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Questions and Answers about Rosacea
This publication contains general information about rosacea (ro-ZAY-she-ah). It defines rosacea and describes its symptoms, possible causes, and treatments. If you have further questions after reading this publication, you may wish to discuss them with your doctor.
Rosacea is a chronic (long-term) disease that affects the skin and sometimes the eyes. The disorder is characterized by redness, pimples, and, in advanced stages, thickened skin. Rosacea usually affects the face. Skin on other parts of the upper body is only rarely involved.
Rosacea most often affects middle-age and older adults. It is more common in women (particularly during menopause) than men. Although rosacea can develop in people of any skin color, it tends to occur most frequently and is most apparent in people with fair skin.
There are several symptoms and conditions associated with rosacea. These include frequent flushing, vascular rosacea, inflammatory rosacea, and several other conditions involving the skin, eyes, and nose.
Frequent flushing of the center of the face, which may include the forehead, nose, cheeks, and chin, occurs in the earliest stage of rosacea. The flushing often is accompanied by a burning sensation, particularly when creams or cosmetics are applied to the face. Sometimes the face is swollen slightly.
A condition called vascular rosacea causes persistent flushing and redness. Blood vessels under the skin of the face may dilate (enlarge), showing through the skin as small red lines. This is called telangiectasia (tel-AN-je-ek-tay-ze-ah). The affected skin may be swollen slightly and feel warm.
A condition called inflammatory rosacea causes persistent redness and papules (pink bumps) and pustules (bumps containing pus) on the skin. Eye inflammation and sensitivity as well as telangiectasia also may occur.
In the most advanced stage of rosacea, the skin becomes a deep shade of red and inflammation of the eye is more apparent. Numerous telangiectases are often present, and nodules in the skin may become painful. A condition called rhinophyma also may develop in some men; it is rare in women. Rhinophyma is characterized by an enlarged, bulbous, and red nose resulting from enlargement of the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. People who have rosacea also may develop a thickening of the skin on the forehead, chin, cheeks, or other areas.
In addition to skin problems, many people who have rosacea have eye problems caused by the condition. Typical symptoms include redness, dryness, itching, burning, tearing, and the sensation of having sand in the eye. The eyelids may become inflamed and swollen. Some people say their eyes are sensitive to light and their vision is blurred or otherwise impaired.
Doctors do not know the exact cause of rosacea but believe that some people may inherit a tendency to develop the disorder. People who blush frequently may be more likely to develop rosacea. Some researchers believe that rosacea is a disorder where blood vessels dilate too easily, resulting in flushing and redness.
Factors that cause rosacea to flare up in one person may have no effect on another person. Although the following factors have not been well-researched, some people claim that one or more of them have aggravated their rosacea: heat (including hot baths), strenuous exercise, sunlight, wind, very cold temperatures, hot or spicy foods and drinks, alcohol consumption, menopause, emotional stress, long-term use of topical steroids on the face, and bacteria.
Although there is no cure for rosacea, it can be treated and controlled. A dermatologist (a medical doctor who specializes in diseases of the skin) usually treats rosacea. The goals of treatment are to control the condition and improve the appearance of the patient’s skin. It may take several weeks or months of treatment before a person notices an improvement of the skin.
Some doctors will prescribe a topical antibiotic, which is applied directly to the affected skin. For people with more severe cases, doctors often prescribe an oral (taken by mouth) antibiotic. The papules and pustules symptomatic of rosacea may respond quickly to treatment, but the redness and flushing are less likely to improve. Recently, a topical gel was approved that can ease the redness associated with rosacea.1
1All medicines can have side effects. Some medicines and side effects are mentioned in this publication. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects.
Some people who have rosacea become depressed by the changes in the appearance of their skin. People who have rosacea may experience low self-esteem, feel embarrassed by their appearance, and claim their social and professional interactions with others are adversely affected. A doctor should be consulted if a person feels unusually sad or has other symptoms of depression, such as loss of appetite or trouble concentrating.
Doctors usually treat the eye problems of rosacea with prescription eye medicine. People who develop infections of the eyelids must practice frequent eyelid hygiene. The doctor may recommend scrubbing the eyelids gently with diluted baby shampoo or an over-the-counter eyelid cleaner and applying warm (but not hot) compresses several times a day.
Electrosurgery, dermabrasion, and laser surgery may be used if red lines caused by dilated blood vessels appear in the skin or if skin thickening develops.
Working With Your Doctor to Manage Rosacea
The role you play in managing your rosacea is important. You can take several steps to keep rosacea under control:
- Keep a written record of when flares occur. This may provide clues about what is irritating the skin.
- Use sunscreen. Most people should use a sunscreen every day that protects against UVA and UVB rays (ultraviolet rays) and has a sun-protecting factor (SPF) of 15 or higher, but sunscreen is particularly important for people whose skin is irritated by exposure to the sun.
- Use a mild lubricant if you find it is helpful, but avoid applying any irritating products to the face. Some people find that a green-tinted makeup effectively conceals skin redness.
- If your eyes are affected, faithfully follow your doctor’s treatment plan and clean your eyelids as instructed.
Ask the doctor about the best options for you. A combination of treatments may work best. Find out:
- How long the treatment may last.
- How long it will take to see results.
- What the possible side effects are.
- What you should do if the side effects are severe.
National Institutes of Health (NIH)-funded scientists continue to search for new insights into rosacea. For example, researchers have found that some people with rosacea have high levels of inflammation-causing chemicals in their skin. Researchers also are studying the role of cathelicidins, peptides with antimicrobial and proinflammatory properties that protect the skin against infection. Others are investigating how the sensory neurons in the skin work with the immune system to cause inflammation and pain. Investigators also discovered that levels of stratum corneum tryptic enzyme or SCTE—the enzyme responsible for cleaving the inactive cathelicidins into their active form—were also elevated in people with rosacea.
Scientists are also trying to understand the structures and functions of the stratum corneum, the outermost layer of the skin. In addition, further understanding about the microbiome of the skin could reveal some insights into the possible causes of rosacea.
More information on research is available from the following websites:
- NIH Clinical Research Trials and You helps people learn more about clinical trials, why they matter, and how to participate. Visitors to the website will find information about the basics of participating in a clinical trial, first-hand stories from actual clinical trial volunteers, explanations from researchers, and links to how to search for a trial or enroll in a research-matching program.
- ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.
- NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.
- PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
American Academy of Dermatology (AAD)
National Rosacea Society
The NIAMS gratefully acknowledges the assistance of the following individuals in the preparation and review of the original version of this publication: Mark Dahl, M.D., Mayo Clinic, Scottsdale, AZ; Sam Huff, National Rosacea Society, Barrington, IL; Robert Katz, M.D., Rockville, MD; M. Carol McNeely, M.D., University Dermatology Associates, Washington, DC; Larry Miller, M.D., Chevy Chase, MD; Alan Moshell, M.D., NIAMS, NIH; and Gary Peck, M.D., Washington Hospital Center, Washington, DC.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The NIAMS Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS website at www.niams.nih.gov.
For Your Information
This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.
For updates and for any questions about any medications you are taking, please contact
U.S. Food and Drug Administration
Toll Free: 888–INFO–FDA (888–463–6332)
For additional information on specific medications, visit Drugs@FDA at www.accessdata.fda.gov/scripts/cder/drugsatfda. Drugs@FDA is a searchable catalog of FDA-approved drug products.
For updates and questions about statistics, please contact
Centers for Disease Control and Prevention’s National Center for Health Statistics
This publication is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed.
Additional copies of this publication are available from:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
NIH Publication No. 13–5038