A long-term skin condition that is often misdiagnosed as acne, rosacea causes redness across the forehead, nose, cheeks and chin, and often visible blood vessels or small pus-filled bumps on the face. While the cause of rosacea is not known, triggers can include spicy foods, caffeine, alcohol, hot drinks or aerobic exercises like running. Antibiotics can help to alleviate the symptoms of rosacea, while applying a topical gel or cream to the affected area can reduce redness and inflammation. 

What is rosacea?

Rosacea is a common skin condition that affects mainly the face. Most people with rosacea will experience something known as facial flushing, where the skin will intermittently become red for short periods of time. However, rosacea sufferers may also present symptoms such as permanent facial redness, a burning or stinging feeling on the skin, spots, visible blood vessels or sore, itchy eyes. 

As a condition, rosacea is prone to relapsing, which means you’re likely to sporadically experience severe symptoms for short periods, in between longer periods of mild to non-existent symptoms. The underlying cause of rosacea is unknown, but an episode can be triggered by a number of factors, including (but not necessarily limited to):

  • Exposure to hot or cold temperatures or strong winds
  • Hot drinks, alcohol or caffeine 
  • Spicy foods
  • Exposure to sunlight or humidity
  • Stress or anxiety
  • Menopause

Rosacea symptoms

Facial flushing (when the skin turns red for short periods of time) is the most common symptom experienced by rosacea sufferers — it will typically affect the face, but in rare cases it can appear across the neck and chest. This temporary skin redness is occasionally accompanied by an uncomfortable burning or stinging feeling. 

Other symptoms of rosacea may include:

  • A permanent facial redness which looks like a little like sunburn — this is a form of rosacea called erythema; it normally impacts the nose, cheeks or chin, but can also spread to the neck, forehead or chest in certain cases
  • Papules or pustules, which mainly appear on the face and are often confused with the symptoms of acne; a papule is a small, round bump (usually red in colour) that protrudes from the skin, while a pustule is a pus-filled, blister-like sore on the skin’s surface (unlike acne, however, these cause no scarring or permanent skin damage)
  • Visible blood vessels (usually on the face) known as telangiectasia or “spider veins”, where blood vessels can become dilated and increasingly visible over time
  • Sore, itchy or bloodshot eyes and inflamed eyelids — these symptoms are associated with ocular rosacea, which is experienced by around half of rosacea sufferers (if you experience painful eyes, blurred vision or increased sensitivity to light, you should seek immediate medical advice)
  • A thickening of the skin (referred to as rhinophyma), a rare symptom that is only seen in severe cases of rosacea — this is caused by excess tissue building up around the nose, making it become bulbous or enlarged (this is very uncommon and will take several years to develop)

Other more general rosacea symptoms may include:

  • Dry or rough skin
  • A slight swelling of the face (known as lymphoedema)
  • Sensitive skin (itching, stinging or burning)

Causes of rosacea

The cause of rosacea is not fully known or understood, but a number of possible causes have been suggested by health experts; some experts believe, for example, that rosacea is caused by an abnormality of the blood vessels (though the cause of this abnormality is not known). 

More up-to-date research suggests that the triggers of rosacea can activate skin molecules called peptides. Having excess peptides in the skin can stimulate the skin’s immune and neurovascular responses, which can cause dilation of blood vessels and lead to skin redness and inflammation.

Microscopic mites known as demodex folliculorum have been suggested as another potential cause of rosacea. Usually residing harmlessly on human skin, it’s been discovered that rosacea sufferers generally carry higher numbers of these mites, and that rosacea could be caused by a reaction to the bacteria found in their faeces. 

Alternatively, a recent suggestion is that rosacea might be caused by helicobacter pylori, a bacteria found within the digestive system. It is argued that this bacteria causes the production of a protein called bradykinin, which is known to cause the expansion of blood vessels — therefore, it is suggested this could be a cause of the effects of rosacea. 

It has been found that rosacea is more common among families, which might suggest a genetic cause; however, it is not known which genes might be involved or how the condition would be passed on.

Rosacea treatments

Unfortunately there’s no permanent cure for rosacea, but there are a number of effective treatments that can help relieve the symptoms of rosacea, along with some non-medicinal techniques that can help to keep the condition under control. The treatment you require will generally be dependent on the symptoms you’re experiencing. 

Treating the facial redness caused by rosacea can be tricky, but a topical gel treatment such as Mirvaso Gel (which contains the active ingredient brimonidine tartrate) is specifically formulated to reduce redness by restricting the flow of blood to the area. Mirvaso can get to work in just 30 minutes, and once applied it can keep redness at bay for up to 12 hours. 

If your rosacea is accompanied by papules or pustules (the small red bumps or pus-filled sores on the skin), there are various medications that can be prescribed to treat these symptoms: the most common (and often most effective) solutions are Finacea Gel (containing azelaic acid) and Rozex Gel (with metronidazole). 

If Finacea or Rozex fail to clear your symptoms, you may be prescribed a course of oral antibiotics such as Efracea Capsules or Erythromycin Tablets.

If you experience the symptoms of ocular rosacea (such as red, itchy eyes), then you can try some lubricating eye drops like Brolene, which are used to treat minor eye infections. Alternatively, these symptoms may require a prescription of oral antibiotics from a GP. 

For thickened skin (rhinophyma) associated with rosacea, generally a referral to a dermatologist or a plastic surgeon will be required. 

Rosacea prevention

As the cause of rosacea is unknown, it is not possible to prevent the condition; however, by identifying the triggers and avoiding certain environmental and lifestyle factors that are known to cause flare-ups, it is possible to keep the condition in remission for as long as possible.

Self-help techniques that can help sufferers to manage the condition include:

  • Avoiding known triggers — if your symptoms are often triggered by caffeine, for example, try to reduce your caffeine intake by switching to decaffeinated alternatives (similarly, avoid spicy foods or alcohol if these are known to trigger symptoms).
  • Using sun protection daily — rosacea is often triggered by sun exposure, so cover up as much as possible when outside and use a sun cream with an SPF of 30 or higher.
  • Avoiding very hot, cold or windy conditions — as rosacea is often sensitive to hot or cold temperatures, try to avoid these conditions (including very humid environments) and cover the face as much as possible, especially in strong winds.
  • Reducing stress — a high level of stress is a key trigger of rosacea symptoms according to the National Rosacea Society, so try to manage stress using mindfulness techniques, breathing exercises and by exercising regularly.
  • Using gentle skin products — you should cleanse and moisturise daily using hypoallergenic, unscented products made for sensitive skin, and avoid ingredients that are known to cause irritation, such as alcohol, clove oil, lanolin, witch hazel, menthol or eucalyptus oil.
  • Not scrubbing the skin — when carrying out your regular skincare routine, avoid scrubbing your face too hard, as this can irritate or inflame the skin.
  • Using camouflage makeup — if you suffer with persistent skin redness, applying suitable makeup products may help to conceal red patches on the face.

Cleaning the eyelids daily — if you suffer from eye-related symptoms of rosacea such as eye redness or irritation, be sure to keep your eyelids clean (if using eye makeup, use products that are gentle and easy to wash off).