What is rosacea? Signs, causes and care

Rosacea is a long-term skin condition that mainly affects the face. It causes flushing, redness in the middle of the face that lasts, and in many people acne-like bumps, small visible blood vessels, and burning or stinging. It can also affect the eyes. There is no cure, but treatment can control it and stop it from getting worse. Only a doctor can confirm rosacea. There is no lab test, so a doctor diagnoses it by examining your skin and eyes and asking about your history. This guide covers the whole condition in plain words, based on the American Academy of Dermatology (AAD), the NHS, the US National Institutes of Health (NIH) and MedlinePlus. Each section links to a longer guide.

Rosacea in one paragraph

NIAMS, NIH's skin institute, describes rosacea as a long-term inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks, and that may also cause eye problems. MedlinePlus, from the US National Library of Medicine, calls it a long-term disease that affects the skin and sometimes the eyes. The AAD adds that it can cause flushing, lasting color (red, violet or brown), acne-like breakouts and visible blood vessels, and that some people develop irritated eyes or thickening skin. MedlinePlus says rosacea is not dangerous. The AAD calls it a chronic condition, which means you may have it for life.

How common rosacea is, and who gets it

The AAD calls rosacea a common skin condition. A 2018 review in the British Journal of Dermatology pooled 32 studies covering more than 26 million people and found rosacea in 5.46 percent of adults. It was most common between ages 45 and 60.

The AAD says women get rosacea more often than men. NIAMS adds that when men get it, it tends to be more severe. The AAD says the chance of getting rosacea seems higher if you:

• Are 30 or older
• Have fair skin, blonde hair and blue eyes
• Have a blood relative who has or had rosacea or severe acne
• Had many acne breakouts, or acne cysts and nodules
• Are going through menopause

Anyone can get rosacea. The AAD says dermatologists are diagnosing it more often in people of Asian, Latin American and African ancestry, and in people younger than 30. Children get it rarely.

The main signs

The AAD lists these signs. Most people have some and not all.

• Flushing. Rosacea often begins with a tendency to flush easily. Over time, the color lasts longer.
• Lasting redness or color. Red or pink on lighter skin, violet or brown on darker skin, across the nose and cheeks.
• Acne-like bumps. Red bumps and bumps filled with pus.
• Visible blood vessels. Thin red lines on the cheeks and nose, harder to see on darker skin.
• Burning or stinging. Some people feel it when they apply anything to the face, even water.
• Dryness. Rough, scaly skin that feels tight.
• Eye changes. Gritty, dry, itchy, burning or sore eyes, and red, swollen eyelids.
• Thickening skin. Less common, usually on the nose, and more common in men.

The NHS says early redness usually lasts a few minutes each time and may come with a face that feels warm, hot or painful. The full list, with what each sign looks like, is in rosacea symptoms.

Rosacea on darker skin

The AAD says rosacea is often missed on darker skin. Early signs like flushing can be hard to see, and a warm feeling on the cheeks may be the only sign of flushing. The NHS says redness can be harder to see on brown or black skin, and NIAMS says rosacea may be under-diagnosed in darker-skinned people for this reason.

On darker skin, the AAD suggests seeing a dermatologist for a warm feeling most of the time, a dusky brown color, acne-like bumps that acne treatment does not clear, yellowish-brown hard bumps around the mouth or eyes, or burning when you apply skin care products.

How rosacea changes over time

NIAMS describes a common pattern: short flushing of the nose and cheeks, then flushing that lasts longer, then a rash and small blood vessels. Without treatment, the skin may thicken, with firm red bumps, most often on the nose.

The AAD says rosacea flares and then calms down. Doctors call the calm periods remissions. Each flush can leave the skin red for longer, and repeated flushing can lead to redness that stays. The AAD says the more rosacea progresses, the harder it becomes to treat.

What causes rosacea

The exact cause is unknown. The AAD says it is unclear, and NIAMS says scientists have several theories. The leading one is inflammation, the body's response of redness, heat and swelling. The AAD says the immune system may set off this inflammation in response to triggers like sunlight, heat or spicy food.

Other factors under study include tiny mites called Demodex, which live on nearly everyone's skin and appear in larger numbers in rosacea, and a stomach infection called H. pylori, where the evidence is mixed. Genes play a part: a 2015 study of 275 pairs of twins found that genes accounted for 46 percent of the rosacea score. The NHS says rosacea is not caused by poor hygiene. Read more in what causes rosacea.

Triggers: what sets off a flare

A trigger is anything that makes rosacea flare. The AAD lists sunlight, stress, heat, alcohol (especially red wine), spicy food, some skin and hair care products, some makeup, wind and cold, some medicines and exercise. The NHS and NIH add hot drinks and hot baths.

Triggers differ from person to person. The AAD suggests a daily record for at least 2 weeks of what you eat, drink and use, and the weather, to see what matches your flares. The guide to rosacea triggers shows how, and how to calm a rosacea flare-up covers what to do when one starts.

Is it contagious, autoimmune, or linked to other diseases?

Rosacea is not contagious. The AAD and the NHS both say so. The major sources describe it as an inflammatory condition in which the immune system plays a part, and none of them lists it as an autoimmune disease. Studies have linked rosacea with some other conditions, including some autoimmune diseases, diabetes and heart disease. The AAD says these studies cannot show that rosacea causes them, and that many people with rosacea never develop them. The full answer is in is rosacea autoimmune or contagious.

How a doctor confirms rosacea

The AAD says a dermatologist diagnoses rosacea by examining your skin and eyes and asking questions, because signs can come and go. NIAMS says there is no specific test. Sometimes a doctor orders tests to rule out other conditions, such as lupus.

Rosacea is easy to confuse with other conditions. The AAD says people mistake it for acne, sunburn or a skin reaction. The NHS lists acne, several types of dermatitis, lupus and keratosis pilaris as lookalikes. The mix-up with acne matters most, because the AAD says standard benzoyl peroxide, a common acne ingredient, can irritate rosacea. See what rosacea looks like and how it is diagnosed and rosacea vs acne.

How rosacea is treated

The AAD says a dermatologist builds a treatment plan around your signs, with three goals: reduce the signs, ease discomfort and stop rosacea from getting worse. Every plan includes a gentle cleanser, a moisturizer, sunscreen, and avoiding your triggers. Depending on your signs, a doctor may offer:

Sign	What a doctor may offer (per the AAD)
Lasting redness	Prescription creams that fade redness for up to 12 hours, laser or light treatment
Acne-like bumps	Prescription creams, gels or foams, and sometimes pills
Visible blood vessels	Laser or light treatment
Eye symptoms	Eyelid care, eye drops and other eye treatments
Thickened skin	Medicine to stop it thickening, and a procedure to remove it

The AAD says treatment for bumps usually takes 2 to 3 months to show a noticeable difference. NIAMS says improvement is usually gradual and can take 3 months or longer. Never change or stop a prescribed treatment without your doctor. Details are in how to treat rosacea, and can rosacea be cured explains what long-term control looks like.

The eyes need special attention

The AAD estimates that half of people with rosacea will have a flare that affects the eyes, and says rosacea sometimes affects the eyes before the skin. Signs include gritty, dry, burning or itchy eyes, light sensitivity, and red, swollen eyelids. 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, or an eye is red or gritty. Severe, untreated eye rosacea can harm eyesight. Read ocular rosacea for the full guide.

Daily care at home

The AAD's daily advice for rosacea skin:

• Wash twice a day with a mild cleanser, using your fingertips and warm water. Pat dry with a clean cotton towel.
• Apply a fragrance-free cream moisturizer once the skin is dry.
• Use a broad-spectrum sunscreen of SPF 30 or higher every day, even on cloudy days. Mineral sunscreen with zinc oxide or titanium dioxide is least likely to irritate.
• Avoid products with alcohol, camphor, fragrance, glycolic acid, lactic acid, menthol, sodium lauryl sulfate or urea.
• Stop toners, astringents, scrubbing and exfoliating.
• Test new products on a small area first.

The guides to skincare for rosacea and sunscreen for rosacea go through each step.

When to see a doctor

The NHS says to see a GP if you have symptoms of rosacea. The AAD recommends a board-certified dermatologist, because rosacea looks like many other conditions and early treatment makes it easier to manage. See a doctor sooner if:

• An eye is painful or red, your vision blurs, or light hurts your eyes. The NHS says to ask for an urgent appointment.
• You notice firm bumps or thickening skin, most often on the nose. The AAD says early treatment gives better results.
• Redness no longer fades between flares.
• Bumps do not clear with acne products.
• Rosacea is affecting your mood or confidence. The AAD says some people with long-lasting rosacea develop depression or anxiety, and that these feelings ease as rosacea improves.

Skinli's photo tool is built for acne. For redness, flushing or eye symptoms, the right next step is a doctor's exam.