If your facial skin is red and irritated for no obvious reason, you may have rosacea. The condition can be embarrassing and disrupt your life if it isn’t treated.
Your doctor will prescribe treatments based on your symptoms. Topical creams and gels can help, and oral medications like oxymetazoline (trade name: Mirvaso) and brimonidine (trade names: Rhofade) can constrict blood vessels, reducing the redness.
Symptoms
People with rosacea often develop redness in the center of their face. This is because small blood vessels near the skin’s surface enlarge, creating a permanent blush or flush. Other symptoms include enlarged pores, a dry or flaky complexion and pus-filled pimples that don’t scar. In some cases, rosacea can spread to the neck, chest, scalp and ears.
In a type of rosacea called erythematotelangiectatic rosacea, the face may become permanently red. Small bumps called papules or pus-filled pimples form, although blackheads don’t appear. Sometimes, the skin on the nose and cheeks thickens to create a bulbous appearance (a condition known as rhinophyma). This rare but treatable form of rosacea is usually found in men.
Some people with rosacea have eye problems, including watery eyes or feeling like you have grit in your eyes. Rosacea can also cause the eyes to swell and develop cysts or styes. If these symptoms happen often, it is important to see a healthcare provider for diagnosis and treatment.
Researchers haven’t identified the exact cause of rosacea, but there are some things that might contribute to it. Problems with the blood vessels in your face could be a factor, as can a reaction to microscopic mites that normally live on the skin (Demodex folliculorum). In addition, certain foods or activities can trigger it.
Diagnosis
A doctor can usually diagnose rosacea by physical examination. People with rosacea have long-lasting redness of the skin, and small blood vessels become more visible (telangiectasia) on the cheeks, nose, and forehead. They often have a red, swollen or pus-filled bump that resembles acne (papulopustular rosacea). The eyes can be irritated and watery or bloodshot (ocular rosacea). The skin may thicken and enlarge, especially on the nose (rhinophyma).
Symptoms of rosacea don’t always show up on the face, but they can appear elsewhere on the body, such as the ears, scalp, chest, and arms. There are many things that can cause rosacea symptoms, including sun damage to the skin, problems with blood vessels (like those caused by aging or high blood pressure), and certain bacteria or mites that live on the skin. It can also run in families.
Rosacea can affect self-esteem and emotional well-being, especially when the skin changes are noticeable. It can lead to feelings of embarrassment and depression. It’s important to see a mental health professional or join an in-person or online support group for help. Getting treatment and avoiding triggers can improve your appearance and your mood. Some people benefit from seeing a dermatologist who specializes in conditions of the skin, hair, and nails. Other people find that seeing a psychiatrist or psychologist helps with emotional problems related to their skin condition.
Treatment
In recent years, new treatments for rosacea have been developed. These drugs are formulated to treat specific symptoms of the disorder, and your doctor may prescribe one or a combination of them depending on your type of rosacea. For example, if you have erythematotelangiectatic rosacea, your doctor may recommend topical antibiotics to reduce inflammation and clear the pores of your skin. This helps to reduce the number of blackheads and pimples you develop. They may also recommend topical retinoids to improve skin texture and slow the growth of the excess skin cells that cause redness.
If you have papulopustular rosacea, your doctor will prescribe a medication to prevent the overgrowth of skin cells that causes bumps and swelling. They may also suggest creams and gels that contain azelaic acid, metronidazole, or ivermectin to minimize the appearance of bumps and reduce bacterial infections. They can also prescribe low-dose oral antibiotics such as doxycycline or ondansetron to reduce the number of bacteria in your bloodstream and ease the discomfort of flare-ups.
Other drugs, such as brimonidine and oxymetazoline, help reduce facial redness by constricting blood vessels. They can be found in prescription-strength gels and are often effective within 12 hours of use. The introduction of these medications, along with azelaic acid, ivermectin, metronidazole, low-dose doxycycline, and light/laser therapy have greatly improved our therapeutic armamentarium for managing this disorder.
Prevention
In many cases, people with rosacea can prevent flare-ups by avoiding things that trigger them. These include spicy foods, hot drinks, alcohol, cosmetics and soaps that can cause skin to irritate, sun exposure and extreme cold or heat. However, these triggers are different for everyone and can take some time to figure out. People with rosacea are also encouraged to keep a diary of the things that affect their symptoms and to try to avoid them.
For example, dairy can make a person’s rosacea worse, so they may want to try switching from cow’s milk to soy or rice milk, which is less irritating. Or they can try iced coffee and tea instead of the warm version. Another common trigger is stress. This can be hard to control, but people can try to find ways to reduce their stress levels, such as meditation and deep breathing exercises.
People with rosacea can also protect their skin by wearing sunscreen with an SPF of 30 or higher, wearing a wide-brimmed hat and staying out of the midday sun. They can also use gentle, fragrance-free moisturizers. Finally, they should avoid hot showers and baths and instead use lukewarm or cool water to wash their faces. This can help to reduce facial flushing. People with rosacea should also be sure to have regular eye exams to check for problems such as dry eyes (blepharitis) and red, inflamed or swollen eyelids.