Rosacea

Overview

Rosacea is a chronic skin condition marked by cycles of flare-ups and periods of remission. Symptoms typically come and go. Many people report that certain factors, such as spending time in the sun or experiencing emotional stress, bring them on.

Treatment usually includes a combination of self-care measures and medicines. Most people respond well to these interventions, but improvement is gradual and can take three months or longer.

Rosacea affects primarily adults ages 30 to 60.

Signs and Symptoms

Most people experience only some of the symptoms of rosacea, and the pattern varies from person to person. The condition usually affects the center of the face, but in rare cases it can extend to the sides of the face, the ears, neck, scalp, and chest.

Symptoms include:

• Facial redness: Redness may start as a tendency to flush or blush, but over time it may persist for longer periods. Sometimes, it’s accompanied by tingling or burning, and the reddened skin may turn rough and scaly.
• Rash: Areas of facial redness can develop red or pus-filled bumps and pimples that resemble acne.
• Visible blood vessels: These typically appear as thin red lines on the cheeks and nose.
• Skin thickening: The skin may thicken, especially on the nose, giving it an enlarged and bulbous appearance. This is one of the more severe symptoms and mostly affects men.
• Eye irritation: When ocular rosacea occurs, the eyes become sore, red, itchy, watery, or dry. They may feel gritty or as if something is in them. The eyelids may swell and become red at the base of the eyelashes, and styes may develop.

Sometimes rosacea follows a progression from temporary flushing of the nose and cheeks to longer-lasting flushing, and then to the appearance of a rash and small blood vessels beneath the skin. If left untreated, the skin may thicken and enlarge, leading to firm, red bumps, especially on the nose.

Important: If you develop eye symptoms, see a healthcare provider right away. Left untreated, eye damage and loss of vision can result.

Related Health Effects

Having a long-term condition like rosacea can raise the risk of anxiety and depression. Many people with rosacea, especially those with more noticeable skin changes, report that it inhibits their social lives.

Causes and Risk Factors

Scientists do not know what causes rosacea. They know that inflammation contributes to key symptoms such as skin redness and rash, but they do not fully understand why inflammation occurs. It may be due in part to increased skin sensitivity, environmental factors such as ultraviolet (UV) light, and microbes that inhabit the skin. Both genetic and environmental factors likely play a role.

Anyone can get rosacea, but it is more common among:

• Middle-aged and older adults
• Women, though when men develop it, it tends to be more severe
• People with fair skin, though it may be underdiagnosed in people with darker skin because darker skin can mask facial redness

People with a family history of rosacea may be at increased risk, but more research is needed to understand the role of genetics.

Diagnosis

There is no specific test for rosacea. Doctors base the diagnosis on the appearance of your skin and eyes, and on your medical history. Your doctor may order tests to rule out other conditions that look like rosacea.

Medical professionals routinely rule out acne, lupus, and seborrheic dermatitis when diagnosing rosacea.

Treatment and Management

There is no cure for rosacea, but there are ways to make your skin look and feel better. Because symptoms differ among people, doctors tailor treatments to each individual. A combination of self-care measures and medicines is typical.

While treatment is usually long-term, there may be times when symptoms improve and you can temporarily stop using medicines.

The goals of treatment are to:

• Control symptoms
• Prevent complications and worsening of the condition
• Improve quality of life

Medicines

Topical agents applied to the affected skin are usually prescribed first for mild symptoms. Oral medicines are typically used only for moderate or severe cases.

Topical agents include:

• Creams, gels, and ointments containing antibiotics, antiparasitics, or vasoconstrictors to treat flushing, redness, and mild rashes
• Lubricating eye drops or ointments containing antibiotics or immunosuppressant medicines for eye irritation

Oral medicines include:

• Antibiotics for moderate to severe rashes and more serious eye symptoms — these are believed to work in part because of their anti-inflammatory properties
• Retinoids, which are compounds related to vitamin A, for some people with severe rosacea
• Drugs approved for other conditions, used occasionally to reduce flushing

Laser and Light-Based Therapies

Lasers and intense pulsed light devices can help shrink blood vessels, making them less noticeable. Doctors may also use laser therapy to remove excess tissue in people who have developed thickened skin.

Surgery

Surgery may be needed when thickened skin requires removal. The procedure may involve a scalpel or special abrasion instruments.

Living With Rosacea

Taking an active role in managing rosacea can help relieve discomfort and prevent flare-ups.

Learn Your Triggers

Many people with rosacea find that certain factors make their symptoms worse. Keeping a written record of what seems to worsen your rosacea may help you identify your personal triggers.

Common triggers include:

• Exposure to sunlight
• Emotional stress
• Hot or cold weather
• Strong winds
• Strenuous exercise
• Alcohol consumption
• Hot baths
• Spicy foods
• Foods or beverages hot in temperature

Treat your Skin Gently

Wash your face with cleansers made for sensitive skin and moisturize regularly. Avoid exfoliants and products that contain alcohol.

Protect your Skin from the Sun

Use an SPF 30 or higher sunscreen formulated for the face every day.

Pay Attention to your Eyes

Be alert for eye redness or burning. If you develop eye irritation, see your doctor right away. Your doctor may recommend gently scrubbing your eyelids with watered-down baby shampoo or an eyelid cleanser, then applying a warm (but not hot) compress a few times a day.

Get Support

Having rosacea can be challenging and may raise the risk of anxiety and depression. Consider visiting a mental health professional or joining an in-person or online support group if emotional problems arise. Connecting with patient advocacy groups can provide emotional support and practical advice.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on inflammatory skin diseases.

Find Treatment

Rosacea is primarily treated by dermatologists, who specialize in conditions of the skin, hair, and nails.

Other healthcare providers who may be involved in care include:

• Mental health professionals, who can help people cope with difficulties in their social and professional lives that may result from their condition
• Ophthalmologists, who specialize in treating disorders and diseases of the eye

Community Support

The following organizations offer information and resources related to rosacea:

• National Rosacea Society
• American Academy of Dermatology
• U.S. Food and Drug Administration

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

Investigators at institutions across the country, many supported by NIH, are working to understand what causes rosacea and to develop new treatment strategies.

Current areas of research include:

• The skin microbiome: Imbalances in the human microbiome (the collection of all microbes that live in and on the human body) have been linked to a number of diseases and conditions. Early evidence points to differences in the types of microbes that populate the skin of people with rosacea, suggesting the microbiome may play a part in the condition.
• Early detection and prevention: Scientists are exploring novel preventative and therapeutic targets for rosacea in an effort to shift the study and management of the condition toward early detection and prevention.
• Antimicrobial peptides: Higher levels of antimicrobial peptides (which are a normal part of the immune system) appear in the skin of some people with rosacea. These peptides help combat infections, but when their levels are too high, they may lead to inflammation and redness typical of the condition. Scientists are investigating the role they play.
• Clinical trials: Investigators are carrying out clinical trials to compare the effectiveness of various combinations of oral and topical medicines for relieving symptoms.
• Genetics: Investigators are searching for gene variants that raise the risk of rosacea by comparing the DNA of people with the condition to healthy controls.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.