Rosacea is a chronic skin condition that causes redness and swelling of the face that can also affect the scalp, neck, ears, chest, and back.  Eye symptoms (ocular rosacea) are also reported by half of people with rosacea.

Those afflicted with rosacea may first notice a tendency to flush or blush easily. The condition progresses to persistent redness, pimples, and visible, threadlike blood vessels (telangiectasias) in the center of the face. These skin changes can eventually spread to the cheeks, forehead, chin, and nose.

Rosacea occurs most commonly in people 30 to 50 years of age. Although women have rosacea more commonly than men, men tend to suffer more severe forms.

The cause of rosacea remains unknown, though it appears to involve a combination of genetics and environmental factors. It is not contagious.

Rosacea, also called acne rosacea, is different from the acne common in teenagers called acne vulgaris.

What Are the Signs and Symptoms of Rosacea?

Even though rosacea afflicts an estimated 14 million people in the U.S., many are unaware that they have rosacea. That could be because most sufferers develop only a few of the signs and symptoms of rosacea, which include:

• A tendency to blush or flush easily
• Persistent redness in the center of the face
• Small visible blood vessels (telangiectasia)
• Bumps and pus-filled pimples on the face 
• Burning or stinging sensation on the face; the skin also may itch or feel tight
• Dry skin on the face
• Swelling on the central face
• Eye problems, such as burning, itching, or watery eyes; swollen eyelids
• Thickening skin on the nose, cheeks, and/or forehead
• Rhinophyma—bumps on the nose that may develop if rosacea is left untreated

Early diagnosis and treatment can control symptoms, alleviate discomfort, and stop rosacea from progressing.

Without proper treatment, rosacea tends to worsen and can become disfiguring. Signs that rosacea is worsening include increasing redness, pimples, and/or thickening skin.

With treatment and lifestyle modifications, rosacea can be effectively controlled.

What Are the Different Types of Rosacea?

There are four subtypes of rosacea. Rosacea patients may have more than one subtype at the same time. Ocular rosacea may occur alone, with no changes to the skin.

              Courtesy of the National Rosacea Society

What Are the Treatments for Rosacea?

Although there is no cure for rosacea, a variety of treatments will reduce its appearance and prevent further progression. If allowed to worsen over a long period, rosacea may become more difficult to treat, and it could take longer to see positive results.

Treatments for rosacea include oral and topical medications, lifestyle modifications, laser and light therapies, and surgical procedures (used mostly for advanced cases).  These treatments are often combined for better results.

Your doctor will recommend a treatment plan based on the following:

• The rosacea subtype(s) you have developed
• The severity of rosacea
• Your skin type (light vs. dark, oily vs. dry)
• Results from previous treatments
• Your personal preferences

Medications for Rosacea

There are several safe and effective medications for rosacea.

Topical medications (applied to the skin) include:

• Azelaic acid (Azelex®, Finacea®)
• Clindamycin
• Erythromycin
• Metronidazole (MetroGel®)
• Sulfacetamide and sulfur lotions (Clenia®, Plexion®)

Oral medications (taken by mouth) include:

• Anti-inflammatory dose doxycycline (Oracea®)
• Doxycycline
• Erythromycin
• Minocycline 
• Tetracycline

A combination of medications may be recommended. For instance, an oral medication, such as doxycycline, may be combined with an antibiotic applied to the skin, such as metronidazole or azelaic acid.

Anti-Inflammatory Dose Doxycycline
Doxycycline is most commonly used as an antibiotic for the treatment of bacterial infections, including the bacteria associated with acne. However, doctors rely on its anti-inflammatory properties when prescribing it for rosacea.

Your doctor may prescribe a form of doxycycline created specifically for rosacea (anti-inflammatory-dose doxycycline).

When doxycycline is used to reduce the inflammation associated with rosacea, it is usually prescribed in 40mg daily doses. These are below the standard antimicrobial doses of doxycycline and thus reduce the risk of yeast overgrowth, diarrhea, and other side effects commonly associated with higher antibiotic doses.

Dermatological Procedures for Rosacea

Your doctor may also recommend one of following procedures:

• Laser therapy—used to shrink a bumpy or swollen nose, reduce  persistent redness, or decrease the number of visible blood vessels (telangiectasias)
• Electrosurgery—a procedure in which the skin is numbed and a small electric needle is used to destroy visible blood vessels (telangiectasias)

Multiple treatments may be necessary to achieve optimal results. Your doctor may also recommend future treatments to maintain long-term results.

If left untreated, chronic rosacea can lead to rhinophyma and skin thickening, which are more difficult to treat. Your doctor may recommend procedures to reshape areas, such as your nose or forehead, to a more normal appearance:

Ocular Rosacea
Most cases of ocular rosacea start off with mildly irritating symptoms, such as watery or itchy eyes, but these symptoms can progress and become more serious. Your doctor may prescribe topical medications, oral antibiotics, or anti-inflammatory drugs, alone or in combination with each other.

What Should I Expect?

It takes time for medications and other therapies to work, but many treatments will show results within the first two months. Your doctor can provide a reasonable estimate for results, depending on the treatment(s) prescribed and any lifestyle changes you make.

Continue with your treatment regimen and lifestyle modifications even if your rosacea clears up.

Stopping your medication too soon can lead to a relapse of symptoms. 

What Are Some Rosacea Self-Care Tips?

The chronic, relapsing nature of rosacea makes it a particularly vexing disorder to keep under control. Flare-ups, seemingly unpredictable, can be stressful. By observing certain lifestyle modifications, you may be able to ensure long-term success in managing your rosacea symptoms. While no lifestyle modification is foolproof, the following tips may help you prevent or minimize flare-ups.

Common Triggers - Identify Yours

The following list of common triggers can help you identify possible triggers for your rosacea symptoms. People with rosacea respond differently (or not at all) to each trigger, and it may take some time to determine what your triggers are. Many people find it helpful to keep a daily diary of food, activities, weather, and other factors that may cause flare-ups. You and your doctor can use the diary to discuss what to do to control your symptoms. 

Weather and the environment
Short of avoiding the outdoors and living in a sealed environment, you probably can’t escape the rosacea triggers associated with weather, including hot and cold temperatures, windy conditions, and humidity. But you can reduce your risk with a few simple measures.

• Protect your skin from the sun. Use sunscreen every day that you’re outside, even when it’s overcast. Choose a sunscreen rated SPF 30 or higher, and make sure it blocks ultraviolet light (UVA and UVB). (Read the skincare section below for tips on buying facial products that won’t aggravate your skin.) On warm, windy days, wear lightweight, loose-fitting long-sleeved shirts, pants, and a wide-brimmed hat. If possible, minimize your exposure to the sun, especially in midday.
• Protect your eyes. Wear sunglasses that protect your eyes from UV rays. 
• Moisturize your skin during cold and windy weather. In the winter or during blustery weather, protect your face with a scarf or ski mask to avoid flare-ups associated with dry skin—use a moisturizer too. On the other hand, avoid overheating when doing something active outside in cool weather, such as raking leaves or jogging. For those times, dress in layers so you can remove items if you feel too warm.
• Control indoor temperatures. Keep the environment indoors comfortable but not too warm in the winter, as indoor heat can trigger your symptoms. Open a window or run a fan in rooms that are stuffy. Avoid sitting near lit fireplaces or stoves. 

Food and beverages
Many seemingly innocuous foods and drinks can aggravate rosacea, so identifying these triggers can be tricky. Thus, what you eat and drink is one of the most useful categories in your rosacea diary. There are some triggers on the list below that seem universal (such as spicy foods and hot beverages), but ultimately you’ll determine your specific sensitivities. 

• Avoid consuming foods that make you flush. Spicy food is an oft-cited culprit for rosacea flare-ups, but alcoholic beverages and even smoking can cause flushing too. Other possible food triggers include processed food, MSG, cayenne and red pepper, curry, chili powder, vinegar, soy sauce, and dairy products. If you consume something that causes you to flush, take note of it, write it down in your diary, and try to avoid it in the future. Consider non-alcoholic drinks if alcohol makes you flush.
• Stick with cool beverages. Heated drinks like coffee, hot chocolate, cider, and tea pose another risk for rosacea sufferers. If you simply can’t go without them, try alternatives like iced coffee or less-heated versions (merely decreasing the temperature of such drinks may do the trick).
• Keep your kitchen cool. Reducing dietary triggers goes hand-in-hand with staying cool while preparing your food and drink. Keep your kitchen, like the rest of your house, comfortable and ventilated—use fans and open windows. Wear loose, comfortable clothing while you cook, and take periodic breaks in cooler rooms.
• Read the label on your vitamins. If you take vitamins or other supplements, you may be ingesting substances like niacin, which can cause flushing in some individuals.
• Watch for trigger foods outside the home. At social events, during business travel, or when eating out, it’s easy to forget the dietary routines you’ve worked hard to establish. In these situations, stick with rosacea-friendly foods.

Skincare
With rosacea, your face is sensitive to certain skincare products, or even cleansing methods that most people easily tolerate. The upside is that you may start treating your facial skin more kindly, preventing identified triggers while you’re at it.

• Be gentle. The easiest change you can make to your skincare regimen is simply to be kinder to your face when applying cosmetics or topical medications. Avoid rubbing or massaging your face.
• Medications. If you are taking a topical medication for your rosacea, be sure to let it dry before applying any moisturizers or other cosmetics to the face. Avoid using topical steroids, such as hydrocortisone, on your face because they may aggravate your rosacea. What little relief these medications provide is temporary, and symptoms often return when the steroids wear off.
• Avoid harsh ingredients. Look at the labels of makeup, lotions, cleansers, hair products, and even sunscreens before buying. Look for products that are designed for sensitive skin and are hypo-allergenic or non-comedogenic. Ingredients to avoid include alcohol, eucalyptus, fragrance, menthol, peppermint, or witch hazel.
• Choose makeup wisely. There’s no need to avoid makeup—in fact, cosmetics with a green or yellow base are a good cover for rosacea-associated redness. But as with the products listed above, know the ingredients before you buy. For rosacea, many doctors or makeup professionals recommend cosmetics that are mineral-based or water-based and oil-free. Since no single type of makeup is suitable for every rosacea patient, use this guideline: If your face stings or burns when you apply the makeup, or after you wear it for awhile, wash it off and avoid that brand.
• Take care of your eyes. Remember to treat your eyes as gently as the rest of your face. Carefully wash them each day with a warm, wet cloth, using a product made for the eyes. Use artificial tears if your eyes feel dry.
• Cosmetic procedures. Procedures such as salicylic peels or microdermabrasion are best left to a dermatologist, as those treatments can aggravate rosacea when performed improperly.

Exercise
Body heat generated from physical activity can inflame rosacea symptoms, yet avoiding exercise is not the answer. With a little modification of your fitness routine, you can enjoy the considerable benefits of exercise while minimizing the risk of a flare-up. The most important thing is to stay as cool as possible.

• Keep it short. A flare-up after exercise may signal that you going too long without a break. Try taking a break every 15 minutes to help your body cool off.
• Exercise during cooler parts of the day. If you exercise outside, try doing so in the morning or evenings, when temperatures are at their lowest.
• Stay cool before and during exercise. To keep your body from overheating, drape a cool towel around your neck, chew some ice chips, or sip a cold beverage while you exercise.
• Avoid running on pavement. Try a cooler jogging alternative, such as a shady trail or air-conditioned indoor track.
• For indoor activities, keep the temperature down. Avoid exercising in hot, stuffy rooms; run a fan or open a window, if possible.
• Monitor the intensity of your workout. If your activity requires heavy exertion or endurance, consider replacing it with a less intensive exercise that can be just as effective, such as water aerobics or power walking. Just shortening your workouts may do the trick. 
• Don’t forget sun protection. When exercising outdoors, protect your skin from the sun. Apply sunscreen, and remember to reapply it after perspiring or swimming.

Stress
Stress is a common, and commonly overlooked, trigger. Many people with rosacea find a lot of opportunity for symptom relief with a few easy steps.

• Don’t cheat on sleep. The more you sleep, the better prepared you are to cope with stress. Sleep also gives your skin time to rejuvenate.
• Find your own relaxation techniques. With so many stress-management options, you are bound to find several that work for you. Try yoga, meditation, or journal writing. Make time for walks or reading. Get a pet. Find a new hobby. Whatever you find relaxing, just do more of it. Visit a bookstore or library if you need more ideas.
• Shake up your routine. Once you’ve used your diary to identify stress triggers, you can avoid or modify some routines, such as avoiding driving during rush hour or running errands during slower times of the week. 

Rosacea Medications

While remembering to take your rosacea medication every day is often no problem during a flare-up, you may be tempted to stop taking it or forget to take it if your symptoms clear up. However, your medication is an important key to getting and keeping your rosacea under control, and if you stop taking it, you could see a return of symptoms. Your doctor may prescribe a medication for many months at a time, making it important to take it as long as directed.

If you find yourself forgetting to take your medication, try these tips:

• Keep your medication near your toothbrush, so you remember to take it when you brush your teeth.
• Put a few pills or an extra tube of topical medication in your purse or backpack so you can take it later in the day if you forget before leaving the house.
• Keep your medication on your nightstand.
• If you use a computer every day, set up a daily reminder.
• Ask your spouse, a family member, or a friend to remind you. 
• Set a daily reminder on your watch alarm.

Find What Works and Stick with It

Since your best chance of success lies in your ability to stick with any changes you make, try a few at a time, instead of taking on a lot at once.

Remember to comply with your treatment regimen and maintain your newfound healthy habits even when life gets hectic, you have to travel for work, you eat at a friend’s house, or during any event outside of your routine. By taking charge of your rosacea symptoms and making sustained lifestyle modifications, you will have a great chance of avoiding flare-ups.

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This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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