Rosacea Overview

Rosacea is a chronic inflammation of the skin causing redness in the face and produces small, red, pus-filled bumps or pustules.
Rosacea is often mistaken for acne, but it's a condition that requires a completely different type of treatment. See more pictures of skin problems.
Photo courtesy National Rosacea Society

If you don't know much about rosacea, you may think of it as a disease that simply gives people red faces, as if they're blushing all the time. Or, you might associate it with alcoholism, an image made famous by film actor W.C. Fields and his bulbous nose. The truth is that rosacea is a distressing condition that can have an intense impact on people who have it. And while W.C. Fields' trademark red nose was a complication of rosacea, it wasn't caused by alcoholism (although alcohol often makes rosacea worse).

Millions of people in the United States have the chronic skin disease rosacea (ro-ZAY-sha or ro-ZAY-she-ah) but don't know it. In fact, almost eight out of 10 Americans said in a Gallup poll that they don't know anything about the condition. Yet, to the more than 14 million people with rosacea in the United States, its effects can be significant, both physically and emotionally [source: National Rosacea Society].


Rosacea is an inflammatory skin condition that is sometimes mistaken for acne, sunburn, eczema or allergies. It affects more women than men, but women's cases are typically less severe than men's. People who blush easily are at risk of developing the disease. Age also matters: Rosacea is most often diagnosed in people between the ages of 30 and 60, and children are rarely diagnosed with it. Menopause ratchets up the risk factor. Rosacea seems to run in families, which makes sense when you know that being fair-skinned is also a risk factor [source: Mayo Clinic]. Fortunately, with proper treatment, rosacea can be controlled and its effects minimized or reversed.

Everyone who has rosacea has at least one of four primary symptoms, but there are other symptoms as well. Read on to learn more about what might cause your doctor to suspect you have rosacea, and find out which former U.S. president has the disease.


Rosacea Symptoms

There's no definitive test for rosacea. Diagnosis comes from the patient's description of symptoms and a doctor's physical exam. A flushed face that comes and goes is one of the four primary signs of rosacea and may be the first symptom noticed. As the disease progresses, it takes longer and longer for the flush to disappear. Rosacea is usually just found on the face, but occasionally symptoms appear on a person's chest, neck, ears or scalp.

Another sign of rosacea is a persistently red hue on your cheeks, nose, chin or forehead or all of the above. Both of these signs -- persistent flushing and intermittent flushing -- can look like a butterfly splashed across your cheeks and nose.


The third sign of rosacea is an outbreak of bumps and pimples that may be mistaken for acne. Rosacea's red bumps are called papules when they don't contain pus. They can be as small as a pencil eraser or as large as a small coin. Bumps with pus inside are called pustules.

The final primary sign of rosacea is tiny, visible blood vessels. Called telangiectasia, it's the result of inflammation or dilation of tiny facial blood vessels.

Some sufferers also experience eye irritation that may eventually lead to vision damage. See your dermatologist or ophthalmologist if you experience:

  • a gritty feeling
  • redness
  • dryness
  • burning
  • sties
  • sensitivity to light
  • blurry vision
  • swollen eyelids
  • crusty mucus

[source: WebMD]

One out of two rosacea patients complain of dry skin. Others may be also be diagnosed with seborrheic dermatitis, which appears as dandruff or a greasy, reddish-yellow scaling.

Rosacea triggers can make the disease's symptoms worse. Continue reading to discover what those triggers are (and why it's difficult to avoid them).


Rosacea Triggers

A day at the beach. A walk on a blustery December day. A glass of wine. A hard day at the office. A good game of tennis. Lounging in a hot tub. Any of these things could trigger a rosacea flare-up. Fortunately, no one has to worry about every trigger; things that bother you may not cause any problems another patient with rosacea.

Rosacea triggers fall into seven categories:


  • Weather
  • Stress
  • Foods and beverages
  • Exercise
  • Bathing and cleansing
  • Medical conditions and medications
  • Skin care products

[source: National Rosacea Society]

Sun exposure is the leading trigger, causing flare-ups in 81 percent of patients, followed by emotional stress. Anything that increases blood flow to the surface of your skin is a likely trigger. Summer heat (and humidity) and winter winds can both aggravate rosacea, as can a sauna or even an overly warm room.

Vigorous exercise brings on a flare-up for more than half of rosacea sufferers. Experts suggest bringing down the intensity of your exercise routine. Try exercising several times a day for short periods instead of getting it all done in one session. Water aerobics is a good way to exercise without overheating. You can also suck on ice cubes, which will bring down your facial temperature, mist yourself with water or drape a damp towel around your neck. These tips work for any heat-related situation, whether it's outdoor activity or an intense cooking session in your kitchen.

Minimizing your exposure to triggers is one powerful way to get the upper hand with your rosacea -- 96 percent of rosacea sufferers reported a reduction in flare-ups when they avoided known triggers [source: National Society Rosacea]. It's not the only weapon in your arsenal, however. You have numerous effective medical options available, too. Read on to find out what they are.


Rosacea Treatments

Rosacea can't be cured, but it can be managed. The sooner you're diagnosed and begin treatment, the more likely you are to respond to it. Moreover, rosacea patients who continue treatment even when their symptoms are in remission tend to fare much better in the long run than those who don't. Continuous treatment may prevent a flare-up or at least lengthen the time between flare-ups [source: National Rosacea Society].

For treatments that don't involve a prescription, try mild skin cleansers and a daily application of sunscreen. Look for something with an SPF of at least 15 that's formulated for kids or people with sensitive skin. But you may find a benefit in getting a doctor involved -- even though there's no proven connection between bacteria and rosacea, antibiotics are an effective treatment to control the disease's facial flush, its pustules and papules, spider veins and thick nose bumps. Mild rosacea will often respond to a topical antibiotic, but oral antibiotics work faster. Oral antibiotics work especially well to treat rosacea problems in the eyes (ocular rosacea). Most people see significant improvement within one to two months [source: IRF].


Treatment may also include surgery, such as in the removal of bumps and excess skin from the nose, one of the possible complications of rosacea. Lasers and other forms of light therapy can be very effective in reducing or eliminating some of rosacea's most distressing effects. A recent study found that patients reported "significant improvement" of flushing, persistent redness and visible blood vessels after just one treatment with the pulsed dye laser treatment. Further improvement came with additional treatments [source: American Academy of Dermatology]. Other types of lasers may be used depending upon specific symptoms. Non-laser light treatments, such as Intense Pulsed Light therapy (IPL), have also successfully treated rosacea symptoms, including breakouts. As with laser therapy, multiple treatments are required.

Not every rosacea patient will benefit from laser or light therapy, and certain medical conditions may rule out this treatment for some. For example, insulin-dependent diabetics or patients with a clotting disorder may make poor candidates for this treatment [source: American Academy of Dermatology].

Treatment is crucial, as patients with rosacea can suffer from aggravating complications. Read on to learn more about these complications.


Complications from Rosacea

Rosacea's complications include both physical and psychological effects. One physical complication is rhinophyma, which occurs when sebaceous glands in the nose slowly expand. This expansion causes a tissue buildup on and around the nose, leading to a bulbous nose (think W.C. Fields). This complication affects male rosacea patients much more often than female sufferers. Lasers, electrosurgery, dermabrasion and the removal of excess skin with a scalpel -- sometimes a combination of these procedures -- are used to treat rhinophyma [source: American Academy of Dermatology].

Cornea damage and vision problems are rare but possible complications from ocular rosacea. That's why it's important to seek treatment as soon as possible for eye symptoms. Oral antibiotics and steroid eye drops are both effective in combating ocular rosacea.


Since rosacea may be treated with antibiotics, some patients may experience side effects from the ongoing use of these medications, such as microbial resistance. To avoid this complication, your doctor may prescribe topical antibiotics for your long-term treatment. Patients may also be treated with an antibiotic specifically made for rosacea treatment that's less likely to result in microbial resistance [source: National Rosacea Society].

Rosacea also brings a variety of social and emotional effects and can negatively impact a patient's sense of self-worth and ability to function in social and professional situations. National Rosacea Society surveys indicate that 76 percent of patients experienced a negative impact on confidence and self-esteem. In addition, about 70 percent said rosacea impacted their careers, and the physical effects of rosacea effects caused almost 30 percent to miss work [source: National Rosacea Society].

An anonymous airline pilot explained rosacea's impact on his career in a 2008 article in the New York Times. He said that part of his job is to inspire passengers' confidence in his ability to safely fly airplanes. Rosacea and rhinophyma made that difficult because many associate a bulbous nose with alcohol abuse. The pilot reported that he never came to work without paying careful attention to his skin care regimen [source: Sweeney].

While rosacea can lead to these complications, you can help keep the condition in check through diet. Continue to the next page to see how what you eat can affect your rosacea symptoms.


Rosacea Diet

Many rosacea patients learn to steer clear of certain trigger foods and alcoholic beverages. Alcohol consumption trumps food as a trigger, according to a survey of more than 1,000 sufferers. Red wine is the worst culprit for most people bothered by an alcohol trigger, but any kind of wine or beer can do the trick. Some people may be able to tolerate gin, vodka or whiskey, but this is by no means a sure thing. One jigger (1.5 ounces = 44 ml) gives you a better chance of sidestepping a flare-up when it's combined with 6 ounces (177 ml) of icy water than if it's combined with soda or juice [source: American Academy of Dermatology].

You may need to forego or cut back on the chips and salsa if you have rosacea. Indulging in a spicy treat causes a problem for 45 percent of rosacea sufferers [source: National Rosacea Society]. Triggering spices include cayenne and red pepper, black and white peppers, curry and chili powder. Hot beverages (as in temperature, rather than spice) can lead to a flare-up in more than a third of all rosacea sufferers. Simply drinking your hot drinks on the warm side rather than steamy may be all it takes to tame this trigger.


Further down on the list of food triggers, but by no means inconsequential, are certain fruits and vegetables; common culprits are eggplant, avocado, spinach, beans, citrus fruits, plums, raisins and bananas. Liver can be a trigger for some people, while others are bothered by marinated meats or dairy products.

With all the restrictions that rosacea place on a person, it's no wonder that people with the condition can benefit greatly from support from experts and fellow sufferers. Read on to learn more about why support is important and where to find it.


Rosacea Support

Rosacea isn't a life-threatening disease. But while this condition may not bring intense physical pain, it can wreak havoc with a person's social and emotional well-being. Many sufferers report that their rosacea symptoms have a negative impact on their confidence and cause them to disengage from social situations [source: National Rosacea Society].

Many people with rosacea get support from family and friends, who can help bolster self-esteem and provide a social circle where they don't feel stigmatized by their condition. Health care professionals also lend a sense of support by giving a name to the condition and offering treatments and strategies to help the patient get symptoms and complications under control.


Some of the most valuable and effective emotional support, however, can come from fellow sufferers who gather in support groups. These groups can be found both on the Internet and through national agencies devoted to this condition. A search on Yahoo! Groups yields more than 100 groups either devoted exclusively to a discussion of rosacea or as part of a larger discussion that includes other topics, such as laser treatments for skin conditions. Another popular source of support is the Rosacea Support Group [source: Rosacea Support Group].

Support groups may connect through e-mail listservs, in which members post questions and comments that are circulated via e-mail, or online communities, where members respond to one another's questions and comments through online bulletin boards. Typically, these online support groups and e-mail listservs allow users to post questions and responses using screen names that preserve anonymity. Through these online support groups, people with rosacea can trade tips about skin care products, diet regimens and medications. Local support groups may also give recommendations about health care professionals in your area who are particularly knowledgeable or helpful, and can provide advice on how to speak to one's doctor about the condition.

One well-known source of support and information for rosacea sufferers and health care providers is the National Rosacea Society. Read on to learn more about this organization.


National Rosacea Society

The National Rosacea Society (NRS) was founded in 1992, when it was thought that perhaps 200,000 people were affected by rosacea. Each year, more than 800,000 people with rosacea access educational services provided by this organization. The NRS also conducts awareness activities that reach out to 400 million people annually [source: National Rosacea Society].

The National Rosacea Society provides services in four areas: public awareness, public education, medical scientific education and research grants


The organization's public awareness efforts are targeted toward educating a public that for the most part knows little or nothing about rosacea. The NRS Web site is part of its public awareness program, as is its designation of April as Rosacea Awareness Month. The site is designed to assist medical personnel, patients and interested members of the general public. The NRS provides further information through its newsletter, Rosacea Review, which is edited by a Harvard dermatologist, as well as other publications, bibliography compilations and patient surveys.

The NRS' medical scientific education includes peer-reviewed scholarly journal articles, conferences to determine standard criteria of different aspects of rosacea and its treatment, and educational workshops. The research component of the NRS has resulted in funding for 45 research studies to date.

Now that you know where you can turn to for information about all aspects of rosacea, read on for some helpful tips about makeup and skin care for rosacea patients.


Makeup for Rosacea

While medical attention provides long-term relief, in the short term, nothing beats good makeup and a gentle skin care regimen. It's crucial, however, to select the best products for your condition. More than 40 percent of patients reported that some skin care products aggravated their rosacea. Cosmetics were a potential source of aggravation for 27 percent of patients [source: National Rosacea Society].

If you suffer from rosacea, washing your face needs to be a gentle endeavor -- this includes both what you use and how you use it. Any sort of rubbing may irritate your skin, so it's best to put the washcloth away. Products from Dove and Cetaphil may be well-tolerated [source: Mayo Clinic]. When you wash, use only lukewarm water. Pat your skin dry, and then let it air dry for a few minutes before applying any topical medications. Give the medication five minutes to sink in before moving on.


"The simpler, the better" should be your mantra when shopping for skin care products and cosmetics. However, one exception applies: If you can find a promising product with multiple functions, such as a sunscreen and moisturizer combination, go for it. When shopping for skin products, avoid anything with fragrance;

products that contain alcohol, witch hazel, menthol, peppermint or eucalyptus oil; and exfoliating and astringent products.

Read all labels carefully. Look for the terms "noncomedogenic" and "allergy-tested." These terms are not interchangeable with "hypoallergenic," which is a standard that hasn't been clearly defined [source: National Rosacea Society]. Always test a bit of a product on an inconspicuous spot of skin first.

To correct uneven skin tone, try an oil-free foundation matched to your natural skin color. Foundation and concealer (one shade lighter than your foundation) should be applied with special antibacterial brushes that you clean daily. Mineral makeup products seem to work well for many rosacea patients [source: National Rosacea Society].

Use the same care in selecting eye products as you do for your other cosmetics. Waterproof mascara is a no-no, because you have to remove it with harsh solvents. You may also want to avoid bright colors, which can contain more pigment.

If you'd like to learn more about skin conditions like rosacea, follow the links on the next page to more HowStuffWorks articles.


Lots More Information

Related HowStuffWorks Articles

More Great Links

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