Rosacea

Rosacea | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Rosacea Rosacea About rosacea Symptoms of rosacea Causes of rosacea Treating rosacea Preventing rosacea About rosacea Rosacea is a common but poorly understood long-term skin condition that mainly affects the face. It can be controlled tosome degree with long-term treatment, but sometimes the changes inphysical appearance can havea significant psychological impact. Symptoms of rosacea 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, but less severe at others. Read about the symptoms of rosacea Rosacea symptoms include redness and flushing, as well as stinging and spots. Source: https://dermnetnz.org/ When to see your GP See your GP if you have persistent symptoms that could be caused by rosacea. Early diagnosis andtreatment can help stop the condition getting worse. Theres no specific test for rosacea, but your GP will often be able to diagnose the condition by: examining your skin asking about your symptoms asking about possible triggers you may have In some circumstances your GP may arrange further teststo rule out other conditions with similar symptoms, such as lupus or the menopause . For example, these could be a blood test orskin biopsy, where a small scraping of skin is removed and examined. Causes of rosacea The exactcause 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 theyre 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 about causes of rosacea Treating rosacea Theres currently no cure for rosacea, but treatment can help control the symptoms. Long-term treatmentis usually necessary, although there may be periods when your symptoms improve and you can stop treatment temporarily. For most people, treatment involves 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 canhelp 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 involvebeams of lightbeing aimed at the visible blood vessels in the skin to shrink them and make them less visible. Read about more about treating rosacea and self-help measures for rosacea Living with rosacea Any long-term (chronic) condition can have an adverse psychological effect, but rosacea can be particularly troublesomeas 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. Its 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, youmay start to feel better psychologically and emotionally. If you have rosacea, take comfort in knowing youre not alone. There are millions of people living with the conditionin the UK and across the world. You can find support and information from organisations like: Changing Faces  a charity for people with a visible difference or facial disfigurement, who can be contacted on0300 012 0275 for counselling and advice Speak to your GP if youre feeling depressed as a result of your condition. They may recommend further treatment if necessary. Ocular rosacea Rosacea that affects your eyes (ocular rosacea) can lead to a number of eye problems, some of which can be serious. 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) 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 isnt possible, visit your nearest accident and emergency (A&E) department . If keratitis isnt treated promptly by an ophthalmologist, a doctor who specialises in treating eye conditions, theres a risk of permanent vision loss. Symptoms of rosacea 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 periodswhen their symptoms are less so. The main symptoms of rosacea include: flushing persistent facial redness visible blood vessels papules and pustules thickened skin These are discussed in more detail below. Other symptoms associated with rosacea include: sensitive skin burning, itching, stinging andpain dry, rough skin raised red patches (plaques) on your skin facial swelling (lymphoedema) Rosacea can cause different symptoms, including facial redness and flushing. Source: https://dermnetnz.org/ Permanent damage to the face (scarring) almost never occurs in rosacea. Flushing Flushingis 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 flushingis 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 (erythema) islikea blush or a patch of sunburn that doesnt go away, or the sort of blotchy skin often associated with drinking too much alcohol. This can be upsetting for those 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 widened(dilated) and visible. The medical name for visible blood vessels is telangiectasia. Papules and pustules If you have rosacea, you may develop round red bumps that rise from your skin (papules) and pus-filled swellings(pustules). These spots appear on your face and are similar to acne . Rosacea used to be called acne rosacea, but the 2conditions are quite different. In rosacea there are no blackheadsandthe skin is not greasy, but dry and peeling. Rosacea spots also dont 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 (rhinophyma). Rhinophyma is an uncommon,severesymptom of rosacea and takes several years to develop. Italmost exclusively affects men. Causes of rosacea The exact cause of rosacea is unknown, although a number of potential factors have been suggested. Its possible a combination of these factors may be responsible for the condition, although there isnt enough evidence to say this for certain. 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. Its not known what causes these abnormalities. But sun damage 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 (particularly red wine), exercise, stress, heat and cold can lead to theactivation of certain molecules within the skin called peptides. Increased levels of these peptides may in turn affect the immune system ornerves and blood vessels(neurovascular system) 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 people with rosacea have particularly large numbers, which may play a role in the condition. It is currently uncertain whether the mite is a cause or an effect of rosacea, although someresearchers have suggested the symptoms may be caused by the skin reacting tobacteria in the mites faeces. Helicobacter pylori bacteria Helicobacter pylori bacteria are bacteriafound in the digestive system. Its been suggested these bacteria may be a possible cause of rosacea, althougha linkhasnt 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 its not clear which genes if any are involved or how theyre passed on. Triggers of rosacea Although theyre not thought to be direct causes ofthe 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 strongwinds strenuous exercise alcohol hot baths spicy foods hot drinks humidity caffeine found in tea, coffee and cola the menopause dairy products othermedical conditions certain medicines such as amiodarone, corticosteroids and high doses of vitamins B6 and B12 Treating rosacea Although rosacea cant be cured, treatment can help keep the symptoms under control. Long-term treatment is usually necessary, although there may be periods where your symptoms improve and you can stop treatment temporarily. Treatment choices depend onwhich type of symptom is most troublesome, but usually involves a combination ofself-help measures and medication, and areoutlined below. Self-help measures There are a number ofthings 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, byusingproducts 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) Treating papules and pustules If you haveround red bumps that rise from your skin (papules) and pus-filled swellings (pustules) caused by rosacea, there are a number of different medications that can be effective. These can be divided into topical treatments that are applied to the skin, or oral treatments, which are taken by mouth. Topical treatments Topical medications are usually prescribed first. These include: metronidazole cream or gel azelaic acid cream or gel ivermectin cream Ivermectin is a relatively new medicine. Theres some evidence to suggest it may be more effective and perhaps less irritating to the skin than metronidazole, although its not currently available on the NHS everywhere and may only be recommended if the other treatments dont work. Youll 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. Side effects of these treatments can include a burning or stinging sensation, itchiness and dry skin. Oral antibiotics If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduceinflammation of the skin. Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These medications are usually taken for 4to 6weeks, but longer courses may be necessary if the spots are persistent. For example, a low-dose doxycycline capsule is available if oral antibiotics need to be taken long term. Common side effects of these medications include: feeling and being sick diarrhoea bloating and indigestion tummy (abdominal)pain loss of appetite Some of the medications used can alsomake 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 takenonce or twice a day and you may not notice a significant improvement in your symptoms for several weeks. Oralisotretinoin Isotretinoin is a medicine often used to treat severe acne ,but at lower doses its 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 aspecialistin treating skin conditions (dermatologist) and not your GP. Common side effects of isotretinoin include: dryness and cracking of the skin, lips and nostrils inflammation of your eyelids (blepharitis) oreyes (conjunctivitis) headaches muscle orjoint pain back pain blood in your urine (haematuria) mood changes Isotretinion can also cause birth defects if taken during pregnancy. Treating facial redness Treatingfacial redness andflushing caused by rosaceais generally more difficult than treating papules and pustules caused by the condition. But as well asthe 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 agel thats applied to the face once a day. The medication works by restricting the widening (dilation) of the blood vessels in your face. Researchhas shown it can start to have an effect about 30 minutes after its first used, and this can last for around 12 hours. Common side effects ofbrimonidine 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 dry skin A rebound effect, where flushing becomes worse, has also been reported with this medication. 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 Its 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 theyre not usually available on the NHS, so you may need to pay for them privately. Around 2to 4treatments 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 theyre no longer visible, with minimal scarring or damage to thesurrounding area. Laser treatment can cause pain, but most people dont 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 asrhinophyma. If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon todiscussways 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 alaser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion. Treating eye problems If rosaceais 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. Ifinitial treatment isnteffective or you develop any further problems with your eyes, youll need to be referred to an eye specialist called an ophthalmologist for further assessment and treatment. Preventing 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 its not always practical or possible, takingstepsto avoid these triggers canhelp reduce the severity and frequency of your symptoms. If youre 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 thingslike the activities you do and foods or drinks you have. Advice about how to avoid some common triggers can be foundbelow. Sunlight As sunlight is the most commonly reported trigger of rosacea, you should use sun cream whenever possible, even when its 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. Try to minimise your exposure to the sun during the summer months, 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 commonlyreported trigger of rosacea. Successfully managing your stress levels can help control your symptoms. Ways you can reduce stress include: learning relaxation techniques, such asdeep 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. Readabout stress management . Food and drink Some of the mostcommonly 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. Butthere are many other dietary triggers that can also affect some people with rosacea. Its a good idea to include information about how your diet affects your rosacea symptoms inyour 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 facewith a balaclava. Skincare techniques The advice below about skincare techniques may also help control your rosacea symptoms. 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 productsinstead 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 arent sure of. You can then graduallyreintroduce 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) Dont use steroid cream unless youre specifically instructed to by your GP, as it may make your symptoms worse Skin camouflage 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 withwarm water and a small amount of cleaning solution can help ease your symptoms. Avoidingeye make-up can also help reduce your symptoms, but if you do choose towear eye make-up, make sure it is a type that washes off easily so you can still clean your eyelids. Source: NHS 24 - Opens in new browser window Last updated: 10 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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