Rosacea: Symptoms, Causes, and Treatments

Many of us deal with skin redness from time to time. But if you've noticed a persistent red flush to your cheeks, visible blood vessels on your skin, or visible red blood vessels that branch across your face, you could be experiencing rosacea (pronounced roh-ZAY-sha). According to the National Rosacea Society, the common skin ailment affects over 16 million Americans and 415 million people worldwide. Rosacea mostly occurs amongst people over 30 and can be treated through various methods, ranging from topical treatments to laser therapy. 

We spoke to two board-certified dermatologists to learn more about the skin condition. Read on to what causes rosacea and the possible treatments.

What Is Rosacea?

As previously mentioned, rosacea is a common, chronic skin condition. "It most often involves the central face (nose, cheeks, forehead, chin) but can also spread to the ears, neck, chest, and back," Dr. Kim says. "It is characterized by redness of the face and a tendency to "flush and blush." Both women and men of all skin colors can be affected, but it is more commonly seen in women with lighter skin types. It usually develops after the age of 30." 

There are four types of rosacea: erythematotelangiectatic (vascular), papulopustular (inflammatory), phymatous, and ocular. 

• Erythematotelangiectatic Rosacea: Dr. Kim says redness, flushing, and dilated blood are associated with erythematotelangiectatic rosacea. This form of the skin condition may "progress to visibly dilated capillaries or blood vessels," according to Dr. Faloloa.
• Papulopustular Rosacea: If you are experiencing acne-like breakouts, you may have papulopustular rosacea. 
• Phymatous Rosacea: With phymatous rosacea, the skin typically thickens and has a granulomatous texture. 
• Ocular Rosacea: Ocular rosacea affects your eyes and eyelids, cousin them to become red and irritated.

Causes of Rosacea

While rosacea affects millions of people, medical professionals are still trying to figure out what exactly causes it. "Although we do not know the exact cause of rosacea, there is a complex interplay of hereditary, vascular, immunologic, and environmental factors that has yet to be elucidated with more research," Dr. Kim says.

While there is more research to be done, existing studies indicate genetics, immune reaction, microorganisms, environmental factors, and neurovascular dysregulation are among the known contributing factors for rosacea. Ultraviolet (UV) exposure may also play a role in causing and triggering the skin condition.

Symptoms of Rosacea

In addition to redness, there are a few other telltale signs of rosacea. "Skin affected by rosacea tends to be hypersensitive and can display itching, burning, stinging, sensitivity, tightness, tenderness, and discomfort," Dr. Faloloa says. "Because the manifestation, triggers, and treatments vary widely, getting guidance on the best possible treatments for you is important."

Treatment Methods

"While there is currently no cure for rosacea, it can be treated with lifestyle changes combined with medical treatment," Dr. Faloloa explains. "The best treatments are those with anti-inflammatory, anti-allergic, antibacterial, or anti-parasitic properties." 

The most common treatment methods are topical or oral prescription medications, avoidance of triggers, laser and light therapy, and the use of soothing skincare products. 

• Topical Medications: Mild-to-moderate rosacea can often be treated with prescription topical medications. "Examples include topical metronidazole, ivermectin, niacinamide, azelaic acid, and sulfur," Dr. Faloloa says. 
• Oral Medications: Your dermatologist may include oral medication in your treatment plan. "Prescription oral medications include oral antibiotics, specifically the tetracycline class," Dr. Kim says. "Low-dose doxycycline is used because of its anti-inflammatory benefits, and it is a first-line therapy for ocular rosacea as well." 
• Avoidance of Triggers: "Several environmental factors may contribute to rosacea flare-ups," Dr. Kim says. These include sunlight, stress, heat, exercise, alcohol, spicy foods, cold temperatures, and topical steroids.
• Laser and Light Therapy: "Vascular lasers and intense pulsed light devices have been a mainstay in the treatment of rosacea in my practice," Dr. Kim notes. "They work by targeting hemoglobin in the blood vessels that are responsible for the flushing and blushing phenomenon, thereby reducing redness and telangiectasias."
• Gentle Skincare Products: Using non-irritating products in your skincare routine is key. "One example is Rodan + Fields Soothe Sensitive Skin Treatment ($90)," Dr. Kim says. "Formulated for sensitive, visibly red, itchy, and dry skin, this product is well-suited for rosacea patients. [Use this with] a soap-free cleanser, gentle moisturizer, and mineral sunscreen, and you have a complete regimen."

When to See The Doctor 

If over-the-counter products and the avoidance of triggers are not controlling your symptoms, Dr. Kim recommends seeking help from a board-certified dermatologist. "Other conditions like contact dermatitis or autoimmune [diseases] can also cause a red, sensitive face, so a dermatologist can properly diagnose your skin condition and set you on the right path for treatment," she says. "If your rosacea is cystic, painful, or you are starting to see granulomatous textural changes to your skin, you may benefit from prescription medications in conjunction with laser treatments. Severe thickening and granulomatous changes of the skin in rhinophyma may require surgical intervention. If you are experiencing dry eyes or a foreign body sensation in your eyes, you should see an ophthalmologist to be evaluated for ocular rosacea." 

The Final Takeaway

Rosacea is one of the most common skin conditions. While it is a chronic inflammatory disorder, there are various ways to treat and reduce symptoms (from topical prescription medication to laser therapy). If you are dealing with rosacea, it is best to visit a dermatologist so they can help you figure out the best course of action.