What is rosacea?

Rosacea¹ is a common, long-term condition that can affect the face and the eyes. It causes redness, visible blood vessels, and, in some cases, red pus-filled bumps. Because of this, rosacea is often mistaken for acne or other skin conditions.

Patients usually report developing rosacea after the age of 30. No one knows exactly what causes rosacea.² The signs and symptoms of rosacea commonly come and go in cycles—they may flare up (become worse) for weeks or months then go away for a period of time.

Flare ups are often caused by triggers (aggravating factors or substances), which can include stress, cosmetics, and certain foods.

There is no cure for rosacea. However, a variety of treatment options are available to help improve the condition and stop—or reverse—its progression.

How common is rosacea?

It is estimated that 415 million people worldwide³—5.53% of the population—have been diagnosed as suffering from rosacea. The National Rosacea Society estimates that roughly 16 million Americans have the condition.

The condition is most frequently reported among people with fair skin⁴ (particularly those with western European ancestry). However, as there has been little investigation into the prevalence of rosacea among darker-skinned populations, this may be due to the fact that rosacea is more easily noticeable against fair skin than dark skin.

A review conducted at the University of Copenhagen, however, found the rate of self-reported cases of rosacea to be almost 9.71% of the global population.

This disparity could be attributed to multiple factors. Many people with relatively mild cases of rosacea may not realize that they have condition (in some cases thinking it to be normal acne). Furthermore, individuals who feel their rosacea to be mild or manageable may not seek treatment, even if they know they have the condition.

Acne rosacea

Acne rosacea⁵ is simply another term for rosacea.

There is a difference between rosacea and common acne (acne vulgaris). Unlike acne vulgaris, which can occur anywhere on the skin, rosacea typically presents across the center of the face (on the cheeks, nose, forehead, and chin).

While both rosacea and acne vulgaris are chronic inflammatory diseases, rosacea tends to occur episodically (flaring up then going away for a period of time), while acne vulgaris can be much more persistent without treatment.

Ocular rosacea

Ocular rosacea⁶ is rosacea that affects the eyes. It causes redness, burning, itching, and the feeling of the presence of a foreign body in the eyes.

Ocular rosacea often develops in people who have rosacea, but can in some cases be the first sign that you may later develop the condition on your face. It primarily affects people ages 30–50 and those that blush or flush easily.

While medications and the right eye care routine can help manage the signs and symptoms of ocular rosacea, it can’t be cured. Like rosacea, this condition often goes away and comes back during flare-ups.

Rosacea causes

The exact cause⁷ of rosacea is unknown. However, theories of its origin include immune system defects, problems in the nervous system and facial blood vessels, and the presence of microbes and Demodex mites. (This does not mean that rosacea is caused by poor hygiene).

It has also been suggested that rosacea may be caused by a combination of hereditary and environmental factors. Certain emotional states and substances can trigger rosacea flare-ups in some individuals. The predisposition for a person to develop the condition in the first place, however, may be genetic.

Studies of twins have opened new possibilities for understanding the origins of rosacea. A study of twins⁸ conducted at Case Western Reserve University found that rosacea may occur significantly more frequently in two identical twins than in two fraternal (nonidentical) twins, suggesting the role of genetics in rosacea. Other twin studies⁹ have shown that both environmental and hereditary factors contribute equally to the development of the condition.

Rosacea triggers

In some people, environmental factors, lifestyle factors, or a combination of the two may aggravate rosacea symptoms or cause flare-ups. These factors are known as triggers.

Some common rosacea triggers¹⁰ include:

• Sun exposure
• Emotional stress
• Hot or cold weather
• Wind
• Heavy exercise
• Alcohol consumption
• Spicy foods
• Certain skin-care products and cosmetics
• Medications

Understanding what factors trigger your rosacea can help you improve your symptoms or even achieve and maintain remission.

Rosacea risk factors

Anyone can develop rosacea. However, a number of risk factors¹¹ may increase your likelihood of developing the condition, including:

• Being female
• Having light skin—particularly if it has been damaged by the sun
• Being over the age of 30
• Smoking
• Having a family history of rosacea

It may be wise to talk to your healthcare provider about the possibility of your developing rosacea—even if you don’t have signs or symptoms—if you have some of these risk factors. He or she will be able to evaluate your likelihood of developing the condition and provide recommendations for preventing flare-ups in the future.

Is rosacea contagious?

No—rosacea is not contagious.¹² Unlike infectious diseases, it cannot be spread through a virus or bacteria.

In some cases, however, antibiotics can effectively treat the signs and symptoms of rosacea. This is believed to be due to the fact that antibiotics have anti-inflammatory properties (rather than their ability to destroy bacteria).

Ocular rosacea causes

Like rosacea, the exact cause¹³ of ocular rosacea is unknown. It has been traced to a variety of factors, however, including:

• Genetics
• Environmental factors
• Bacteria
• Blocked glands in the eyelids
• Eyelash mites

Some of the situational and environmental factors that have been identified as aggravating and triggering flare-ups in rosacea may do the same in ocular rosacea, including:

• Heightened emotions like stress, anger, or embarrassment
• Hot or spicy foods
• Alcohol
• Sunlight, wind, or extreme temperatures
• Heavy exercise
• Certain medications, such as ones that dilate the blood vessels

Ocular rosacea risk factors

It is possible to have ocular rosacea without your skin being affected. However, ocular rosacea is common in people who already have rosacea. Furthermore, some studies have suggested that among people who already have rosacea, those who blush easily may be more prone to developing ocular symptoms.

Unlike rosacea of the face, gender is not a risk factor¹⁴ for ocular rosacea: the condition affects both men and women equally.

Rosacea symptoms

It is possible to manage the signs and symptoms of rosacea with a variety of medical and lifestyle interventions. When left untreated, however, rosacea progressively worsens.

There are four progressive stages of rosacea¹⁵:

• First stage: Facial flushing and intermittent facial redness
• Second stage: Persistent redness on the cheeks, nose, chin, and/or forehead
• Third Stage: Small, pus-colored or red bumps accompanied with tiny blood vessels that appear as thin red lines (called telangiectasias)
• Fourth stage: Small, knobby bumps and thickening of the skin on the nose

The signs and symptoms of rosacea commonly come and go. Your symptoms may abate and you may go into remission after treatment until a trigger causes a flare-up or agitates your condition.

The most common preliminary symptoms of rosacea include:

• Facial redness: Rosacea commonly causes a persistent redness in the center of the face that can appear like a sunburn or blush. This flushing occurs when excess blood rapidly flows through the skin’s blood vessels, forcing them to enlarge to accommodate the flow. Facial redness does not go away and gradually becomes more noticeable. This may also be accompanied by dry skin.
• Swollen, red bumps: Many people with rosacea develop small, red solid bumps or pus-filled “papules” on the face, sometimes accompanied by warmth and tenderness. They can appear similar to those found in acne. The two conditions have different causes, however, and adults with rosacea do not get the whitehead or blackheads (called comedones) seen with acne vulgaris.
• Enlarged blood vessels (telangiectasias): The facial flushing characteristic of rosacea causes small blood vessels to expand, eventually showing through the skin. These enlarged blood vessels appear as thin red lines on the face (especially on the cheeks). While they may be hidden by flushing, telangiectasias usually reappear after redness fades.
• Eye irritation: Roughly half of people with rosacea develop red, dry, or irritated eyes. While eye involvement is usually relatively mild in rosacea, ocular rosacea can develop and require more serious intervention.

If you experience one or more of the signs and symptoms of rosacea, contact your healthcare provider. He or she will be able to provide you with the proper diagnosis and treatment.

Rosacea complications

When left untreated, rosacea can create small, knobby bumps on the nose, making it appear enlarged and swollen. This condition is called rhinophyma¹⁶.

The exact cause of rhinophyma has not been determined. However, some factors¹⁷ have been suggested to contribute. The swelling that accompanies skin flushing may, over time, lead to the growth of excess tissue as the damaged lymphatic system fails to clear accumulated plasma proteins.

It has also been proposed that rhinophyma results from the oil glands in the nose (and, in some cases, the cheeks) becoming enlarged and causing a buildup of tissue. The leakage of a substance called blood coagulation factor XIII has also been identified as a common contributor to excess tissue.

Rhinophyma develops slowly over a period of years. While rosacea most commonly affects women, men are much more likely to develop rhinophyma.

Ocular rosacea symptoms

The signs and symptoms¹⁸ of ocular rosacea can occur at various points in time: they can come before rosacea shows on the skin, develop at the same time, develop later, or occur without any other facial symptoms. The symptoms of ocular rosacea don’t always match those of the face in severity.

Some common signs and symptoms of ocular rosacea include:

• Dry eyes
• Burning, stinging, or itchy eyes
• The feeling of having a foreign body in the eye(s)—may feel gritty, like sand
• Blurred vision
• Sensitivity to light
• Redness
• Dilated small blood vessels in the whites of the eye(s)
• Red, swollen eyelids
• Producing tears