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
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
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
- 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:
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
are several safe and effective medications for rosacea.
Topical medications (applied to the skin) include:
acid (Azelex®, Finacea®)
- Metronidazole (MetroGel®)
and sulfur lotions (Clenia®, Plexion®)
Oral medications (taken by mouth) include:
dose doxycycline (Oracea®)
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.
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.
doctor may prescribe a form of doxycycline created specifically for rosacea (anti-inflammatory-dose doxycycline).
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
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)
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
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.
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
Stopping your medication too soon can lead to a relapse of symptoms.
What Are Some Rosacea
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.
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.
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
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.
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
- 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
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.
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
- 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
- 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.
forget sun protection. When exercising outdoors, protect your skin from the sun. Apply sunscreen, and remember to
reapply it after perspiring or swimming.
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.
cheat on sleep. The more you sleep, the better prepared you are to cope with stress. Sleep also gives your skin time
- 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.
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
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.
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.
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.
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.
sure to follow specific instructions given to you by your physician or health care professional.
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Sun Protection Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important
for everyone to be aware of its damaging effects and take measures to avoid overexposure.
Although many people enjoy
the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation
in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin)
to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun,
the more likely you are to develop skin problems later in life.
The damaging part of sunlight
is called ultraviolet radiation, or UV rays. It is categorized into three types:
- UVC rays
(wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is
the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere.
However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface.
It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and
during the summer.
- UVA rays (wavelengths = 320 nm to 400 nm)
are the least powerful of the UV rays, but they are present all year and can penetrate
windows and clouds.
The first and more effective way to avoid sun damage is
to stay out of tthe sun as much as possible.
If you cannot avoid being exposed to sunlight,
there are five basic defenses that you should keep in mind when you go outdoors:
peak hours of sunlight
Avoid Peak Hours of Sunlight (UV Index)
In general, UV rays are the greatest between 10 a.m. and 4 p.m.
It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or
at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and
You can obtain an accurate measure of the amount of UV rays in your area by looking
up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a
report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day
to day according to time of year, cloud cover, atmospheric ozone, and other factors.
The following table is a breakdown
of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You
should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.
- 0 to 2
- 3 to 4 = Low
- 5 to 6 = Moderate
- 7 to 9 = High
or more = Very high
The UV Index can be found on our Website or in local
papers, usually in the weather section.
There are several factors to consider when selecting the right
sunscreen. (See the Sunscreens handout for more information.)
actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun
protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens
that offer a minimum SPF of 15.
Broad-spectrum sunscreens - It is best to use a sunscreen that can
protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens.
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the
development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product
with greater protection.
Common sunscreen ingredients that provide protection
from UVB rays:
- PABA (para-aminobenzoic
- Padimate O and Padimate A (Octyl Dimethyl PABA)
sunscreen ingredients that provide protection from UVA rays:
- Avobenzone (Parsol 1789)
(oxybenzone, dioxybenzone, sulisobenzone)
Sunblocks - "Physical"
sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful
for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:
- Titanium dioxide
- Iron oxide
Although past formulations
were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being
applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.
- Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute
immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute
immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as
swimming or water skiing, or will be actively sweating.
However, independent testing has shown many products do not
perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently
if you are actively sweating.
Using a Sunscreen
Sunscreen should be applied
evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect.
(Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming
or sweating. Apply sunscreen generously and reapply frequently at least every two hours.
The chemicals may lose
effectiveness over time, so it is important to throw away sunscreen that is past its expiration date
or is over two years old.
No sunscreen is 100% effective; take additional measures to avoid the
damaging effects of the sun's rays.
Clothing can provide excellent
protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection
from UV rays. When selecting clothes for sun protection, consider the following:
- Cover your head, shoulders, arms,
legs, and feet.
- Use a hat that is broad-brimmed (brim should be at least four
- Wear fabrics that are thicker or with a tight weave; these allow less
sunlight to penetrate the skin.
- Wear darker-colored clothes that absorb more UV rays.
- Wear clothing
made from nylon or Dacron because it is more protective than cotton.
- Avoid remaining
in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
clothing with chemical absorbers to increase their protectiveness.
- Some clothing
comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric
to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation
to penetrate your skin as compared to uncovered skin.
Garments fall into 3 categories:
protection: UPF = 15 to 24
- Very good protection: UPF = 25 to 39
protection: UPF = 40 to 50+
Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a
garment will decrease over time as the fabric wears.
Overexposure to sunlight can cause cataracts
and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of
value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection.
Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking
99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.
possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because
UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics
used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth,
look for a fabric that is thick, tightly woven, and dark-colored.
Clear window glass provides protection from UVC and
UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which
prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use
of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but
this is illegal in some states.
- Avoid the sun when its
UV rays are strongest, between 10 a.m. and 4 p.m.
- Use a broad-spectrum sunscreen with SPF 15 or greater.
Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen
if you will be active (sweating) or in the water.
- Use a sunblock on your lips.
- Wear a broad-brimmed hat
- Wear sunglasses.
- Wear tightly woven, dark clothing to
cover your arms, legs, and feet.
- Stay in the shade when possible.
reflective surfaces, such as water or snow.
- Avoid sunbathing.
be fooled by cloudy days since damaging rays can penetrate clouds.
Open 7 Days A Week — Se Habla Español
NYC Dermatology - Manhattan Dermatology - Skin Institute of
New York - Skin Cancer Doctor- NYC Cosmetic Dermatology- Cosmetic Dermatological Surgery - New York City -
Board Certified Dermatologist
Dr. Gary Rothfeld
- Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022