FAQs: Rosacea and treatment options
How do I know if I have rosacea?
Rosacea should be diagnosed by a GP or dermatologist. It is a condition which leads to reddening and sensitivity of skin, with increased flushing and sometimes visible thready blood vessels in the areas of the cheeks, forehead, nose and chin. There are also often red pimples/papules which can develop into inflamed pustules in severe cases.
What causes rosacea?
That is not an easy question to answer, as the cause of rosacea remains unknown. There are associations with fair complexion and blue eyes, certain microbes on the skin, and also bacterial colonisation in the gut. Causal links have not been proved. UV light exposure is thought to play a role. The most recent research suggests that altered immune response is involved. In rosacea, vasodilators are released by white blood cells, causing the visible blood vessels and the redness. It is not known why. Demodex mites may play a part in triggering rosacea.
How common is rosacea?
Up to 1 in 10 Caucasians, but most of these cases will be mild. About 14% of Caucasian women have rosacea and about 5% of men. The more severe cases of rosacea tend to be in men.
I had bad acne in my teens - will I develop rosacea in later life?
No. Although rosacea is sometimes called acne rosacea, this is a misleading name. Rosacea is not a type of acne and is not linked to acne. In rosacea there are no black heads and white heads, or the infected nodules found in severe acne.
At what age does rosacea develop?
As no one knows why rosacea occurs, this question is not possible to answer. Rosacea is most likely to develop either in your 20s or in your 40s. From observation we know that rosacea mostly (80%) starts after the age of 30.
Are there different types of rosacea?
Doctors sometimes divide rosacea into four sub types, but most people overlap the groups. They are:
- Erythematotelangiectatic – skin redness and thread veins.
- Papulopustular – pimples, papules and pustules.
- Phymatous - thickening and swelling especially of the nose (rhinophyma).
- Ocular – eye symptoms.
Is rosacea hereditary?
As mentioned above, people of fair skin seem to be more likely to be affected, and skin type tends to run in families, as can rosacea. It is not directly inherited though, and it is not possible to predict who in a family may be affected.
Is rosacea hormone related?
There is no research supporting a link between rosacea and hormones. However menopausal flushes can contribute to symptoms. And some women feel that it is worse at different times of their menstrual cycle.
Does rosacea go away with age?
Unfortunately no, rosacea is a condition of middle and older life, and is a long-term condition, although it tends to fluctuate, with alternating periods of being more settled and flare-ups.
Does rosacea get better on its own?
With no treatment it is likely that the rosacea will worsen over time, with more permanent redness, spider veins, and papules and pimples.
Is rosacea infectious?
No, theories regarding the cause of rosacea include reaction to microbes, but the rash does not spread via touch. Antibiotic treatment is thought to be effective due to its anti-inflammatory properties rather than because of its anti-bacterial properties.
Can diet help with rosacea?
A lot of people find that things that cause facial flushing, including alcohol and spicy foods, worsen the redness. Avoiding these can help. Some people do find certain diets to be of benefit. There is no evidence that this is true for most rosacea sufferers, but if this interests you, you may like to read Brady Barrow's Rosacea Diet.
What are common triggers?
As well as alcohol and spices, as mentioned above, sun (although some people report that sunlight eases symptoms), heat, stress, hot or cold weather, wind, exertion, hot baths, hot drinks, and applying steroid creams or ointments.
What can I do to help my rosacea?
You can avoid triggers (see above), which are usually things that cause flushing. These may vary from person to person. Keeping a symptom diary may help to work out what yours are. Triggers may include skin care products - particularly if oily. Rosacea sufferers have a degree of inflamed skin, so skin is likely to be sensitive. Be careful what you apply and stop using any products that irritate your skin. Wearing a water based sunscreen is advised, especially if sun exposure noticeably worsens your symptoms. The UK's National Institute for Health and Care Excellence recommends Uvistat and Sunsense.
Does drinking water help rosacea?
Drinking water helps to keep skin hydrated but it is unlikely to make a significant difference to the main symptoms of rosacea.
How should I wash my face if I have rosacea?
It is important not to further irritate your skin with soap, strong cleansers, and rubbing or scrubbing. Use a mild, unperfumed soap substitute (emollient), and apply gently with finger tips. Rinse with lukewarm (not hot) water.
What skin products/make-up can I use with rosacea?
Avoid greasy products and perfumed products. Choose those for sensitive skin and use as sparingly as possible. If a product stings or causes dryness or irritation then do not continue to use. Some foundation is formulated with a greenish tinge which tends to disguise redness. Eucerin and Clinique both have a range of anti-redness facial skin products.
Which sun screen should I use?
One that does not aggravate your skin, as sunscreen itself may cause irritation. These tend to be chemical sunscreens (that soak in nicely but work by chemicals absorbing the light) rather than physical ones. Look for ingredients Zinc oxide or titanium dioxide, as these reflect away the harmful rays without being absorbed into the skin, and therefore are less likely to cause irritation.
Do steroid creams help rosacea?
No. Steroids are used to treat many skin conditions but they actually make rosacea worse, despite initially appearing to help. They should NOT be used.
Can steroid tablets cause rosacea?
Yes. Steroid tablets and some other medications are linked with triggering rosacea.
Is rosacea curable?
How do I choose which treatment to use?
There are many different treatments for rosacea and it can be confusing to decide which is best for you.
Dr Fox prescribes 4 different treatments to use depending on the main symptoms and severity.
- Flushing/redness – Mirvaso (brimonidine) applied once daily lasts 12 hours.
- Mild-to-moderate papules and/or pustules - Soolantra (ivermectin) applied once daily, or Rozex (metronidazole antibiotic) applied twice daily.
- Moderate to severe papules and/or pustules - In addition to topical treatments, add-in Efracea (doxycycline 40mg) capsules daily for 8-16 weeks.
Efracea capsules (contains sucrose) should only be used in moderate to severe rosacea, after a trial of a topical treatment (applied to skin). The capsules contain an anti-inflammatory dose of doxycycline and can improve rosacea in more than 80% of patients.
How long will I need treatment?
In some people treatment settles the symptoms, others need repeated doses or treatment may need to be ongoing. It is generally a long term recurring condition.
Will the cream/gel become less effective over time?
Rosacea is a condition which comes and goes. The creams and gels should not become any less effective but the rosacea flare-ups may sometimes be worse.
I take other medications - can I use rosacea treatments?
There are a few interactions between some rosacea treatments and other medications. During the online consultation Dr Fox will check if the treatment is suitable for you.
Why prescribe antibiotics for rosacea?
Some antibiotics have been shown to help rosacea, but it is unclear why as bacteria do not cause rosacea. Efracea is used in a low dose which is anti-inflammatory rather than antibacterial. Rozex gel also helps but it is not clear exactly how. The doses of antibiotic prescribed by Dr Fox to treat rosacea are very low so there is a low risk of developing antibiotic resistance.
Are there any non medical treatment options?
Tackling the visual appearance can be very helpful. There are three ways of doing this: skin camouflage, anti-red make-up, and laser treatment.
You can be colour matched to special camouflage make-up, this can then be prescribed for you by your GP. You can find out about skin camouflage at:
Lasers of certain wave-lengths target various colours. Redness and red blood vessels can be treated with vascular laser or intense pulsed light. The laser causes the blood vessels to shrink. As their capacity for holding blood decreases, so does the redness. Flushing as well as the red colour can improve. Usually more than one treatment is required (2-4) and it is not generally available on the NHS. Treatment does not require anaesthetic but is uncomfortable. The treatment is not guaranteed to be permanent.
Is it linked to migraine?
People with rosacea are twice as likely to suffer with migraines as people without. A Swedish study found that in a rosacea group, 27% also had migraine, compared with 13% in the control group. Regulation of blood flow is likely to be a factor in both these conditions.
Can rosacea affect the eyes?
Ocular symptoms occur in 20-50% of rosacea cases. In most cases, it is mild but it can be more severe and in very severe cases can lead to keratitis (corneal inflammation and ulceration) which needs urgent specialist assessment.
What are the symptoms of ocular rosacea?
Eye dryness is an early sign. Later blockage of oil glands causes inflammation and crusting around the eyelashes. More severe symptoms include bloodshot/red eyes, eye irritation such as stinging, itchy, or gritty sensation. Light sensitivity can occur as can blurring of vision. Consult your GP or an optician if you develop severe eye symptoms.
How to treat ocular rosacea?
Mild cases can be managed yourself.
Eye care - keeping the eyelid margin (meibomian) glands unblocked and thus eyelids clean from crust - is important. This can be done by applying a warm water compress twice daily or by gently wiping with a cotton bud soaked in cooled boiled water. It may also be helpful to wear UV protection sun glasses. Your GP may prescribe artificial tears for dry eye and antibiotic tablets, as for facial rosacea, to ease the inflammation. More severe or persistent cases may be treated by an ophthalmologist.
Further information from Eyecare Trust.
Will stopping smoking help with rosacea?
No, probably not. Smoking is associated with a reduced risk of developing rosacea. Of course smoking is not generally beneficial to health.
Can rosacea cause disfigurement of the nose?
Yes in one rare type of rosacea called rhinophyma. This is more common in men. It can be treated either surgically or with a CO2 laser. Either way the bulky tissue is removed. Skin slowly grows over the treated area.
Is perioral dermatitis a form of rosacea?
There is debate amongst dermatologists about this. However there is a definite overlap of features and perioral dermatitis responds to the same treatments as rosacea. Perioral dermatitis is most often triggered by use of steroid based medication or creams, and similarly rosacea can be triggered by steroid use. Sometimes people with perioral dermatitis go on to develop full rosacea.
For further information see British Association of Dermatologists - Peri-oral dermatitis.