Rosacea
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is rosacea?
Rosacea is a chronic inflammatory skin condition affecting the central face, causing persistent redness, flushing, visible blood vessels and sometimes inflammatory bumps. It is often mistaken for acne or a sensitive skin reaction. Topical steroids make it worse, and eye involvement is common and frequently missed.
Causes
- Dysregulated innate immune response
- Abnormal vascular reactivity
- Demodex mite overgrowth in some subtypes
- Skin barrier dysfunction
- Genetic predisposition
Symptoms
- Persistent redness across cheeks, nose, chin and forehead
- Easy flushing triggered by heat, alcohol or spicy food
- Visible small blood vessels
- Red bumps and pustules without blackheads
- Burning or stinging sensation
- Gritty, dry or irritated eyes
- Thickened nose skin in advanced rhinophyma
Risk factors
- Fair skin that flushes easily
- Age between 30 and 60
- Female sex, though rhinophyma is commoner in men
- Family history
- Sun exposure
- Frequent hot drinks, alcohol or spicy food
Diagnosis
- Clinical diagnosis from distribution and features
- Absence of comedones distinguishing it from acne
- Eye examination for ocular rosacea
- Exclusion of lupus and seborrhoeic dermatitis
- Trigger diary to identify personal precipitants
Treatment
- Daily broad spectrum sun protection
- Gentle non irritating skincare and avoiding harsh products
- Topical ivermectin, metronidazole or azelaic acid
- Topical brimonidine for persistent redness
- Oral doxycycline at anti inflammatory dose
- Laser or intense pulsed light for visible vessels
- Ophthalmology referral and lid hygiene for eye involvement
Self care
- Use daily broad spectrum sun protection, the single most useful measure
- Choose gentle fragrance free skincare
- Identify personal flush triggers with a diary
- Avoid topical steroids on the face entirely
- Use lukewarm water and pat the skin dry
- Use green tinted makeup to reduce visible redness
- Practise lid hygiene if the eyes are involved
When to see a doctor
Book an appointment if:
- Redness or bumps not responding to gentle skincare
- Eye grittiness, dryness or redness
- Thickening of the skin on the nose
- Significant impact on confidence or mood
- Flares becoming more frequent
- Diagnosis uncertainty, since it is often confused with acne
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Rosacea cannot be prevented, but flares can be reduced
- Daily sun protection year round
- Avoid known dietary and environmental triggers
- Avoid harsh exfoliants and alcohol based toners
- Never use topical steroids on rosacea
- Manage stress and extremes of temperature
Outlook
Rosacea is chronic and tends to relapse, but it is well controlled with modern topical and oral treatments. Redness and bumps respond well, while visible blood vessels usually need laser treatment. Rhinophyma is uncommon and treatable surgically. Eye involvement needs ongoing attention to protect the cornea.
Common questions
Why should topical steroids be avoided?
Steroid creams may briefly reduce redness but cause rebound worsening and can produce steroid induced rosacea. They are not an appropriate treatment for this condition.
Is rosacea caused by poor hygiene or drinking?
No. It is an inflammatory condition with a genetic basis. Alcohol can trigger flushing in some people but does not cause the disease, and the association fuels unfair stigma.
What is ocular rosacea?
Eye involvement causing grittiness, dryness, redness and lid inflammation. It affects up to half of people with rosacea, can occur before skin changes, and needs treatment to protect the cornea.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.