Red skin, visible blood vessels and pus-filled spots on the face are all typical symptoms of rosacea. This is a common facial skin inflammation that typically comes and goes in episodes.
Like any visible skin condition, rosacea can affect your wellbeing and self-esteem. But a lot of people aren’t aware that the blotchy red skin on their face is caused by a treatable condition. There are various ways to reduce the inflammation and prevent flare-ups.
Rosacea is a chronic, non-contagious inflammation of facial skin. It can vary in severity and affect the cheeks, chin, forehead and nose. There are four different types of rosacea, each with its own set of symptoms:
- Type 1 - vascular rosacea: Red areas of skin on the face, sometimes small blood vessels are visible.
- Type 2 - inflammatory rosacea: As well as facial redness, there are red bumps (papules) and pus-filled spots (pustules).
- Type 3 - phymatous rosacea: The skin thickens and becomes bumpy, particularly on the nose.
- Type 4 - ocular rosacea: This type of rosacea leads to inflammations of the eyes and eyelids (blepharitis), sometimes with no noticeable skin symptoms.
The skin may also become dry, a little swollen, flaky and burn or itch. It is more sensitive and more irritable than healthy skin.
Rosacea can cause a wide range of symptoms in various combinations. Sometimes the skin on the chest, scalp and nape of the neck becomes inflamed too.
Type 1 and type 2 rosacea (varying degrees of severity)
Type 3 and type 4 rosacea
The exact cause of rosacea is not clear. Inflammatory reactions and abnormal blood vessels in the skin are known to be involved. Various things are thought to trigger flare-ups, including sunlight, extreme heat or cold, a certain type of hair mites (demodex mites, also known as eyelash mites), bacteria, stress, and problems with the protective function of the skin. Genes play a role too.
The long-term use of steroid medication can lead to rosacea-like symptoms. But the risk of developing steroid-induced rosacea is very low if steroids are used properly.
Although the symptoms may include pimples, rosacea is not a type of acne. Unlike acne, rosacea isn’t associated with the production of too much oil in the skin.
Rosacea usually develops in people over the age of 30. About 2 to 5% of all adults in Germany are affected. It is more common in women and light-skinned people. But a lot of people don’t know that their persistent facial redness is caused by a skin condition.
Rosacea symptoms often come and go in episodes: There are periods when the symptoms are more severe, and there are periods when they improve or go away completely.
Most people have type 1 (vascular) rosacea. The skin may change over time, and other symptoms might appear. But they often stay the same for a long time.
Sometimes the nose of people who have type 3 rosacea becomes large, red, bumpy or bulbous. Known as rhinophyma, this is more common in men.
Type 4 rosacea, where the eyelids or eyes become inflamed, can be particularly troublesome. But the severity of eye symptoms varies. They may only be very mild, or they may be severe.
If rosacea affects the eyes, it can cause them to water, turn red and itch. They may become more sensitive to light, too. If the sebaceous glands in the eyelids become blocked, the eyes may be dry. Other parts of the eye may become inflamed as well, including the edge of the eyelid, the cornea, and the conjunctiva (the membranes lining the visible part of the eyeball and the inner surface of the eyelids). This can be painful. It sometimes feels like you have something in your eye.
Over time, people often learn that certain things trigger their rosacea flare-ups. Generally speaking, anything that makes your face flush might make rosacea worse. Typical triggers include the following:
- Hot drinks
- Cosmetics or soaps that irritate your skin
- Skin injuries
- Certain medications, e.g. drugs that dilate (widen) blood vessels
- Hot spices and spicy foods
- Extreme temperatures
Keeping a rosacea diary can help you to find out what may be triggering your migraines. That way, you can avoid at least some of the triggers.
There are various treatment options, depending on the type of rosacea. If the symptoms are mild, taking good care of your skin may be enough. Protecting your skin from the sun, using soap-free cleansing products with a low pH, and avoiding irritants is thought to help too. Noticeable areas of rosacea can be covered up using cosmetics for sensitive skin.
More severely affected areas are usually treated with medication that is applied directly to the skin. Commonly used topical (externally applied) medications include creams, gels or lotions containing azelaic acid, brimonidine tartrate, ivermectin or the antibiotic metronidazole. The medication options will depend on the type of rosacea.
If the symptoms are severe or if topical treatments don’t help, the inflammation-reducing antibiotic doxycycline can be taken in the form of a tablet. If rosacea really affects the nose (rhinophyma), surgery may be considered.
Although rosacea is usually harmless, having a red face or nose can affect your psychological wellbeing. Many people with rosacea will know what it’s like to be stared at, or to realize that others suspect that their nose is red because they drink too much alcohol. This is because rosacea isn’t a well-known condition. Other common skin conditions like acne are much better known. So it can help to be open about the skin condition and tell your family, friends and colleagues what it is.
If the redness is very noticeable, you can cover it up with make-up. Some cosmetic products can make rosacea worse, so you may have to try out different kinds. A dermatologist (skin doctor) can help you choose the right products.
When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.
Augustin M, Herberger K, Hintzen S, Heigel H, Franzke N, Schäfer I. Prevalence of skin lesions and need for treatment in a cohort of 90 880 workers. Br J Dermatol 2011; 165(4): 865-873.
National Rosacea Society (USA). Patients’ perspectives: living with rosacea. Dermatol Nurs 2007; 19: 105-110.
Rebora A. Papulopustular rosacea. In: Williams H, Bigby M, Diepgen T, Herxheimer A, Naldi L, Rzany B (Ed). Evidence-based Dermatology. London: Blackwell Publishing; 2008. S. 105-110.
Van Zuuren EJ, Fedorowicz Z, Carter B, van der Linden MM, Charland L. Interventions for rosacea. Cochrane Database Syst Rev 2015; (4): CD003262.
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.