Expert tips to combat your chronic skin condition.
Medically reviewed by Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP and words by Annie Hayes
Rosacea is a long-term skin condition characterised by flushed skin on the face – typically the nose, cheeks, forehead and chin – for which there’s no cure. Rosacea can affect anyone, although people with light skin are more prone to the condition.
As well as causing redness, swelling and visible blood vessels, rosacea can also produce small, red bumps and pus-filled pimples, so it’s sometimes mistaken for acne, eczema, or an allergic skin reaction. Symptoms can flare up for weeks or months and then disappear for a while.
We spoke to Dr Kristina Semkova, consultant dermatologist at the Cadogan Clinic, and Dr Daron Seukeran, consultant dermatologist at sk:n Clinics, about rosacea causes, symptoms and treatment options:
What is rosacea?
Rosacea is a skin condition that tends to affect the cheeks, forehead, chin and nose. Visually, it’s characterised by redness, dilated blood vessels, small red bumps and pus-filled spots. There may also be burning and stinging sensations. People with rosacea often have a tendency to blush easily, and may also experience uncomfortable inflammation of the eyes and eyelid.
Rosacea commonly affects fair-skinned people aged 35-55 and is more prolific in women, but tends to be more severe in men.
Rosacea commonly affects fair-skinned people aged 35 to 55 years old. It’s more prolific in women, but tends to be more severe in men. Being a smoker, having family members with rosacea, and having light skin, blonde hair, and blue eyes increases your risk factor for rosacea. It is a chronic condition and, in any individual, the severity tends to come and go. Rosacea is diagnosed by its appearance, and there are no diagnostic laboratory tests for it.
What causes rosacea?
Expert aren’t completely sure what causes rosacea, but the condition appears to be triggered by a combination of hereditary and environmental factors, including:
- Intense exercise
- Sunlight or wind
- Temperature extremes
- Cosmetic products, like hairspray
- Hot drinks
- Alcoholand caffeine
- Spicy foods
- Drugs that dilate blood vessels
Rosacea appears to run in some families, but there’s no clear genetic link. Other possible causes include abnormalities in the blood vessels of the face, a heightened sensitivity to microscopic mites that live on your skin, and certain gut bacteria. Rosacea is not contagious.
Rosacea usually starts with a tendency to blush and flush easily. After a while, the central areas of the face turn a deeper shade of red, with small dilated blood vessels studded with small red bumps. Pus-filled spots come and go in crops, though scarring is seldom a problem.
Other rosacea symptoms include:
- Sensitive skin that feels hot, burns or stings
- Patches of rough, dry skin
- Red, itchy, sore eyes and eyelids, a gritty feeling and sensitivity to light
- Swelling of the face, especially around the eyes
- Enlarged pores
- Eye problems, such as inflammation and blurred vision
- A swollen, bulbous, red nose – more common in men than women
Aside from the physical symptoms, such as rash and facial flushing, rosacea can cause feelings of embarrassment, low self-esteem, anxiety and even depression.
Rosacea treatment options
There’s no cure for rosacea, but treatment can help manage the symptoms. If you suspect you have rosacea, make an appointment with your doctor (who may refer you to a specialist) or a dermatologist to confirm your diagnosis.
Depending on the severity of your rosacea, they may prescribe certain medicines – applied to the skin or taken by mouth – or suggest certain procedures, including:
There are a variety of antibiotic treatments available to treat the inflammation associated with rosacea, both topical and oral. The duration of an antibiotic course depends on your response. ‘Lymecycline and doxycycline are the most commonly used tablets for treatment of rosacea, but patients should be aware that the treatment may take a few months and the course might need to be repeated every so often,’ says Dr Semkova.
✔️ Topical treatments
Treatment of the Demodex Mite may have a beneficial effect on rosacea. It is not known how involved the mite is as this area is a subject of ongoing research. Speak to your dermatologist about treatment using topical creams such as metronidazole (antibiotic) and ivermectin (antiparasitic).
✔️ Laser and light treatments
Laser therapy can ease symptoms of rosacea if there is a thread vein element . Different types of lasers target different aspects of the condition – some help to reduce patches of enlarged blood vessels by shrinking them, while others treat redness and inflammation, or reduce the appearance of thickened skin. Intense pulsed light (IPL) therapy may also be helpful in treating redness.
✔️ Reducing inflammation and improving gut health
Many dermatologists are now looking more closely at the gut skin axis and using a holistic approach to treat inflammatory conditions like rosacea. In some patients improving the gut microbiome by eating a healthy diet rich in probiotics and prebiotics can help. A course of probiotics may also be beneficial, so speak to a dietician for advice.
Rosacea home remedies
There are a number of ways to manage and even prevent rosacea flare-ups from occurring. Follow our 8 simple lifestyle tips to minimise irritation to your skin:
- Stay out of the sun
On sunny days, seek out shade. ‘Rosacea is a disorder of the blood vessels that are just beneath the skin surface, and with sun exposure, these vessels get dilated and release blood into the tissue,’ says Dr Semkova. ‘The dilated vessels give the flushing of the skin, and the released blood causes an inflammatory reaction – responsible for the redness that persists for weeks.’
- Wear sunscreen
When you can’t stay out of the sun, wear sunscreen – ideally SPF 30 or higher and designed for sensitive skin. ‘A broad spectrum sunscreen with both UVA and UVB protection would be ideal to protect the skin and the underlying vessels,’ says Dr Semkova. ‘It will also prevent wrinkles, so well worth using it.’
- Avoid the cold
Notice frequent flare-ups and flushing in winter? That’s because the dry, cold air is harsh on your skin. ‘It’s important to note that blood vessels dilate in hot and cold weather, so neither extreme is good for rosacea,’ says Dr Semkova. Keep wrapped up with thick scarves and consider wearing a balaclava when the temperature plummets.
- Limit your alcohol intake
Your favourite tipple can trigger flare-ups. Alcohol dilates blood vessels, and causes an inflammatory response, says Dr Semkova. ‘Alcohol also dehydrates the skin, thus removing its natural glow,’ she says. ‘Interestingly, some types of alcoholic drinks are better tolerated than others – with wine being at the top of the list for causing reactions.’
- Take care with cosmetics
Rethink the contents of your bathroom cabinet to avoid irritating your skin – exfoliating products are out. ‘There are a number of ingredients in many cleansers, moisturisers, and makeup removers that are known to dry out skin,’ says Dr Seukeran. ‘It’s worth avoiding products that contain alcohol, witch hazel, menthol, peppermint, camphor, eucalyptus oil, fragrances and propylene glycol.’
- Keep a food diary
Certain foods are known to worsen rosacea, especially spicy foods. By keeping a food diary, you can identify any trigger foods that cause a reaction. ‘The response may be quite different from one person to another, but avocado, some strong flavoured cheeses, chocolate and citrus fruit are amongst the well-known culprits,’ says Dr Semkova. ‘Foods high in sugar and refined carbohydrates may increase the inflammation or make it worse.’
- Avoid hot food and beverages
Piping-hot food and drinks cause your blood vessels to dilate due to the high temperatures, leading to facial redness – so wait for them to cool before you enjoy them. ‘Whatever you eat, try to opt for cold meals, rather than steaming hot servings,’ says Dr Semkova.
- Tailor your exercise
Exercise is a well-known rosacea trigger, but it’s also essential to your health and mental wellbeing. There are easy changes you can introduce to minimise its impact, says Dr Semkova. ‘Exercise in a well-ventilated room, and try to keep your body temperature down with cold drinks and a cool damp towel around your neck,’ she says. ‘Avoid outdoors exercise in very cold or hot weather – choose the morning or evening during the summer.’