Rosacea Disease: What It Is, Causes, Symptoms, and Treatment

Rosacea, also known as "rose disease," is a skin condition that causes redness and acne-like lesions, particularly on the cheeks and nose. Rosacea is a common condition and can affect people of all ages. However, it is most often seen in middle-aged, fair-skinned women. Treatment for rosacea primarily aims to alleviate symptoms.

What is Rosacea?

Rosacea, also known as "rose disease," is a chronic skin condition that leads to redness and the visibility of capillaries beneath the skin. This disease causes small red lesions filled with pus to form on the skin. Rosacea has periods of flare-ups, during which symptoms intensify. These flare-ups can last a few weeks or even several months, after which symptoms subside.

Rosacea can present in different subtypes depending on the affected areas and the type of lesions on the skin. The subtypes of rosacea include:

Type 1: Erythematotelangiectatic Rosacea (ETR): This subtype is characterized by redness on the face and visible capillaries close to the skin's surface.
Type 2: Inflammatory / Papulopustular Rosacea: This subtype causes acne-like lesions on the skin and is more commonly seen in middle-aged women.
Type 3: Phymatous Rosacea: This rare subtype is typically identified by thickening of the nasal skin (rhinophyma). Rhinophyma is more frequent in men and is often accompanied by other rosacea subtypes.
Type 4: Ocular Rosacea: In this subtype, symptoms are primarily concentrated around the eyes.

What Are the Symptoms of Rosacea?

The symptoms of rosacea vary depending on its subtypes.

Symptoms seen in the ETR subtype of rosacea:

Initially transient redness in the center of the face, becoming permanent over time
Visible fine capillaries
Swelling or edema on the skin
Sensitive skin
Burning or stinging sensation on the skin
Dry, tight, rough-textured skin

Symptoms associated with the papulopustular subtype:

Skin that appears very red with acne-like lesions
Oily skin
Sensitive skin with a burning or stinging sensation

Symptoms seen in phymatous rosacea, characterized by thickened skin:

Rough skin texture
Thickening of the nasal skin
Large pores on the skin
Thickening of the skin on the forehead, cheeks, chin, and ears
Visible blood vessels

Symptoms of ocular rosacea include:

Redness and watering of the eyes
Feeling of grittiness in the eyes
Burning or stinging sensation in the eyes
Dry, itchy eyes
Sensitivity to light
Reduced vision
Cracked blood vessels on the eyelids

What Causes Rosacea?

The underlying mechanisms of rosacea are not yet fully understood. It is believed that genetic and environmental factors jointly play a role in the development of the disease. Rosacea is not a disease caused by inadequate hygiene conditions.

Certain triggers may cause rosacea to flare up, including:

Hot beverages
Spicy foods
Extremely hot or cold environments
Sunlight, wind
Emotional changes
Physical exercise
Medications that cause blood vessels to dilate (e.g., certain blood pressure medications)
Certain makeup products

Rosacea can affect anyone, but women, people over the age of 30, fair-skinned individuals, smokers, and those with a family history of rosacea are at higher risk.

How Is Rosacea Diagnosed?

There is no specific test for diagnosing rosacea. The doctor examines the patient and inspects skin lesions. Patients may be asked how long they have had symptoms, if symptoms become more pronounced at certain times, and what factors trigger their symptoms. The doctor will also aim to rule out other conditions such as lupus, psoriasis, or eczema. If the patient's history and examination are consistent with rosacea, a diagnosis is made.

Associated Symptoms with Rosacea

Rosacea can lead to conjunctivitis, an inflammation of the outer layer of the eye, which may cause symptoms such as itching, watering, and redness in the eyes.

How Is Rosacea Treated?

There is no definitive cure for rosacea. The goal of treatment for rosacea patients is to alleviate symptoms and reduce flare-ups, though the condition may periodically worsen. Treatment should include both prescription medications and proper skincare routines.

The duration of rosacea treatment depends on the severity of the disease and the intensity of symptoms. Even in patients successfully treated, the condition may recur.

Medications used in rosacea treatment include:

Redness-reducing creams: For mild to moderate rosacea, topical gels or creams applied to the affected areas of the face may be prescribed. Medications containing brimonidine and oxymetazoline can help reduce facial redness by preventing capillary dilation. These medications start working within 12 hours of application, but since their effects are temporary, they must be applied regularly for ongoing improvement.
There are also creams that may not be highly effective for facial redness in mild rosacea but can improve acne-like lesions. Examples include azelaic acid, metronidazole, and ivermectin. It may take 2-6 weeks for visible results with azelaic acid and metronidazole, while results with ivermectin may take longer, though ivermectin can lead to longer remissions.
Oral Antibiotics: For moderate to severe rosacea, antibiotics like doxycycline may be used to treat acne-like lesions.
Oral Acne Medication: For severe rosacea cases unresponsive to other treatments, isotretinoin may be prescribed. This powerful medication can help heal acne-like lesions in rosacea. However, isotretinoin is not suitable for pregnant women.

Laser and other light-based treatments may also be used to reduce skin redness in rosacea. These treatments may require multiple sessions to help restore the skin’s natural appearance.

Skincare Tips for Rosacea Patients
Certain skincare practices can help reduce the frequency of rosacea flare-ups and alleviate symptoms. Suggested skincare tips include:

Identify and avoid foods, drinks, and situations that trigger rosacea flare-ups. Increasing the intake of foods rich in antioxidants and high in vitamin B, like avocado, ginger, and cabbage, may be beneficial.
Use sunscreen daily. Choose a sunscreen that protects against both Ultraviolet A (UVA) and Ultraviolet B (UVB) rays, with an SPF of at least 30. If used with a topical medication, apply the medication first, followed by sunscreen.
Protect the face from the sun by avoiding outdoor activities during peak hours. If going outside, wear a hat. In cold weather, use a scarf to protect the face from wind.
Avoid excessive touching or scrubbing of the face. Use non-soap cleansers and moisturize regularly. Select skincare products free from alcohol and other irritating ingredients.

Rosacea can significantly affect a person’s quality of life. Although there is no permanent cure, appropriate treatment can reduce symptoms. For rosacea treatment, patients should consult a dermatology department. Ocular rosacea can affect the eyes, so those with this condition may also need to visit an ophthalmology department.

Last Updated Date: 31 August 2021

Publication Date: 31 August 2021

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