Rosacea: Causes & Treatments

A skin condition that causes facial redness, rosacea is thought to affect about one in 10 people in the UK(i). It most often affects people between the ages of 30 and 60 (ii), and those with fair skin are more likely to have rosacea than those with darker skin (children can be affected too, but it’s rare). Women are three times more likely to have rosacea than men (ii), though men can often have more severe symptoms.

Rosacea is most common on the cheeks, forehead, chin and nose, though it can extend beyond the face, usually to the neck, chest, scalp or ears. But because it mostly affects the face – where it can’t be easily covered up – rosacea can cause embarrassment, low self-esteem, anxiety and depression.

The main symptoms of rosacea tend to flare up from time to time and vary from one person to the next:

• Flushing
  This affects many people with rosacea and is often an early sign of the condition.

• Persistent redness
  Thought to be the most common individual rosacea sign, this can look like blushing or permanent sunburn (it’s also called erythema).

• Visible blood vessels
  Thought to be the most common individual rosacea sign, this can look like blushing or permanent sunburn (it’s also called erythema).

• Spots and bumps
  Many people with rosacea have noticeable small blood vessels (telangectasia) on their face.

Other symptoms can also include facial swelling, a burning or stinging sensation, and red raised patches known as plaques. Thickening of the skin can also be a symptom of rosacea – typically thick, bumpy skin on the nose (rhinophyma), a condition that usually only affects men (i). Some people also get rosacea-related eye symptoms, including dryness, burning, stinging, itching and sensitivity to light (see Types of rosacea (ocular rosacea), below).

Rosacea usually starts with occasional redness on the cheeks, nose, forehead or chin. In this early stage you may also notice tiny blood vessels appearing on the surface of your skin, and your eyes may feel gritty. The redness can turn darker and more permanent in time, with any tiny blood vessels becoming more noticeable. At this point you may also start getting papules and pustules. During the advanced stage of rosacea, your skin can become increasingly inflamed – including the skin around the eyes in some people – and you may find the skin on your nose becoming thick and bumpy (rhinophyma).

What causes it?

Nobody really knows exactly what causes rosacea. Some experts think it may be caused by abnormalities in the blood vessels of the face, while others believe it may be triggered by the activation of molecules in the skin called peptides (iii). There’s also a theory that large numbers of microscopic mites – called demodex folliculorum – that live naturally on human skin cause a reaction in people with rosacea (lower numbers of these mites don’t usually cause any harm) though these days having large numbers of mites is thought to aggravate rosacea rather than cause it (ii).

Genetics may play a part too, since many cases of rosacea are found in those who have other family members with the condition (though a definite genetic link has yet to be discovered).

What experts do know, however, is that certain things can make rosacea worse once it has already started. These triggers include the following:

• Hot/cold weather

• Alcohol

• Sun exposure. (Learn more on how the sun affects your skin in our guide)

• Hot baths

• Hot drinks

• Certain skincare products

• Spicy foods

• Emotional stress

• Exercise

Rosacea triggers vary from one person with the condition to the next. To determine which trigger or triggers make your rosacea flare up, it may be a good idea to keep a symptoms diary.

Types of rosacea

The National Rosacea Society in the USA claims there are four subtypes of rosacea that can be identified by their signs and symptoms (iv). You may be affected by more than one subtype at a time:

Subtype 1

Called erythematotelangiectatic rosacea, this includes symptoms such as flushing, persistent redness and possibly also visible blood vessels.

Subtype 2

If you have persistent redness as well as papules and pustules, the name of your particular subtype is papulopustular rosacea.

Subtype 3

This subtype is characterised by skin thickening, which can cause enlargement of the nose (rhinophyma).

Subtype 4

Also called ocular rosacea, this is when rosacea also affects your eye or eyes. Your eyes may feel dry – or you may feel as if something is in your eyes – and they may look irritated or bloodshot. Ocular rosacea can also cause eyelid inflammation, a condition called blepharitis.

More serious eye complications include a condition called keratitis, which is when rosacea causes inflammation and damage to the cornea, the transparent layer at the front of the eyeball. This can cause eye pain, light sensitivity as well as vision problems, and can lead potentially to vision loss.

If you have rosacea and you think your eyes have been affected, see your GP straight away, as early diagnosis and treatment are essential to protect your eyesight.

Rosacea treatments

Conventional treatment for rosacea involves controlling the symptoms, as there’s currently no cure for the condition. Avoiding your triggers and taking care of your skin will help, but you may also need medical treatments – which one or ones you’ll need will depend on your symptoms. It’s likely that you’ll need these treatments in the long-term, though during periods when your symptoms improve you may be stop using them temporarily.

Flushing and redness

Medications used to treat facial redness caused by rosacea include brimonidine tartrate, a gel that you apply once a day. This limits the dilation (widening) of the blood vessels. But while the effects are fast-acting, they are also temporary (the effects last for around 12 hours). Using certain types of cosmetic chemicals on the skin can also make redness worse in people with rosacea, so it’s also advisable to use products designed for sensitive skin (avoid abrasive or perfumed products, as well as those that contain acetone or alcohol, and stay away from oil-based or waterproof make-up).

There are also some oral medications used to treat rosacea redness, including anxiety medications, beta-blockers (most commonly used for heart problems such as angina, heart failure, high blood pressure and atrial fibrillation) and a medicine called clonidine, which helps the blood vessels to relax.

Visible blood vessels

Few medical treatments to date have been successful in removing the visible blood vessels on the face of someone with rosacea. But many people are able to hide them using camouflage creams and make-up. Laser and intense pulsed light (IPL) therapy is sometimes used and can be effective, but this type of treatment tends to be expensive (it’s not usually available under the NHS). Laser and IPL therapy can also be used to treat rosacea-related facial redness.

Spots and bumps

These include topical treatments – creams or gels that you apply directly to your skin – as well as oral treatments, most commonly antibiotics. In the first instance you may be prescribed a gel or cream, though it may be several weeks before you see any improvement. More severe spots and cysts may need treatment with an oral antibiotic, which is usually prescribed for four to six weeks (you may need to take antibiotics for longer if your spots are particularly stubborn).

Another oral medicine called isotretinoin can sometimes be used to treat rosacea spots. However, this can cause a range of unwelcome side effects, and should never be taken by pregnant women (it can cause birth defects).

Thickened skin

If you have advanced rosacea with rhinophyma, you may need specialist advice from a dermatologist or plastic surgeon. Treatments that may help include laser or scalpel remodelling – where the thickened skin is trimmed back – or dermabrasion (this involves treating the skin with a special abrasive surgical instrument).

Eye problems

Several treatments are available for the eye symptoms associated with rosacea, including lubricating eye drops or ointment for dry eyes and antibiotic tablets for blepharitis. If your corneas are affected, you may also need steroid eye drops.

Self-care tips for rosacea

Besides medical treatments, here’s what you can do to help yourself and keep the symptoms of rosacea under control:

Stay out of the sun

Try to avoid exposing your skin to the sun, especially during the hottest part of the day in summertime. If you’re going out and about, use sunscreen with a minimum SPF30 as well as a high-star UVA rating. It’s also a good idea to wear a wide-brimmed hat to keep the sun off your face whenever possible.

Since high temperatures can trigger rosacea symptoms, it’s advisable to stay as cool as possible on hot, humid days. If you can, stay indoors where it’s cool (ideally in an air-conditioned environment). Or try keeping yourself cool by having plenty of cold drinks and spraying your face with cool water. Learn more on how to protect your skin from the sun.

Keep warm in winter

Cold temperatures can trigger rosacea symptoms too, so wear a scarf to cover your cheeks and nose whenever you go outdoors in winter. Try to stay indoors as much as possible if you find the cold is a particular trigger for your rosacea symptoms. And if you do have to go out when it’s cold and windy, always use a protective moisturiser on your skin beforehand.

Avoid stress

Many people with rosacea find stress triggers their symptoms. But stress management techniques can help. For instance, try doing some deep breathing exercises when you feel under pressure, or try to visualise a calm, relaxing spot where you can retreat for a few minutes during times of stress.

Avoid trigger foods and drinks

Alcohol, caffeine, spicy foods and very hot drinks have all been identified as rosacea triggers. You could, however, still have hot drinks if you leave them to cool a little before drinking them. If you’re not sure which foods or drinks trigger your symptoms, try keeping a food and symptom diary (a wide range of foods – not all of which are spicy – have been linked with triggering rosacea, including cheese, citrus fruit, chocolate, vinegar, yoghurt, soy sauce and even avocados). Some natural health practitioners also recommend cutting down on sugar, processed and fried foods in an attempt to improve rosacea symptoms.

Stay away from hot water

Having a hot bath or shower can trigger rosacea symptoms, so try to make sure the water temperature is warm rather than hot before stepping in. Similarly, avoid saunas and hot tubs.

Don’t wet shave

Men with rosacea may find using an electric shaver rather than a razor blade helps keep their skin in better condition. It’s also a good idea to avoid harsh shaving lotions, which can irritate the skin.

Use gentle skincare products

Avoid using skincare products that contain abrasive ingredients, as well as rough washcloths, sponges or facial brushes (don’t rub or scrub your skin if you have rosacea). Use a cream cleanser designed for sensitive skin twice a day, then follow with a suitable moisturiser (medical moisturisers called emollients may be useful – these are available over the counter at pharmacies). Ask your doctor or pharmacist for advice if you’re using medical cream or gel treatments for rosacea – usually these should be applied at least 10 minutes before applying a moisturiser (follow the instructions on the patient information leaflet that comes with the treatment).

Choose non-irritating make-up

Certain ingredients in make-up products may irritate your skin, causing further facial redness. Try to use sensitive skin make-up products that are free from fragrance and other potential irritants. Also avoid products that contain alcohol. Green-tinted primers – creams that prepare your skin for foundation – may also be useful if you have persistent redness. If your skin is also dry, avoid using facial powders, as these can cause further dryness.

Get medicines advice

Certain medicines can also cause facial flushing in people who have rosacea. If you think a medicine you’re taking is making your symptoms worse, discuss it with your GP or ask a pharmacist for advice.

 

Natural rosacea relief

For further skin support, you may want to consider the following natural supplements:

Anthocyanidins

Flavonoid antioxidants called anthocyanidins may be useful if you have noticeable blood vessels on your face. Anthocyanidins are often recommended to people with rosacea by natural health practitioners, as they’re believed to support small blood vessel health by repairing damaged collagen in blood vessel walls and capillaries. Anthocyanidins are found naturally in dark, richly coloured fruit and vegetables, such as blackberries, blackcurrants, blueberries, black and red grapes, raspberries, aubergines, red cabbage and red onions (they give these fruits and vegetables their vibrant colours). You can also find anthocyanidins in supplement form.
 

Friendly bacteria

Some natural health practitioners believe there may be a link between rosacea and poor digestion. Conditions such as leaky gut syndrome and small intestinal bacterial overgrowth (SIBO) are both suspected causes of rosacea (one study suggests that not only are people with rosacea more likely to have SIBO than others, but eradicating the condition may also bring about a regression of their rosacea symptoms for at least nine months) (i). Supplements containing so-called friendly bacteria/ are often recommended for both conditions to reduce inflammation in the gut and to help rebalance gut flora.

Digestive enzymes

Poor digestion may also be caused by a lack of digestive enzymes – substances that break down the food we eat into nutrients our bodies can absorb. Factors that may affect your normal production of digestive enzymes include low stomach acid, inflammation in the digestive tract and even stress. Digestive enzymes available in supplement form (often in a multi-enzyme formula) include bromelain, papain, amylase, lactase, cellulase, protease and lipase. Meanwhile, enzyme-rich foods include fruits such as pineapple, mango, papaya, kiwi and grapes, sprouted seeds and nuts, avocado and raw honey.

For more information on a range of other common ailments and conditions, feel free to visit our health library.

 

References:

1. Available online: https://patient.info/skin-conditions/skin-rashes/rosacea

2. Available online: https://patient.info/doctor/rosacea-and-rhinophyma

3. Available online: https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/rosacea#causes-of-rosacea

4. Wilkin J. et al., Standard classification or rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J of the Am Ac of Derm. 2002 Apr;46(4). Available online: https://www.rosacea.org/physicians/classification-of-rosacea/view-online

5. Parido. A, et al.Small intestinal bacterial overgrowth inrosacea: clinical effectiveness of its eradication. Clin Gastroeneterol Hepatol. 2008 Jul;6(7):759-64. Available online: https://www.cghjournal.org/article/S1542-3565(08)00155-9/fulltext

Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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