What is Rosacea?

Rosacea is a chronic inflammatory skin condition primarily affecting the cheeks, nose, chin, and forehead. It often goes underrecognized or undertreated, and its diagnosis is frequently delayed because it is mistaken for acne, dermatitis, or other skin conditions. Many mild cases go unnoticed since rosacea is mainly diagnosed through clinical judgment.

The visible effects can impact the quality of life, self-esteem, and overall well-being. Rosacea causes repeated flushing or temporary redness, enlarged blood vessels, skin thickening and small pus-filled bumps (pustules).

While there is no cure for rosacea, it can often be managed with skin care, medication, and avoiding triggers that cause flare-ups.

Rosacea is estimated to affect more than 5% of the global population. It typically affects women more than men. It appears between 30 and 50, with a peak incidence between 40 and 50 (phototypes I and II). However, some people start to get the early signs in their 20s.

Why does Rosacea develop?

The exact mechanisms that trigger the development of rosacea remain unclear. However, studies have shown different possible factors that could be involved:

• Immune system and inflammatory responses: Facial redness is likely the first stage of inflammation, caused by a combination of blood vessel dysfunction and the body’s immune response.
• Changes in blood vessel function within the skin.
• Genetic factors.
• Increased sensitivity to Demodex mites, which naturally live in sebaceous follicles. Studies have shown that they are in higher numbers on the skin of those with rosacea and may play a role in the condition.

What are the symptoms?

Rosacea usually appears on the face, especially across the nose and cheeks. It can sometimes spread to the forehead, chin, ears, scalp, neck, upper chest, or back, though this is less common.

Furthermore, the eyes can also be affected, and about half of people with rosacea experience eye-related symptoms at some point.

The following are common symptoms of rosacea:

• Flushing: Rosacea often starts with frequent flushing, causing redness or warmth on the face. In darker skin tones, it may only be felt as warmth on the cheeks.
• Redness or violet discolouration: As rosacea progresses, discolouration, depending on skin tone, can appear red, violet, or brown and may last for weeks or months.
• Acne-like breakouts: Rosacea breakouts are common and appear on all skin tones. Dermatologists call them papules and pustules.
• Visible blood vessels: Blood vessels may be visible on the cheeks or nose. They are typically noticeable in lighter skin tones but are less in darker skin tones.
• Changes in eye appearance (ocular rosacea): Eyes may become dry, itchy, or gritty. They often feel burning, tearing, soreness, or sensitivity to light. Other signs include redness, discolouration, or a sensation of something in the eye. Some may develop flaky crusts on the eyelashes, small painless cysts, or vision changes.
• Thickening skin: Thickened skin is a less common symptom of rosacea. It usually develops after years without treatment. It is more prevalent in men than women and most often affects the nose, though it can also appear on the chin, ears, forehead, or eyelids.
• Burning/stinging (or a combination of both): Some may feel burning or stinging when applying anything to their face, including water.
• Dryness and Itchiness: The skin may feel rough, scaly, tight, or itchy.

Rosacea subtypes

Rosacea is classified into different subtypes based on distinct patterns of symptoms. Many rosacea patients experience a transition from one subtype to another over time. Each subtype is defined by a particular set of symptoms used for diagnosis:

Type 1: Vascular Rosacea- Characterized by persistent facial redness (visible small blood vessels may appear)

Type 2: Inflammatory Rosacea: facial redness with papules and pustules.

Type 3: Phymatous Rosacea – skin thickening and a bumpy texture (often affecting the nose).

Type 4: Ocular Rosacea—The eyes and eyelids are affected, causing inflammation (sometimes without visible skin symptoms).

These classifications serve as general guidelines, and symptoms often overlap between subtypes.

Common triggers of Rosacea and what to look out for

While there is no cure, recognizing triggers, following a gentle skincare routine, and using medical treatments can help manage symptoms effectively. These are the triggers to be aware of:

• Make sun protection a priority: Sun exposure on rosacea-prone skin can trigger excessive flushing and persistent redness. Therefore, it is always a good idea to apply a broad-spectrum fragrance-free sunscreen with at least SPF 30 daily and seek shade.
• Be aware of alcohol’s impact on rosacea: Red wine is often the most common trigger for alcohol-related flare-ups.
• Limiting intake of hot beverages: Research shows that hot beverages can trigger rosacea flare-ups in some people. Allowing the beverage to cool slightly before drinking may help reduce symptoms.
• Spicy foods: opting for milder versions of food instead of spicy can reduce the flare-ups.
• Seasonal Changes: Extreme weather conditions, summers or winters, can worsen rosacea symptoms.
• Physical Activity: Intense exercise can increase body temperature, which leads to flushing and redness.
• Emotional stress: stress can trigger flare-ups. Managing stress may help reduce symptoms.

Certain skincare and cosmetic products can trigger rosacea. Dermatologists recommend to be aware of ingredients. Here are some ingredients to look out for:

• Alcohol
• Camphor
• Fragrance
• Glycolic acid
• Lactic acid
• Menthol
• Sodium lauryl sulfate
• Urea

Conducting a patch test before using a new product can help prevent unwanted reactions. Apply a small amount to an area that won’t be rubbed off and use it twice daily for seven days. If no irritation occurs after ten days, the product is likely safe to use.

References

American Academy of Dermatology. (z.d.). 7 rosacea skin care tips dermatologists recommend. https://www.aad.org/public/diseases/rosacea/triggers/tips

American Academy of Dermatology. (z.d.). How to prevent rosacea flare-ups. https://www.aad.org/public/diseases/rosacea/triggers/prevent

Farshchian, M., & Daveluy, S. (2023, 8 augustus). Rosacea. In StatPearls. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK557574/

Institute for Quality and Efficiency in Health Care (IQWiG). (2023, 19 september). Overview: Rosacea. InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK279476/

Mayo Clinic. (z.d.). Rosacea – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353815

National Rosacea Society. (z.d.). All About Rosacea. https://www.rosacea.org/patients/all-about-rosacea

National Rosacea Society. (z.d.). The Many Faces of Rosacea. https://www.rosacea.org/patients/faces-of-rosacea

National Rosacea Society. (z.d.). New Survey Shows Rosacea Tends to Evolve Beyond One Subtype. https://www.rosacea.org/rosacea-review/2004/fall/new-survey-shows-rosacea-tends-to-evolve-beyond-one-subtype

Study finds evidence for rosacea subtype progression. (2020, 13 november). Dermatology Times. https://www.dermatologytimes.com/view/study-finds-evidence-rosacea-subtype-progression

Van Zuuren, E. J., Arents, B. W. M., van der Linden, M. M. D., Vermeulen, S., Fedorowicz, Z., & Tan, J. (2021). Rosacea: New concepts in classification and treatment. American Journal of Clinical Dermatology, 22(4), 457–465. https://doi.org/10.1007/s40257-021-00595-7