The exact cause of rosacea is unknown, although a number of potential factors have been suggested.

It is possible a combination of these factors may be responsible for the condition, although there isn’t enough evidence to say this for certain.

Possible factors

Some of the main factors that have been suggested are outlined below.

Blood vessel abnormalities

Some experts believe abnormalities in the blood vessels of the face may be a major contributing factor for rosacea. This may explain symptoms of flushing, persistent redness and visible blood vessels.

It is not known what causes these abnormalities. However, damage to the skin by sunlight may be responsible for degeneration of the elastic tissue of the skin and the dilation of blood vessels.

Skin peptides

Recent research has shown external triggers such as ultraviolet (UV) light, spicy food, alcohol, exercise, stress, red wine, heat and cold can lead to the activation of certain molecules within the skin called peptides.

Increased levels of these peptides may in turn affect the immune system or neurovascular system (nerves and blood vessels) of the skin. Activation of these systems can cause dilation of blood vessels, redness and inflammation.

Microscopic mites

Microscopic mites called demodex folliculorum usually live harmlessly on human skin, but higher numbers of mites have been found on people with rosacea, and it has been suggested they may play a role in the condition.

It is currently uncertain whether the mite is a cause or an effect of rosacea, although some researchers have suggested the symptoms of rosacea may be caused by the skin reacting to bacteria in the mites’ faeces.

Helicobacter pylori bacteria

Helicobacter pylori bacteria are bacteria found in the digestive system. It has been suggested these bacteria may be a possible cause of rosacea, although a link has not been proven.

One theory is the bacteria may stimulate the production of a protein called bradykinin, which is known to cause blood vessels to expand.

Genetics

Rosacea seems to be more common in families, although it is not clear which genes (if any) are involved or how they are passed on.

Triggers of rosacea

Although they are not thought to be direct causes of the condition, many people with rosacea find certain triggers make their symptoms worse.

Different people can have different triggers, but triggers that have been commonly reported include:

• exposure to sunlight
• stress
• hot or cold weather
• strong winds
• strenuous exercise
• alcohol
• hot baths
• spicy foods
• hot drinks
• humidity
• caffeine (found in tea, coffee and cola)
• the menopause
• dairy products
• other medical conditions
• certain medicines, such as amiodarone, corticosteroids and high doses of vitamins B6 and B12

Rosacea can cause complications that affect you physically and psychologically.

Eye problems

Rosacea that affects your eyes (ocular rosacea) can lead to a number of eye problems, some of which can be serious.

In particular, rosacea can sometimes cause the cornea (the transparent layer at the front of the eyeball) to become inflamed and damaged. This is known as keratitis.

This damage can make the cornea vulnerable to ulceration and infection, which could potentially threaten your sight.

Symptoms of serious problems with your corneas include:

• eye pain
• sensitivity to light (photophobia)
• deterioration in your vision

Contact your GP immediately if you think you may have a problem with your corneas. If this is not possible, visit your nearest accident and emergency (A&E) department.

If keratitis is not treated promptly by an ophthalmologist (a doctor who specialises in treating eye conditions), there is a risk of permanent vision loss.

Psychological and social effects

Any chronic (long-term) condition can have an adverse psychological effect, but rosacea can be particularly troublesome as it affects your appearance. This can change how you feel about yourself and how you interact with others.

Many people with rosacea have reported feelings of low self-esteem, embarrassment and frustration.

It is important to try to come to terms with the fact you have a chronic condition that, although incurable, is controllable. Persevering with your treatment plan and avoiding your individual triggers are the best ways of controlling your symptoms.

As your physical symptoms improve, you may start to feel better psychologically and emotionally.

If you have rosacea, take comfort knowing you are not alone. There are millions of people living with the condition in the UK and across the world. You can find support and information from organisations such as:

• the National Rosacea Society – an American charity whose website has useful information and advice for people with rosacea
• Changing Faces – a charity for people with facial disfigurements, who can be contacted on 0300 012 0275 for counselling and advice

Speak to your GP if you are feeling depressed as a result of your condition. They may recommend further treatment if necessary.

Rosacea is a common but poorly understood long-term skin condition that mainly affects the face.

Symptoms often begin with episodes of flushing (where the skin turns red for a short period), but other symptoms can develop as the condition progresses, such as:

• burning and stinging sensations
• permanent redness
• spots (papules and pustules)
• small blood vessels in the skin becoming visible

Rosacea is a relapsing condition, which means there are periods when symptoms are particularly bad, followed by periods when the condition is less severe.

Many of the symptoms of rosacea can be controlled to a degree with treatment. But the changes to your physical appearance that may occur as a result of the condition can still have a significant psychological and social impact, affecting how you feel about yourself and how you interact with others.

Read more about the symptoms of rosacea and the complications of rosacea.

Seeking medical advice

You should see your GP if you have persistent symptoms that could be caused by rosacea, as early treatment can help stop the condition getting worse.

There is no specific test for rosacea, but your GP will often be able to diagnosis the condition by examining your skin, asking about your symptoms and asking about possible triggers you may have.

In some circumstances, your GP may arrange further tests, such as a blood test or skin biopsy (where a small scraping of skin is removed and examined), to rule out other conditions with similar symptoms, such as lupus or the menopause.

What causes rosacea?

The exact cause of rosacea is unknown, although a number of possible factors have been suggested, including abnormalities in the blood vessels of the face and a reaction to microscopic mites commonly found on the face.

Although they are not thought to be direct causes of the condition, several triggers have been identified that may make rosacea worse. These include:

• exposure to sunlight
• stress
• strenuous exercise
• hot or cold weather
• hot drinks
• alcohol and caffeine
• certain foods, such as spicy foods

Read more about the causes of rosacea.

Who is affected?

Rosacea appears to be quite common, with some estimates suggesting up to 1 in 10 people may have it. Around 1 in every 600 people in the UK are diagnosed with the condition each year.

It most commonly affects people with fair skin, but can also occur in people of Asian and African origin.

Rosacea occurs in both men and women, but tends to be more common in women. Most cases are first diagnosed in people aged 30 to 50.

How rosacea is treated

There is no cure for rosacea, but treatment can help control the symptoms. 

Long-term treatment will usually be necessary, although there may be periods where your symptoms improve and you can stop treatment temporarily.

For most people, treatment will involve a combination of self-help measures and medication, such as:

• avoiding known triggers – for example, avoiding drinks containing alcohol or caffeine
• creams and gels – medications applied directly to the skin to reduce spots and redness
• oral medications – tablets or capsules that can help clear up more severe spots, such as oral antibiotics

In some cases, procedures such as laser and intense pulsed light (IPL) treatment may be helpful. These involve beams of light being aimed at the visible blood vessels in the skin to shrink them and make them less visible.

Read more about treating rosacea and self-help measures for rosacea.

If you have rosacea, there are a number of things you can do to help keep the condition under control.

Avoid triggers

Many people with rosacea notice certain triggers make their symptoms worse. Although it is not always practical or possible, taking steps to avoid these triggers can help reduce the severity and frequency of your symptoms.

If you are not sure whether your symptoms have a specific trigger, it may be useful to keep a diary to identify whether your symptoms get worse depending on things such as the activities you do and foods or drinks you have.

Advice about how to avoid some common triggers can be found below.

Sunlight

As sunlight is the most commonly reported trigger of rosacea, you should use sun cream whenever possible, even when it’s overcast.

A sun cream with a sun protection factor (SPF) of at least 30 is recommended. A broad-spectrum sun cream that protects against UVA and UVB light should be used.

Using sun creams specifically designed for children may help reduce skin irritation. Covering exposed skin with clothes or a sun hat may also help.

During the summer months, try to minimise your exposure to the sun, particularly in the middle of the day when the sun is at its hottest. 

But remember, sun can also be strong in the morning and evening, so take adequate precautions at these times as well.

Stress

Stress is also a commonly reported trigger of rosacea. Successfully managing your stress levels can help control your symptoms.

Ways you can reduce stress include:

• learning relaxation techniques, such as deep breathing exercises, meditation and yoga
• taking regular exercise

As strenuous exercise can sometimes make rosacea symptoms worse, a low-intensity exercise programme, such as walking or swimming, may be better than high-intensity activities, such as running or aerobics.

Read about stress management for more information about coping with and reducing stress.

Food and drink

Some of the most commonly reported food- and drink-related triggers are alcohol and spicy foods. You may want to try completely removing these from your diet to see if your rosacea improves.

But there are many other dietary triggers that can also affect some people with rosacea.

It’s a good idea to include information about how your diet affects your rosacea symptoms in your rosacea diary.

Cold weather

Covering your face and nose with a scarf can help protect your skin from cold temperatures and wind.

If you need to spend considerable time outside during cold weather, protect your face with a balaclava.

Skincare techniques

The advice below about skincare techniques may also help control your rosacea symptoms.

• Gently clean your skin every morning and evening using a gentle, non-abrasive cleanser. Use soap-free cleansers with non-alkaline or neutral pH. Avoid scented soaps and alcohol-based skin cleansers.
• Rinse your face with lukewarm water and allow skin to dry thoroughly before you apply medication or make-up.
• Look for products suitable for sensitive skin. These are usually described as mild, hypoallergenic, fragrance-free and non-comedogenic (will not block pores).
• Use a moisturiser to soothe skin if it feels sore.
• Avoid oil-based or waterproof cosmetics requiring solvents for removal. Use water-based make-up and skin products instead. 
• Avoid astringents, toners and other facial or hair products that contain ingredients that might irritate your skin, such as fragrances, alcohol, menthol, witch hazel, eucalyptus oil, camphor, clove oil, peppermint, sodium lauryl sulphate and lanolin.
• You may want to avoid using anything on your skin that you aren’t sure of. You can then gradually reintroduce products once your symptoms have been treated and cleared to see if you can use them again without any problems.
• Men may find that using an electric razor, rather than a blade, helps reduce skin irritation.
• Some people find regular gentle facial massage reduces swelling (lymphoedema).
• Do not use steroid cream unless you are specifically instructed to by your GP, as it may make your symptoms worse.

Make-up

It may be possible to disguise patches of persistent red skin using specially designed “camouflage” make-up.

The charity Changing Faces offers a skin camouflage service, available nationally and free of charge, to help with the use of these creams.

Your GP or dermatologist can refer you to the skin camouflage service and prescribe skin camouflage make-up.

Eyelid hygiene

If your eyelids are inflamed as a result of rosacea (blepharitis), cleaning your eyelids every day with warm water and a small amount of cleaning solution can help ease your symptoms.

Avoiding eye make-up can also help reduce your symptoms, but if you do choose to wear eye make-up, make sure it is a type that washes off easily so you can still clean your eyelids.

Read about treating blepharitis for more information about eyelid hygiene.

Rosacea causes a range of symptoms, although not everyone will experience them all.

Most people with rosacea have periods when their symptoms are particularly troublesome, followed by periods where their symptoms are less so.

Main symptoms

The following are the main symptoms of rosacea.

Flushing

Flushing is when your skin turns red for a short period – usually a few minutes. It tends to mainly affect the face, although it can spread to your neck and chest. In some cases, the redness may be accompanied by an unpleasant feeling of heat.

In rosacea, flushing is often caused by a certain trigger, such as sun exposure, hot drinks or exercise. See causes of rosacea for more information about possible triggers.

Persistent facial redness

Persistent facial redness, known as erythema, is like a blush or a patch of sunburn that does not go away, or the sort of blotchy skin often associated with drinking too much alcohol.

This can be upsetting for people with rosacea as people can mistakenly assume they are heavy drinkers.

The redness usually affects the cheeks, nose and chin, but may spread to other areas such as the forehead, neck and chest.

Visible blood vessels

Over time, the blood vessels in the skin may become permanently dilated (widened) and visible. The medical name for visible blood vessels is telangiectasia.

Papules and pustules

If you have rosacea, you may develop papules (round red bumps that rise from your skin) and pustules (pus-filled swellings).

These spots appear on your face and are similar to acne. Rosacea used to be called acne rosacea, but the two conditions are quite different.

In rosacea, there are no blackheads (small blocked pores) and the skin is not greasy, but dry and peeling. Rosacea spots also do not cause scarring.

Thickened skin

In the most serious cases of rosacea, the skin can thicken and form excess tissue, usually around the nose. This causes the nose to take on a large, bulbous appearance. This is known as rhinophyma.

Rhinophyma is an uncommon, severe symptom of rosacea and takes several years to develop. It tends to affect more men with rosacea than women.

Eye problems

In addition to skin problems, many people with rosacea also experience symptoms that affect their eyes. This is known as ocular rosacea.

Symptoms of ocular rosacea can include:

• feeling like there is something in your eyes
• dry eyes
• irritated and bloodshot eyes
• inflammation of the eyelids (blepharitis)

In some cases, ocular rosacea can cause the cornea (the transparent layer at the front of the eye) to become inflamed, causing symptoms such as eye pain, blurred vision and sensitivity to light (photophobia).

Read about the complications of rosacea for more information.

Other symptoms

Other symptoms associated with rosacea include:

• sensitive skin (burning, itching, stinging, pain)
• dry, rough skin
• raised red patches (plaques) on your skin
• facial swelling (lymphoedema)
• sensitive skin

Permanent damage to the face, such as scarring, almost never occurs in rosacea.

When to seek medical advice

You should see your GP if you have persistent symptoms that could be caused by rosacea, as early treatment can help stop the condition getting worse.

If you develop eye pain, blurred vision or sensitivity to light, you should contact your GP immediately because your sight may be at risk if you don’t receive prompt treatment.

If you cannot contact your GP, visit your nearest accident and emergency (A&E) department.

 

There is no cure for rosacea, but there are treatments available to help keep the symptoms under control.

Long-term treatment will usually be necessary, although there may be periods where your symptoms improve and you can stop treatment temporarily.

For most people, treatment will involve a combination of self-help measures and medication. The specific treatments that are recommended will depend on your symptoms.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

Self-help measures

There are a number of important things you can do yourself to help keep the symptoms of rosacea under control, including:

• avoiding things that trigger your symptoms – for example, by using sun cream and covering yourself up if direct sunlight makes your symptoms worse
• taking good care of your skin – for example, by using products suitable for sensitive skin
• using make-up – patches of persistent red skin can be disguised using specially designed “camouflage” make-up
• keeping your eyelids clean – if rosacea is causing your eyelids to become inflamed (blepharitis)

Read more about self-help measures for rosacea.

Treating papules and pustules

If you have papules (round red bumps that rise from your skin) and pustules (pus-filled swellings) caused by rosacea, there are a number of different medications that can be effective.

These can be divided into topical treatments (applied to the skin) or oral treatments (taken by mouth).

Topical treatments

For mild rosacea, topical medications are usually tried first. The two medications most often recommended are metronidazole or azelaic acid creams and gels.

There is some evidence azelaic acid may be more effective than metronidazole in treating rosacea, although it is also more likely to cause side effects such as skin irritation, a burning or stinging sensation, itchiness, or dry skin.

You will usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth. It may be several weeks before you notice any significant improvement in your symptoms.

Oral antibiotics

If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduce inflammation of the skin.

Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These medications are usually taken for four to six weeks, but longer courses may be necessary if the spots are persistent.

Common side effects of these medications include:

• feeling and being sick
• diarrhoea
• bloating and indigestion
• abdominal (tummy) pain
• loss of appetite

Some of the medications used can also make your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds.

As with the topical treatments mentioned above, these medications usually need to be taken once or twice a day and you may not notice a significant improvement in your symptoms for several weeks.

Oral isotretinoin

Isotretinoin is a medicine often used to treat severe acne, but at lower doses it’s also occasionally used to treat rosacea.

As isotretinoin is a strong medication that can cause a range of side effects, it can only be prescribed by a dermatologist (a specialist in treating skin conditions) and not your GP.

Common side effects of isotretinoin include:

• dryness and cracking of the skin, lips and nostrils
• inflammation of your eyelids (blepharitis) or eyes (conjunctivitis)
• headaches
• muscle or joint pain
• back pain
• blood in your urine (haematuria)

Treating facial redness

Treating facial redness and flushing caused by rosacea is generally more difficult than treating papules and pustules caused by the condition. 

But as well as the self-help measures mentioned above, there are some medications that can help.

Brimonidine tartrate

Brimonidine tartrate is a relatively new medication for facial redness caused by rosacea. It comes in the form of a gel that is applied to the face once a day.

The medication works by restricting the dilation (widening) of the blood vessels in your face. Research has shown it can start to have an effect about 30 minutes after it is first used and this can last for around 12 hours.

Common side effects of brimonidine tartrate include itchiness and a burning sensation where the gel is applied. Less common side effects can include a dry mouth, headaches, pins and needles, and dry skin.

Oral treatments

Alternatively, there are a number of oral medications that may help improve redness caused by rosacea.

These include:

• clonidine – a medication that relaxes the blood vessels
• beta-blockers – medications that decrease the activity of the heart
• anxiety medications – medications sometimes used to help calm the person and reduce blushing 

It’s not clear how effective these medications are at treating redness caused by rosacea, but they may sometimes be prescribed under the supervision of a dermatologist.

Laser and intense pulsed light (IPL) treatment

Redness and visible blood vessels (telangiectasia) can also sometimes be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing.

A referral to a dermatologist is usually required before having these treatments and they are not usually available on the NHS, so you may need to pay for them privately. Around two to four treatments may be needed, so the overall cost may be significant.

Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated veins and causes them to shrink so they are no longer visible, with minimal scarring or damage to the surrounding area.

Laser treatment can cause pain, but most people do not need an anaesthetic. Side effects of laser treatment are usually mild and can include:

• bruising
• crusting of the skin
• swelling and redness of the skin
• blisters (in rare cases)
• infection (in very rare cases)

These side effects usually only last a few days and are rarely permanent.

Treating thickened skin

In some people with rosacea, the skin of the nose can become thickened. This is known as rhinophyma.

If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon to discuss ways the appearance of your skin can be improved.

A number of surgical treatments are available to remove any excess tissue and remodel the nose into a more pleasing shape.

This may be done with a laser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion.

Treating eye problems

If rosacea is affecting your eyes (ocular rosacea), you may require further treatment. 

For example, you may need to use lubricating eye drops or ointment if you have dry eyes, or oral antibiotics if you have blepharitis.

If initial treatment is ineffective or you develop any further problems with your eyes, you will need to be referred to an eye specialist called an ophthalmologist for further assessment and treatment.

Read about treating dry eye syndrome and treating blepharitis.