Q. What causes rosacea?
A. Although the exact cause of rosacea is unknown, various theories about the disorder's origin have evolved over the years. Facial blood vessels may dilate too easily, and the increased blood near the skin surface makes the skin appear red and flushed. Various lifestyle and environmental factors -- called triggers -- can increase this redness response. Acne-like bumps may appear, often in the redder area of the central face. This may be due to factors related to blood flow, skin bacteria, microscopic skin mites (Demodex), irritation of follicles, sun damage of the connective tissue under the skin, an abnormal immune or inflammatory response, or psychological factors.
None of these possibilities has been proven, although potential inflammatory pathways have been identified in recent ongoing research -- including an immune response triggered by a type of antimicrobial protein known as cathelicidin. A recent study also found that certain bacteria present on otherwise harmless Demodex mites could prompt an inflammatory response in rosacea patients, and other research identified two genetic variants that may be linked to rosacea, located in areas of the genome that are also associated with autoimmune disease..
To read study results from NRS-funded research, see the Research Grants section.
Q. Is rosacea contagious?
A. No. Rosacea is not considered an infectious disease, and there is no evidence that it can be spread by contact with the skin or through inhaling airborne bacteria. The effectiveness of antibiotics against rosacea symptoms is widely believed to be due to their anti-inflammatory effect, rather than their ability to destroy bacteria.
Q. Is rosacea hereditary?
A. Although no scientific research has been performed on rosacea and heredity, there is evidence that suggests rosacea may be inherited. Nearly 40 percent of rosacea patients surveyed by the National Rosacea Society said they could name a relative who had similar symptoms. Recent research in twins showed that the aggregate contribution of genes to the presence of rosacea is almost half, with environmental effects accounting for the rest.
In addition, there are strong signs that ethnicity is a factor in one's potential to develop rosacea. In a separate survey by the Society, 33 percent of respondents reported having at least one parent of Irish heritage, and 26 percent had a parent of English descent. Other ethnic groups with elevated rates of rosacea, compared with the U.S. population as a whole, included individuals of Scandinavian, Scottish, Welsh or eastern European descent.
Q. Can rosacea be diagnosed before you have a major flare-up?
A. It is sometimes possible to identify "prerosacea" in teenagers and persons in their early 20s. These individuals generally come to the dermatologist for acne treatment and exhibit flushing and blushing episodes that last longer than normal. The prolonged redness usually appears over the cheeks, chin, nose or forehead. These patients also may find topical acne medications or certain skin-care products irritating.
Once identified, these rosacea-prone individuals can be counseled to avoid aggravating lifestyle and environmental factors known to cause repeated flushing reactions that may lead to full-blown rosacea. If you recognize the symptoms of prerosacea in a younger family member or others, they might be advised to consult a dermatologist.
Q. Is there any kind of test that will tell you if you have rosacea?
A. There are no histological, serological or other diagnostic tests for rosacea. A diagnosis of rosacea must come from your physician after a thorough examination of your signs and symptoms and a medical history. During your exam you should explain any problems you are having with your face, such as redness; flushing; the appearance of bumps or pimples; swelling; burning, itching or stinging; or other information.
Q. Will my rosacea get worse with age?
A. There is no way to predict for certain how an individual's rosacea will progress, although physicians have observed that the signs and symptoms tend to become increasingly severe without treatment. Moreover, in a National Rosacea Society survey, about half of rosacea sufferers said without treatment their condition had advanced from early to middle stage within a year. Fortunately, compliance with medical therapy and lifestyle modifications to avoid rosacea triggers has been shown to effectively control its signs and symptoms on a long-term basis.
Q. How long does rosacea last?
A. Rosacea is a chronic disorder, rather than a short-term condition, and is often characterized by relapses and remissions. A retrospective study of 48 previously diagnosed rosacea patients found that 52 percent still had active rosacea, with an average ongoing duration of 13 years. The remaining 48 percent had cleared, and the average duration of their rosacea had been nine years. While at present there is no cure for rosacea, its symptoms can usually be controlled with medical therapy and lifestyle modifications. Moreover, studies have shown that rosacea patients who continue therapy for the long term are less likely to experience a recurrence of symptoms.
Q. How can I find a rosacea specialist?
A. As with most disorders, there is no formal medical specialty devoted to rosacea alone. The appropriate specialist for rosacea is a dermatologist, who specializes in diseases of the skin, or for those with eye symptoms, an ophthalmologist. Visit the Physician Finder section to identify a dermatologist or ophthalmologist in your area.
Q. Are there any studies or research that I can participate in?
A. As a member of the National Rosacea Society (NRS), from time to time you may be given an opportunity to participate in research to help improve treatment or patient care. If you have not done so, this is one more reason to join the NRS today.
Q. Can rosacea occur in children?
A. Although the incidence of rosacea in adolescents and children is infrequent, such cases have been documented in the medical literature. Eyelid styes may be one form. Rosacea often runs in families, and rosacea sufferers would be wise to be on the lookout for early signs in children in order to seek diagnosis and treatment before the condition worsens.
Q. Are there support groups for rosacea sufferers?
A. The National Rosacea Society is the world's largest support organization for rosacea, offering information and educational services to hundreds of thousands of rosacea patients and health professionals each year.
Q. Does rosacea cause facial swelling, burning or itching?
A. Facial burning, stinging and itching are commonly reported by many rosacea patients. Certain rosacea sufferers may also experience some swelling (edema) in the face that may become noticeable as early as the initial stage of the disease. The same flushing that brings on rosacea's redness can be associated with a build-up of fluid in the tissues of the face. It often occurs above the nasolabial folds -- the creases from the nose to each side of the mouth -- and can cause a "baggy cheek" appearance. It is also believed that in some patients this swelling process may contribute to the development of excess tissue on the nose (rhinophyma), causing it to become bulbous and bumpy.
If you experience any of these symptoms, discuss them with your physician. For a complete description of the signs and symptoms of rosacea, visit the All About Rosacea section.
Q. Are rosacea symptoms generally symmetrical or asymmetrical?
A. Rosacea can present itself in different ways for different individuals. Rosacea patients may exhibit varying levels of severity of symptoms over different areas of the face. Patients have often reported that the disorder actually began with a red spot or patch on one cheek or another part of the face, and then spread to other areas. On the other hand, many rosacea patients exhibit similar symptoms on both sides of their faces.
Q. I suffer from regular acne in addition to rosacea. Is this common?
A. Rosacea and regular acne, called acne vulgaris, usually appear separately, but some patients are affected by both. While both conditions in adults are often informally referred to as "adult acne," they are two separate diseases, each requiring different therapy. Acne vulgaris is associated with plugging of the ducts of the oil glands, resulting in blackheads and pimples on the face and sometimes also the back, shoulders or chest. Rosacea seems to be linked to the vascular network of the central facial skin and causes redness, bumps, pimples and other symptoms that rarely go beyond the face. Special care is necessary in treating patients with both conditions because some standard medications for acne vulgaris can make rosacea worse.
Q. Is dry, flaky skin typical with rosacea?
A. It has been estimated that approximately half of all rosacea sufferers may appear to experience dry skin. With treatment, this dryness often eases along with disappearance of papules and pustules. To combat dry, flaky skin, use a moisturizer daily after cleansing and applying medication. You also may wish to check with your dermatologist to see which medication is best for your skin type, since some have a drying effect and others are more moisturizing.
Q. Is oily skin common for rosacea sufferers?
A. There is no standard skin type for rosacea patients. Many sufferers experience dry, flaky skin, while others may have normal or oily skin, or both. The key is to identify your skin type and use medication and skin-care products that are suitable for you.
Q. Is there any connection between rosacea and seborrheic dermatitis?
A. It is not unusual for seborrheic dermatitis to appear concurrently with rosacea. Seborrhea manifests as reddish-yellow greasy scaling in the central third of the face. Scalp, eyebrows and beard may have fine flakes of white scale, dandruff or patches of thicker, greasy yellow scale. Eruptions may also appear beyond the face. To learn more, visit the Seborrhea section.
Q. Is there any connection between ordinary eczema and rosacea?
A. No, nothing in the medical literature links rosacea and atopic eczema. The two diseases may share some symptoms, but also have many differences. Rosacea is more common in fair-skinned individuals and nearly always affects the face only, causing such signs and symptoms as redness, visible blood vessels, bumps and pimples and sometimes swelling of the nose from excess tissue. Atopic eczema is more common in individuals with dry skin and can appear in various areas of the body, producing red scaling and crusted or weeping pustules that itch fiercely.
Q. Is there a connection between lupus and rosacea?
A. No. Discoid lupus is a chronic, scarring skin disease. Another form, systemic lupus, is characterized by a variety of signs, including some in the vascular system. Because lupus can cause a reddish skin rash that spreads across the bridge of the nose and face, often in a butterfly pattern, it can appear similar to rosacea. However, while both rashes can be smooth in texture, the presence of bumps and pimples, which rarely occur in a lupus flare, may help differentiate the diseases. In addition, lupus is almost always accompanied by other symptoms not associated with rosacea, such as fever, arthritis and signs of renal, lung or heart involvement. A dermatologist can usually quickly tell the difference between a butterfly rash of lupus and rosacea.
Moreover, unlike lupus, as many as 50 percent of rosacea patients may also have ocular signs. Visually, an eye affected by rosacea often appears watery or bloodshot. Sufferers may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.
Q. Are rosacea sufferers more likely to get skin cancer later in life?
A. No medical evidence has linked rosacea directly with skin cancer. Rosacea sufferers may be more likely to develop skin cancer later in life because of their frequent light complexions and propensity to injury from ultra-violet radiation from the sun. It is important that you consult your dermatologist if you have any signs of possible skin cancer, such as a mole that is enlarged or asymmetric or that has an irregular border or varying color. Although unrelated to rosacea, skin cancer is a potentially fatal disease whose incidence has been on the rise.
Q. I've been using medication for some time now and it has cleared my pimples and reduced my redness, but it also seems to have made me develop more spider veins. What's going on?
A. Visible blood vessels (telangiectasia) sometimes develop with rosacea and were likely always there, but were hidden or less noticeable because of your redness. Once medication has diminished the redness, it is not uncommon for spider veins to become more noticeable. These can be camouflaged with makeup, or removed with a vascular laser, intense pulsed light source or other medical device.
Q. Can you get rosacea on other parts of your body?
A. Although it is not a common feature of rosacea, symptoms have been reported to appear beyond the face. In a National Rosacea Society survey, rosacea patients reported experiencing symptoms on the neck, chest, scalp, ears and back.
Q. How does menopause affect rosacea?
A. The hot flashes sometimes associated with menopause may bring on a flare-up or even the initial onset of rosacea. A Swedish study also noted that postmenopausal women with rosacea may be more likely to experience migraine headaches.
Several articles about the relationship between menopause and rosacea have appeared in Rosacea Review. To view those archives, click here.
Q. Can rosacea involve the eyes?
A. Yes. Known as ocular rosacea, eye symptoms may include a watery or bloodshot appearance and a dry, gritty feeling with burning, itching and/or stinging. Individuals with rosacea may be prone to styes, and light sensitivity and blurred vision may also be present. Left untreated, decreased visual acuity due to corneal involvement may occur. Eye involvement may appear before as well as after any skin signs or symptoms, and individuals who suspect they may have ocular rosacea should consult a dermatologist or ophthalmologist for appropriate therapy.
Q. What are the most common lifestyle and environmental factors that aggravate rosacea or trigger flare-ups?
A. According to a National Rosacea Society survey, some of the most common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, heavy exercise, hot baths, heated beverages and certain skin-care products. For a list of common triggers, visit the Rosacea Triggers section.
Q. How effective is avoiding lifestyle and environmental factors?
A. In a survey of 1,221 rosacea sufferers by the National Rosacea Society, 96 percent of those who believed they had identified personal trigger factors said avoiding those factors had reduced their flare-ups. Full survey results are available in the Rosacea Review archives.
Q. How long after a rosacea trigger will a rosacea flare-up occur?
A. Although there are no data available on how quickly a rosacea trigger may lead to a flare-up, the time is likely to vary depending on the individual and the nature of the trigger. Try monitoring your individual case to see how quickly your rosacea has responded. And remember, while a wide range of factors has been identified as potential triggers, not every trigger affects every individual every time.
Q. Is there any relationship between rosacea and allergies?
A. Allergies may cause an altered reaction of the body that includes flushing, which frequently triggers rosacea symptoms. As with more common rosacea triggers, identifying and avoiding allergens -- the substances you are reacting to -- may also help control your rosacea.
Q. Will exercise cause my rosacea to flare up?
A. Any activity such as exercise that causes flushing or overheats the face has the potential to spark a rosacea flare-up. The good news is that signs and symptoms may be avoided or reduced by managing your workout. Ways to help reduce the incidence of flare-ups include working out in the early morning or late evening when weather is cooler; working out more frequently but for shorter intervals; keeping cool indoors by running a fan or opening a window; and cooling off by keeping a damp towel on your neck, drinking cold fluids or chewing on ice chips. Choosing low-intensity exercise or water aerobics may also be useful.
Q. How do I determine what causes a flare up?
A. Rosacea signs and symptoms may be prompted by a vast array of environmental and lifestyle factors that differ from one individual to another. Some of the most common factors are listed here. As with an allergy, it is useful to keep a diary to pinpoint the particular elements that may prompt a flare-up in your individual case. The National Rosacea Society publishes a booklet, "Rosacea Diary," designed to help patients identify and avoid their individual rosacea triggers.
Q. Can rosacea be cured?
A. While rosacea cannot be cured, medical treatments are available that can control or eliminate its various signs and symptoms.
Q. How is rosacea treated?
A. The signs and symptoms of rosacea vary substantially from one patient to another, and treatment must therefore be tailored by a physician for each individual case. Some patients are troubled by redness and flushing, while others have bumps and pimples, thickening of the skin, or eye rosacea or combinations. For patients with bumps and pimples, doctors often prescribe oral and topical rosacea therapy, and a topical therapy to reduce facial redness is now available.
When appropriate, laser treatment or other surgical procedures may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Eye symptoms are commonly treated with oral antibiotics and ophthalmic therapy.
In addition, rosacea patients are advised to identify and avoid lifestyle and environmental factors that may aggravate their individual conditions. Patients may also benefit from gentle and appropriate skin care, and cosmetics may be used to reduce the effect of rosacea on appearance.
Q. Why are antibiotics prescribed for rosacea? Is it a bacterial infection?
A. It is unknown exactly why antibiotics work against rosacea, but it is widely believed that it is due to their anti-inflammatory properties, rather than their bacteria-fighting capabilities.
Q. What about bacterial resistance from antibiotic use?
A. Topical antibiotics result in such minimal levels of medication in the bloodstream, if any, that there is virtually no risk of developing bacterial resistance at sites other than where the topical antibiotic is being applied. A version of an oral antibiotic with less risk of microbial resistance has been developed specifically for rosacea.
Q. What medications are used for rosacea besides antibiotics?
A. Physicians may use a variety of medications to help control rosacea in individual patients. Products containing a sulfur drug or azelaic acid may be prescribed as an alternative or adjunct to antibiotic therapy, and a cardiovascular medication is sometimes used to control severe flushing. Other medications may also be considered, especially in cases that do not respond to initial therapy.
Q. What about long-term side effects?
A. Topical therapy results in such minimal levels of medication in the bloodstream, if any, that there is virtually no risk of systemic side effects except allergic reactions. Possible side effects associated with oral antibiotic therapy include upset stomach, sensitivity to sun exposure, tooth discoloration, diarrhea, allergic reactions and vaginal yeast infections.
Q. If I take long-term medication consistently, will it lose its effectiveness?
A. Topical therapy usually controls rosacea on a long-term basis, without loss of effectiveness.
Q. Should I still use my medication between flare-ups?
A. Rosacea is characterized by flare-ups and remissions, and a study found that long-term medical therapy significantly increased the rate of remission in rosacea patients. In a six-month multicenter clinical study, 42 percent of those not using medication had relapsed, compared to 23 percent of those who continued to apply a topical antibiotic. In general, treatment between flare-ups can prevent them.
Q. How should I care for my skin?
A. A rosacea facial care routine recommended by many dermatologists starts with a gentle and refreshing cleansing of the face each morning. Sufferers should use a mild soap or cleanser that is not grainy or abrasive, and spread it with their fingertips. A soft pad or washcloth can also be used, but avoid rough washcloths, loofahs, brushes or sponges.
Next, rinse the face with lukewarm water several times and blot it dry with a thick cotton towel. Never pull, tug, scratch or treat the face harshly. Sufferers should let their face air dry for several minutes before applying a topical medication. Let the medication soak in for an additional five or 10 minutes before using any makeup or other skin care products.
For additional information, visit the Skin Care & Cosmetics section.
Q. What skin-care products are appropriate to use with rosacea?
A. The skin of many rosacea sufferers may be sensitive and easily irritated. Patients should avoid using any products that burn, sting or irritate their skin. In a National Rosacea Society survey, many individuals with rosacea identified alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus oil, clove oil and salicylic acid as ingredients that irritated their individual cases, and many also avoided astringents and exfoliating agents. A useful rule of thumb may be to select products that contain no irritating or unnecessary ingredients.
Sunscreens or sunblocks effective against the full spectrum of ultraviolet A and B radiation can be especially important for rosacea patients, whose facial skin may be particularly susceptible to sun damage and consequent rosacea flare-ups. An SPF of 15 or higher is recommended, and physical blocks utilizing zinc or titanium dioxide may be effective if chemical sunscreens cause irritation.
Q. How does laser therapy work?
A. To remove visible blood vessels or reduce extensive redness, vascular lasers emit wavelengths of light that target tiny blood vessels just under the skin. Heat from the laser's energy builds in the vessels, causing them to disintegrate. Generally, at least three treatments are required, depending on the severity of redness or visible blood vessels.
Vascular lasers may also be used to help retard the buildup of excess tissue, and in severe cases a CO2 laser may be used to remove unwanted tissue and reshape the nose. New laser technology has been developed to minimize bruising, and recently developed devices called intense pulsed light sources mimic lasers but generate multiple wavelengths to treat a broader spectrum of tissue. As with any surgical technique, the safety and effectiveness of laser therapy may depend on the skill of the physician.
Q. Is there research being conducted on rosacea?
A. The National Rosacea Society has instituted a research grants program to encourage and support scientific investigation into the potential causes and other key aspects of rosacea that may lead to improvement in its treatment, as well as its potential prevention or cure. Information on this program can be found under Research Grants.
Q. How do I control flushing/blushing?
A. As always, the best offense is a good defense. Individuals with rosacea should identify and avoid environmental and lifestyle factors that cause flushing. A list of the most common rosacea triggers can be found here. In severe cases, certain medications may be prescribed by a physician to lessen the intensity and frequency of flushing, and a topical therapy is now available to treat persistent facial redness.
Q. Do steroids induce rosacea?
A. While effective in treating certain skin conditions, long-term use of topical steroids may prompt rosacea-like symptoms informally called "steroid-induced rosacea." While some physicians may prescribe a short course of a steroid to immediately reduce severe inflammation, if you are concerned about a medication you are taking, your best bet is to discuss this with your physician.
Acknowledgments: This section has been reviewed and edited by Dr. Mark Dahl, chairman of Dermatology, Mayo Clinic Arizona.
The National Rosacea Society is a 501(c)(3) nonprofit organization whose mission is to improve the lives of people with rosacea by raising awareness, providing public health information and supporting medical research on this widespread but little-known disorder. The information the Society provides should not be considered medical advice, nor is it intended to replace
consultation with a qualified physician. The Society does not evaluate, endorse or recommend any particular medications, products, equipment or treatments. Rosacea may vary substantially from one patient to another, and treatment must be tailored by a physician for each individual case. For more information, visit About Us.