10 Facts About Rosacea You Probably Don’t Know
Rosacea is a skin condition that causes redness or darkening (depending on your tone) and sometimes small bumps and/or visible blood vessels on your face. Sounds simple. But in fact, it can be misunderstood, says Daniel Bach, M.D., a dermatologist at UCLA Health. “Rosacea is an actual condition,” he says, “and not just ‘ruddy’ cheeks.” It has no cure but can be treated. And the more you know about it, the more likely you are to find a treatment that works for you. Read on to discover a few things about the skin condition you might not know.
Both Genetics and Environment Play a Role in Rosacea
Scientists don’t know the exact cause of rosacea. But research suggests that having a family history of the condition puts you at risk, says Anne Chang, M.D., a dermatologist at Stanford Health Care in Palo Alto, CA. (Rosacea has also been linked to other inflammatory diseases, such as G.I. disorders and some neurological diseases, like Parkinson’s.) In people who are genetically susceptible, certain environmental “triggers”—like sunlight, spicy food, and stress—can cause an immune response, leading to the redness (or violet tones in darker skin), bumps, and pimples characteristic of the disease.
Rosacea Often Starts With Blushing or Flushing
People who tend to flush or blush easily—from drinking a glass of wine, or eating spicy food, or feeling embarrassed—may actually be experiencing rosacea, says Jessica Gandy Labadie, M.D., chief resident in the department of dermatology at Northwestern University in Chicago. Over time, the redness may last longer and become more noticeable. If you’re looking a little rosy—especially on your cheeks, nose, forehead, or chin—and think you may have rosacea, see your doctor. Early diagnosis and treatment can help keep it from getting worse, says Dr. Labadie.
Acne Treatments Can Make Rosacea Worse
Many people with rosacea develop bumps and pimples that can easily be mistaken for acne, Dr. Labadie says. But here’s a clue: If you use acne treatments like benzoyl peroxide, Retin-A, or retinol, and that makes your symptoms worse, then rosacea is more likely. “Acne treatments tend to be abrasive and can irritate the skin, leading to rosacea flares,” Dr. Labadie says. Another telltale sign: The breakouts tend to happen after you’ve been exposed to common rosacea “triggers” like alcohol, heat, or spicy foods.
Rosacea Can Affect the Eyes
Most people don’t associate the eyes with the skin, but the eyes are affected in up to 50% of rosacea cases. Your eyes may feel dry, itchy, burning, or gritty (like you have something in them). They may also look red or have redness or crusting along the eyelash margin, says Mary Sheu, M.D., medical director at Johns Hopkins Dermatology & Cosmetic Center, in Lutherville, MD. Sometimes eye symptoms develop even before skin symptoms do. If you do have ocular rosacea, you’ll likely be referred to an ophthalmologist, who can prescribe antibacterial eye drops to treat the condition, Dr. Labadie says.
Not Every Patient Is Triggered by Every Trigger
Sure, lots of triggers are the same for lots of rosacea patients—but you’ve got to identify your triggers. Keep a diary where you can track what you ate and did before flares. (National Rosacea Society members can send in for a free diary here.) Common triggers include sunlight, stress, heat, intense exercise, alcohol, and spicy foods. And don’t overlook sneaky triggers, like hair dryers and hot showers, says Dr. Chang. “If you can get 50% better just by avoiding your triggers, then we can use medications to clean up the end,” says Angela Lamb, M.D., director of the Westside Mount Sinai Dermatology Faculty Practice in New York City.
Treatment depends on the type of rosacea
Your dermatologist will use visual observation to determine whether your rosacea is mild, moderate, or severe. But that may not reflect how the condition is truly impacting you, Dr. Labadie says: “Some people have very mild rosacea but are deeply affected by it. And others have very severe rosacea but it doesn’t bother them at all.” Do you avoid going out because of your rosacea? Is it affecting your work? Does the itch drive you crazy? Speak up! Your doctor needs that info to find the best treatment for you.
Rosacea Can Happen to Anyone (but Some People Are at Higher Risk)
Fair-skinned women between 30 and 50 years old have the highest risk of developing rosacea. But the truth is it can happen in anyone, including children and people from all ethnic groups. “I certainly have seen African-American, Asian, and Latino patients with rosacea,” says Dr. Sheu. And one type of rosacea—called rhinophyma, characterized by a large, red, bumpy nose—is more common in men. Speaking of types of rosacea...
There Are Four Main Types of Rosacea (Plus a Rare Fifth Type)
All rosacea involves facial redness (or darkening), but other symptoms separate it into four types: Erythematotelangiectatic (ERT) rosacea is the “blushing and flushing” kind: red cheeks, red nose, and sometimes visible blood vessels. Papulopustular rosacea causes red or pus-filled bumps form. Rhinophyma leads to skin thickening, possibly leading to a red, bumpy, bulbous nose. Ocular rosacea involves the eyes. (And a very rare fifth type called granulomatous rosacea leaves yellowish-brown or pink bumps and patchy redness around the cheeks, eyes, and mouth.) These types may progress from one to another, and you can have more than one, says Dr. Labadie.
Treatment Is Tailored to the Type of Rosacea
Rosacea has no cure but can be treated. It often responds to antimicrobial meds—such as antibiotics or anti-demodex meds (which attack the facial mites associated with the condition). But sometimes laser- or light-based therapies are needed, especially for ERT rosacea, says Dr. Labadie. Expect one to six sessions, four to six weeks apart. (In severe cases, you might need laser treatments every year.) Rhinophyma patients may need surgery—often also done with a laser—to repair a disfigured nose, she says. A few surgeries may be needed, but the deformity may not reoccur for years or decades.
Rosacea Is Not Just Harmless Blushing
It can be painful and seriously impact quality of life. In fact, research shows that people with rosacea are at greater risk for depression, social phobia, stress, and embarrassment, says Dr. Labadie. Worse, many people may assume that’s just how their skin has to be, says Dr. Bach. But simple interventions can help. If you have rosacea symptoms, don’t hesitate to call your primary care doc, or head straight to the dermatologist, says Dr. Labadie. “It’s never wrong to think, ‘I have something on my skin. I need help,’” she says. That’s what derms are there for!
Rosacea and Parkinson’s: Parkinson’s Foundation. “Rosacea May Signal Increased Parkinson’s Risk.” parkinson.org/blog/science-news/science-article/rosacea-parkinsons-risk
Prevalence of Eye Involvement in Rosacea: Dermato-Endocrinology. (2017). “Rosacea: Epidemiology, pathogenesis, and treatment.” tandfonline.com/doi/full/10.1080/19381980.2017.1361574
Ocular Rosacea: Mayo Clinic. “Ocular rosacea.” mayoclinic.org/diseases-conditions/ocular-rosacea/symptoms-causes/syc-20375798
Common Rosacea Triggers: National Rosacea Society. “Rosacea Triggers Survey.” rosacea.org/patients/rosacea-triggers/rosacea-triggers-survey
Granulomatous Rosacea: National Center for Advancing Translational Sciences. “Granulomatous rosacea.” rarediseases.info.nih.gov/diseases/6548/granulomatous-rosacea