The cause is unknown.
Typical symptoms include redness, small visible blood vessels, and sometimes small pimples that appear on the cheeks and nose.
The diagnosis is based on the typical appearance of the rash and on the person's age when symptoms first appear.
Worsening of rosacea may be prevented by avoiding certain foods, alcohol, hot beverages, and exposure to sunlight, extremes of temperature, wind, and cosmetics.
Treatment includes antibiotics applied to the skin or, for some people, taken by mouth.
Rosacea typically affects people aged 30 to 50. The disorder is most common among people of Irish and 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 Acne Acne is a common skin condition causing pimples and other abnormalities on the face and upper torso. Acne is caused by a buildup of dead skin cells, bacteria, and dried sebum that blocks the... read more 
and certain other skin disorders. It is often called adult acne.
The cause of rosacea is not known, but some people may be prone to developing this disorder.
Spicy foods, alcohol, or hot beverages may trigger flare-ups. Other triggers may include sunlight, sunscreen, emotional stress, cold or hot weather, exercise, wind, cosmetics, and hot baths.
Some drugs, such as amiodarone, corticosteroids that are applied to the skin or inhaled through the nose, and high doses of vitamins B6 and B12 may worsen rosacea.
Symptoms of Rosacea
Rosacea affects only the face and scalp. It has four phases:
Pre-rosacea phase (phase 1): The skin over the cheeks and nose becomes flushed, but for longer periods of time than normal, and may sting.
Vascular phase (phase 2): The skin appears red and swollen, with small blood vessels visible just below the surface (called telangiectasia).
Inflammatory phase (phase 3): Often small pimples develop, sometimes with some pus (called pustules).
Late phase (phase 4): In some people, the skin around the nose occasionally thickens, making it look red and bulbous (called rhinophyma).
In rosacea, the face can become red and develop pimples and pustules.
Image provided by Thomas Habif, MD.
This photo shows redness and telangiectasias on the cheeks of a woman who has vascular rosacea.
© Springer Science+Business Media
This photo shows vivid redness and small solid pimples (papules) in a woman who has inflammatory rosacea. Surface bumps containing pus (pustules) are also present, but they are faint.
© Springer Science+Business Media
This photo shows rhinophyma, characterized by thickened skin and enlargement of the nose, in a person who has rosacea.
© Springer Science+Business Media
Rosacea that affects the eyes (called ocular rosacea) often accompanies rosacea that affects the face. Symptoms of ocular rosacea may include inflammation of the eyelids, conjunctiva, iris, sclera, cornea, or a combination that causes itching, a feeling as though something is in the eye (foreign body sensation), redness, and swelling of the eye.
Diagnosis of Rosacea
A doctor's examination
Doctors base the diagnosis of rosacea on the typical appearance of the rash. There are no specific tests. The person's age when the symptoms first appear and a lack of blackheads and whiteheads help distinguish rosacea from acne.
Treatment of Rosacea
Avoidance of triggers
For inflammatory rosacea, antibiotics taken by mouth or applied to the skin or azelaic acid or ivermectin applied to the skin
For flushing, brimonidine gel or oxymetazoline cream
For telangiectasia, lasers and electrocautery
For rhinophyma, dermabrasion, lasers, and/or removal of excess tissue
The first treatment of rosacea is avoiding triggers. Treatment is aimed at controlling symptoms because there is no cure for rosacea.
Antibiotics that are applied to the skin, such as metronidazole, benzoyl peroxide, clindamycin, minocycline, and erythromycin, as well as azelaic acid cream may be effective for inflammatory rosacea. Ivermectin cream is also effective. Corticosteroids applied to the skin tend to make rosacea worse.
Certain antibiotics taken by mouth are given to people who have many pustules or ocular rosacea. Doxycycline, tetracycline, minocycline, azithromycin, or erythromycin is usually used. Isotretinoin may be effective when taken by mouth but, because of possibly severe side effects, is not used unless other treatments are ineffective.
Persistent flushing or redness may be treated with brimonidine gel or oxymetazoline cream.
Treatment of telangiectasia includes laser treatment and electrocautery (an electrical current applied to the skin removes the telangiectasia).
Severe rhinophyma is unlikely to improve completely with drugs. Therefore, a person with this disorder may need dermabrasion (a procedure in which the skin surface is rubbed with an abrasive metal instrument to remove the top layer), laser treatment Using Lasers to Treat Skin Problems 
, and/or surgery to remove the excess tissue.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
amiodarone |
Cordarone, Nexterone, Pacerone |
azelaic acid |
Azelex, Finacea, Finacea Plus, Finevin |
ivermectin |
Sklice, Soolantra, Stromectol |
brimonidine |
Alphagan, Alphagan P, LUMIFY, Mirvaso |
oxymetazoline |
12 Hour Nasal , Afrin, Afrin Extra Moisturizing, Afrin Nasal Sinus, Afrin No Drip Severe Congestion, Dristan, Duration, Genasal , Mucinex Children's Stuffy Nose, Mucinex Full Force, Mucinex Moisture Smart, Mucinex Sinus-Max, Mucinex Sinus-Max Sinus & Allergy, NASAL Decongestant, Nasal Relief , Neo-Synephrine 12-Hour, Neo-Synephrine Severe Sinus Congestion, Nostrilla Fast Relief, Reliable-1 12 hour Decongestant, Rhinase D, RHOFADE, Sinex 12-Hour, Sudafed OM Sinus Cold Moisturizing, Sudafed OM Sinus Congestion Moisturizing, Upneeq, Vicks Qlearquil Decongestant, Vicks Sinex, Vicks Sinex Severe, Visine L.R., Zicam Extreme Congestion Relief, Zicam Intense Sinus |
metronidazole |
Flagyl, Flagyl ER, Flagyl RTU, MetroCream, MetroGel, MetroGel Vaginal, MetroLotion, Noritate, NUVESSA, Nydamax, Rosadan, Rozex, Vandazole, Vitazol |
benzoyl peroxide |
Acne Medication, Acne-10, Acneclear, Benprox , Benzac AC, Benzac W, Benzac-10, Benzac-5, Benzagel, Benzagel-10 , Benzagel-5, BenzaShave, BenzEFoam, BenzEFoam Ultra , BenzePrO, Benziq, Benziq LS, BP Cleanser, BP Cleansing Lotion, BP Foaming Wash, BP Gel, BP Topical , BP Wash, BP Wash Kit, BPO, BPO Creamy Wash, BPO Foaming Cloth, Brevoxyl-4, Brevoxyl-8, Clean&Clear Persa-Gel, Clearplex , Clearplex X, Clearskin, Clinac BPO, Del Aqua, Delos, Desquam-E, Desquam-X, EFFACLAR, Enzoclear, EPSOLAY, Ethexderm BPW, Inova Easy Pad, Lavoclen-4 , Lavoclen-8, NeoBenz Micro, NeoBenz Micro Cream Plus Pack, NeoBenz Micro SD, NeoBenz Micro Wash Plus Pack, Neutrogena Acne Cream, OC8, Oscion, Pacnex, Pacnex HP, Pacnex LP, Pacnex MX, PanOxyl, PanOxyl 10 Maximum Strength, PanOxyl 5, PanOxyl AQ, PanOxyl Aqua, PanOxyl-10, PanOxyl-5, PanOxyl-8, Peroderm, RE Benzoyl Peroxide , Riax, SE BPO, Seba, Seba-Gel, Soluclenz Rx , Theroxide, TL BPO MX, Triaz, True Marker Lintera, Zaclir, Zoderm Cleanser , Zoderm Cream, Zoderm Gel, Zoderm Redi-Pads , Zoderm Wash |
clindamycin |
Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clindacin ETZ, Clindacin-P, Clinda-Derm , Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO |
minocycline |
Amzeeq, Arestin, Dynacin, Minocin, minolira, Myrac, Solodyn, Ximino, Zilxi |
erythromycin |
A/T/S, Akne-mycin, E.E.S., Emcin Clear , EMGEL, E-Mycin, ERYC, Erycette, Eryderm , Erygel, Erymax, EryPed, Ery-Tab, Erythra Derm , Erythrocin, Erythrocin Lactobionate, Erythrocin Stearate, Ilosone, Ilotycin, My-E, PCE, PCE Dispertab , Romycin, Staticin, T-Stat |
doxycycline |
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs |
tetracycline |
Emtet-500, Panmycin, Sumycin |
azithromycin |
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric |
isotretinoin |
Absorica, Absorica LD, Accutane, Amnesteem , Claravis , MYORISAN, Sotret, ZENATANE |
