Rosacea symptoms: signs on the skin and eyes

Rosacea symptoms change from person to person, and most people have only some of them. The main signs are flushing, redness in the middle of the face that lasts, acne-like bumps, small visible blood vessels, and a burning or stinging feeling. Some people also get dry skin, swelling, eye problems or thicker skin on the nose. Only a doctor can confirm that these signs come from rosacea, because several other skin conditions look the same. This guide lists each sign, what the American Academy of Dermatology (AAD), the NHS and the US National Institutes of Health (NIH) say about it, and when to book a visit.

For an overview, including who gets rosacea and how common it is, start with what rosacea is.

Flushing is often the first sign

The AAD says rosacea often begins with a tendency to flush easily. The face turns red or darker and feels warm. At first the color fades. With time, the AAD says, it may last longer.

The NHS describes the same early pattern. Redness spreads across the nose, cheeks, forehead, chin, neck and chest, comes and goes, and usually lasts a few minutes each time. The face may also feel warm, hot or painful.

Everyone flushes sometimes: when embarrassed, hot, after a drink, or on a cold, windy day. The AAD separates normal flushing from rosacea by how long it lasts. Normal flushing clears within a few hours or less. If you flush more often than before, or the color and the warm feeling last longer and longer, the AAD says you might have rosacea.

On darker skin tones, flushing is harder to see. The AAD says a warm feeling on the cheeks may be the only sign.

Redness or color that stays

As rosacea progresses, the AAD says the redness or violet color can stay for weeks, months or longer. On lighter skin it looks red or pink. On darker skin it can look violet or brown. It sits across the nose and cheeks and can reach the chin, forehead, ears, neck, upper chest or scalp.

The AAD calls a permanently red face the most common sign of rosacea. It starts in the center of the face. NIH's skin institute (NIAMS) describes a common path: short flushing of the nose and cheeks, then flushing that lasts longer, then a rash and small blood vessels.

Not everyone follows this path, and the order can differ. What matters is the change over time. Redness that used to fade and now stays is a reason to see a doctor.

Bumps and pimples

Many people with rosacea get acne-like breakouts. The AAD says doctors call these papules (red bumps) and pustules (bumps filled with pus). They appear on all skin tones. On darker skin, the AAD says these bumps may be the first sign a person notices.

The NHS describes small pink or red bumps, sometimes filled with a yellowish liquid. The AAD adds that the face may feel oily, and that these bumps are often mistaken for acne. The two conditions need different care, so the difference matters. Our guide to rosacea vs acne covers how a doctor tells them apart.

Visible blood vessels

Small blood vessels can become visible on the cheeks and nose. NIAMS says they look like thin red lines. The AAD says they usually appear after the face has become red all the time, and that they are easy to see on lighter skin and hard to see on darker skin. When the redness is strong, the single vessels can be hard to pick out.

The NHS says these tiny broken blood vessels do not go away on their own. A dermatologist can treat them with a laser or light treatment. The guide on how rosacea is treated explains what a doctor may offer.

Burning, stinging, dryness and itch

Rosacea often makes the skin sensitive. The AAD says some people feel burning or stinging when they apply anything to the face. Even water can cause it. The NHS lists this feeling as one of the first signs of rosacea. Sunscreen and makeup can sting too.

Dry skin is common. The AAD says rosacea can cause rough, scaly skin that feels dry, tight or itchy, and that dry skin burns and stings more often. Itching is less common. The AAD says the skin may itch when it is dry or irritated.

This sensitivity changes daily care. A gentle cleanser, a moisturizer and a mild sunscreen are part of every rosacea treatment plan, per the AAD. The guide to skincare for rosacea lists the ingredients the AAD says to avoid.

Swelling and thickened skin

The AAD says skin with rosacea can swell, most often around the eyes, on the forehead or on the cheeks. Over time the skin can feel bumpy. The NHS lists swelling, especially around the eyes, and yellow-orange patches on the skin as other symptoms.

Thickened skin is a less common sign. The AAD says fewer people develop it, that it can happen when rosacea goes untreated for years, and that men are more likely to get it. It usually forms on the nose, where doctors call it rhinophyma. It can also appear on the chin, ears, forehead or eyelids. NIAMS says a thickened nose can look enlarged and round.

The AAD advises seeing a dermatologist when firm, round bumps or thicker skin appear, because early treatment works better. Once the skin has thickened, removing it takes a procedure.

Eye symptoms

Rosacea can affect the eyes. The AAD estimates that half of people with rosacea will have a flare-up that affects the eyes. This is called ocular rosacea.

The eyes may feel gritty, dry or itchy. They may water, burn or feel sore. Some people notice light sensitivity, red eyes, or the feeling that something is in the eye. The eyelids may be red and swollen, and crusts can form on the lashes. The AAD says rosacea sometimes causes eye problems before any sign appears on the skin.

The NHS asks people with rosacea to get an urgent appointment if an eye is painful, the vision is blurred, the eyes are sensitive to light, an eye is red, or it feels gritty. These can be signs of a serious eye problem. Read the full guide to ocular rosacea for the signs and who treats them.

How rosacea shows on darker skin

The AAD says rosacea is often missed on darker skin, because early signs like flushing are harder to see. The NHS says redness can be harder to see on brown or black skin. NIAMS says darker skin can hide facial redness, so rosacea may be under-diagnosed.

The AAD suggests a dermatology visit if you notice any of these on your face:

• A warm feeling most of the time
• Dry, swollen skin and patches of darker skin
• A dusky brown color change
• Acne-like breakouts that acne treatment does not clear
• Yellowish-brown, hard bumps around the mouth or eyes
• Burning or stinging when you apply skin care products
• Swelling and thickening on the nose, cheeks, chin or forehead

The AAD also says rosacea on darker skin can look like acne, seborrheic dermatitis (a flaky, red rash), an allergic reaction or lupus. A dermatologist can tell these apart.

Why the signs are grouped the way they are

Older articles split rosacea into separate types. In 2017, an expert committee of the National Rosacea Society published an update in the Journal of the American Academy of Dermatology. It groups rosacea by the signs each person actually has. That is why a doctor may describe your rosacea by its signs, for example lasting redness with bumps, or redness with eye symptoms.

The AAD says it is common to have more than one sign. Knowing which signs you have helps a doctor choose treatment, because each sign responds to different options.

When to see a doctor about these symptoms

The AAD says that if you have any of these signs, a dermatologist can tell you whether it is rosacea, and that early diagnosis and treatment can stop rosacea from getting worse. The NHS says to see a GP if you have symptoms of rosacea.

Book a visit sooner for these:

Sign	Why it needs a doctor
Painful eye, blurred vision, light sensitivity	The NHS asks for an urgent appointment, as these can be signs of a serious eye problem
Firm bumps or thicker skin on the nose	The AAD says early treatment gives better results
Bumps that acne products do not clear	Rosacea needs different treatment, per the AAD
Redness that no longer fades	The AAD says treatment can stop rosacea from getting worse

Before the visit, it helps to take a few photos of your face on a bad day and a good day, and to write down when the redness appears. The AAD says rosacea signs come and go, so a doctor may not see them on the day of your appointment. The guide to what rosacea looks like and how it is diagnosed explains what happens during the exam.