanced cases of rosacea, surgery may be considered to treat rhinophyma by reshaping the nose.

Skin care

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

• Gently clean your skin twice daily using a gentle, soap-free, non-abrasive cleanser.

• Avoid oil-based cosmetic products that require solvents for removal.

• Use alcohol-free facial products.

• Quit smoking and avoid secondhand smoke.

• Avoid alcohol, hot beverages and hot spicy food.

• 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 30+ to protect your skin from the sun.

• Reduce stress levels.

References

BPAC (2016). Rosacea: seeing red in primary care (Web Page). Dunedin: Best Practice Advocacy Centre (BPAC) New Zealand. https://bpac.org.nz/BPJ/2016/May/contents.aspx [Accessed: 18/08/20]
NHS (2020). Rosacea (Web Page). Redditch: National Health Service (NHS) England. http://www.nhs.uk/Conditions/Rosacea/Pages/Introduction.aspx [Accessed: 18/08/20]
Ngan, V., Oakley, A. (2014). Rosacea (Web Page). Hamilton: DermNet New Zealand. https://www.dermnetnz.org/topics/rosacea/ [18/08/20]
O’Toole, M.T. (Ed.) (2017). Rosacea. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last reviewed: August 2020

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