What is Rosacea? Rosacea is a chronic inflammatory condition of the skin causing redness and associated symptoms affecting the central face. It is usually diagnosed in those over 40, but the onset may be at any age. Over 13 million people in the United States have Rosacea. Rosacea was previously classified as four subtypes but has since been thought to exhibit a continuum of symptoms that may develop as the condition progresses. The new classification is based on phenotypes- diagnostic, major, and secondary.

What causes Rosacea?

Rosacea is thought to be caused by the interaction of several factors causing oxidative damage and skin barrier dysfunction. Internal factors, including genetic predisposition, neurovascular hyperreactivity, and dysregulation of the immune system, along with external influences, such as ultraviolet light and an altered microbiome, are implicated in the pathogenesis. 

Flares of rosacea may be triggered by:

  • Stress and other strong emotions
  • Sunlight
  • Alcohol
  • Heat
  • Spicy Foods
  • Hot beverages
  • Exercise
  • Some cosmetic products


Signs and Symptoms of Rosacea

The most common and primary symptom to be noticed is erythema of the central face. Other symptoms vary by person and can present as:

  • Phymatous changes such as skin thickening, glandular hyperplasia, and bulbous appearance of the nose.
  • Frequent and prolonged flushing
  • Telangiectasias of the face or the eyes.
  • Papules and pustules
  • Burning or stinging
  • Edema
  • Dryness
  • Ocular manifestations, including lid margin telangiectasias, interpalpebral conjunctival injection, corneal infiltrates, scleritis and sclerokeratitis. Patients may experience burning or stinging of the eyes, light sensitivity, and foreign object sensation.

Rosacea is often delayed in diagnosis or missed in people of color because the erythema is not as noticeable, however, the presence of other symptoms should be used for evaluation and diagnosis. In teenagers and young adults, rosacea presenting with papules and pustules may be misdiagnosed as acne vulgaris.


Management of Rosacea

Early treatment of rosacea is key to preventing the progression of disease. In addition to the discomfort caused by the symptoms, rosacea can reduce the quality of life because of feelings of embarrassment and low-self esteem. This impact can cause social and work-related problems, leading to anxiety and depression.

Management of rosacea is may be different for each person depending upon their symptoms and severity of disease, however, lifestyle modifications can prevent flares or worsening of symptoms for all:

  • Avoidance of triggers
  • Sun protection
  • Frequent use of emollients
  • Gentle skin cleansing


Medical treatment options include:

  • Topical medications: ivermectin, metronidazole, azelaic acid, minocycline, benzoyl peroxide, or retinoids may be prescribed to improve symptoms of rosacea. Brimonidine and oxymetazoline are used to reduce flushing temporarily. 
  • Oral medications: Antibiotics, such as doxycycline, are often used for their anti-inflammatory properties at low doses. Oral retinoids may be used to control pustular and popular symptoms of rosacea. 
  • Laser treatment options include intense pulsed light (IPL), potassium titanyl phosphate (KTP), pulsed dye laser (PDL), and ablative CO2 and erbium laser (for phymatous lesions).

Source: Marson, J. W., & Baldwin, H. E. (2019). Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. International Journal of Dermatology, 59(6).