Rosacea (acne rosacea) is a persistent skin disorder that produces redness, tiny pimples, and noticeable blood vessels, usually on the central area of the face.

• The cause is unknown.
• Typical symptoms include redness, small visible blood vessels, and small pimples that appear on the cheeks and nose.
• The diagnosis is based on symptoms and on the person's age when symptoms first appear.
• Worsening of rosacea can be prevented by avoiding certain foods, alcohol, caffeine, and exposure to sunlight, extremes of temperature, wind, and cosmetics.
• Treatment includes antibiotics taken by mouth or applied to the skin and antifungal or other medicated creams.

The cause of rosacea is not known. The disorder usually appears during or after middle age—age of onset helps distinguish it from acne. Rosacea is most common among people of Celtic or Northern European descent who have fair complexions but it does affect and is probably under-recognized in darker-skinned people. Although usually easy for doctors to recognize, rosacea sometimes looks like acne and certain other skin disorders. It is often called adult acne.

The skin over the cheeks and nose becomes red, often with small pimples. The skin may appear thin and frail, with small blood vessels visible just below the surface. The skin around the nose may thicken, making it look red and bulbous (rhinophyma).

Rosacea

Treatment

People with rosacea should avoid foods that cause the blood vessels in the skin to dilate—for example, spicy foods, alcohol, coffee, and other caffeinated beverages. Other triggers include sunlight, emotional stress, cold or hot weather, exercise, wind, cosmetics, and hot baths or hot drinks.

Certain antibiotics taken by mouth relieve rosacea. Tetracyclines are usually most effective and produce the fewest side effects. Antibiotics that are applied to the skin, such as metronidazoleSome Trade Names
FLAGYL
, clindamycinSome Trade Names
CLEOCIN
, and erythromycinSome Trade Names
E-MYCIN ERYTHROCIN
, are also effective. In rare cases, antifungal creams, such as ketoconazoleSome Trade Names
NIZORAL
or terbinafineSome Trade Names
LAMISIL AT
cream, are used. Topical azelaic acidSome Trade Names
AZELEX FINACEA
gel also can be an effective treatment for rosacea.

IsotretinoinSome Trade Names
ACCUTANE
is effective when taken by mouth or when applied to the skin. Corticosteroids applied to the skin tend to make rosacea worse. Severe rhinophyma is unlikely to improve completely with drugs. Therefore, a person with this disorder may need surgery or laser treatment (see see Noncancerous Skin Growths: Using Lasers to Treat Skin Problems).

Last full review/revision December 2006 by Peter C. Schalock, MD