Complete Guide to Rosacea

Rosacea is a chronic condition, which means you’ll always have it, but your symptoms may come and go. Tell your doctor about your symptoms and how often you have flare-ups. What you say today will help shape your treatment plan.

Ask Your Doctor . . .

Newly diagnosed:

What kind of rosacea do I have?

What are my treatment options?

Can you recommend over-the-counter products to help my skin?

Do I need to change my bathing and skincare routines?

How quickly will my skin start to look better?

Living with rosacea:

If my first treatment doesn’t work, what else can I try?

What should I do if I have side effects?

Are there any lifestyle changes I can make to help my skin?

How often should I schedule follow-up appointments?

TIP: Always share with your doctor any updates since your last visit—from new medicines to major life changes. These can impact what happens with your skin. 

Rosacea is a common skin condition that causes redness and other symptoms on your face. It is more common in women over 30 who have light skin but it can happen to anyone, even people with dark skin.

Researchers don’t know exactly what causes rosacea but they do know that it tends to run in families. They suspect that it could be related to several different systems in your body that don’t work the way they should. 

For example:

• You may react more strongly to microscopic mites that live on everyone’s skin.
• Your immune system may overreact to certain bacteria on your skin.
• The blood vessels in your face may become swollen and visible.

Types of Rosacea

There are four different types of rosacea that are named for the kinds of symptoms they cause.

Erythematotelangiectatic rosacea (ETR) is what most people think of when they hear the term “rosacea.” It causes broken blood vessels and redness on your cheeks, forehead, chin and nose.

Papulopustular rosacea causes redness and swelling, but also breakouts that can look like acne.

Phymatous rosacea causes the skin on your face to thicken and get rough. When this happens on the nose, it’s called rhinophyma.

Ocular rosacea causes eye irritation, redness and swelling.

Rosacea is a progressive condition, which means that it tends to get worse over time without treatment.

What are Skin Mites?

Some researchers think that a microscopic skin mite called “demodex” may be a cause of rosacea. Demodex is a tiny bug that lives in human hair follicles, usually on your nose and cheeks. You can’t see them unless you use a microscope. They are usually harmless, but some people are more sensitive to them than others. Researchers think almost all adults have demodex living on their skin.

There are four different types of rosacea and each one has its own signs and symptoms. It’s also possible to have more than one kind of rosacea at a time. Share all your symptoms with your doctor so he can figure out which treatment will work best for you.

Erythematotelangiectatic rosacea (ETR) symptoms include blushing easily, redness, broken blood vessels under your skin and sensitive or dry skin.

Papulopustular rosacea symptoms include the redness of ETR along with breakouts that look like acne. Your skin may also be very oily and sensitive.

Phymatous rosacea is a rare subtype that usually happens after you’ve had symptoms of another kind of rosacea. Your skin can become thick and bumpy with large pores and broken blood vessels.

Ocular rosacea causes symptoms in your eyes that can include burning or stinging, redness, cysts on your eyelids, feeling more sensitive to light and blurry vision.

Flare ups of rosacea symptoms usually happen in cycles. You may have symptoms for a while and then they go away, until they flare up again.

Rosacea Triggers

Rosacea flare-ups can be triggered by:

• Sun exposure
• Hot, cold, or windy weather
• Stress or anger
• Drinking alcohol
• Very hot baths, showers or saunas
• Exercise that makes you sweat heavily
• Medicines including some blood pressure medicines and corticosteroids

You can help your doctor choose the right treatment for you by keeping track of your symptoms and writing down what you think could be causing them. Share this information with your doctor during each visit.

Complications

If you don’t get treatment for your rosacea it can get worse over time. 

You could also develop more serious concerns including:

• low self-esteem or depression from feeling self-conscious because of how your skin looks
• vision loss from damage to your eyes (if you have ocular rosacea)
• damage to your nose that causes you to need plastic surgery (if you have phymatous rosacea)

So don’t ignore the signs of rosacea. Talk to your doctor to develop a treatment plan.

TIP: Rosacea is very common and affects 16 million Americans. There’s no reason to be embarrassed by it. Your doctor can help you find an effective treatment to control your symptoms.

The main goals of treatment are to:

• reduce redness and swelling
• prevent flare-ups

Your doctor will recommend a treatment based on your specific symptoms and triggers. 

Common treatments include:

• Topical medicines that are applied directly to your face. Active ingredients include metronidazole, azelaic acid and dapsone, which help control inflammation; brimonidine, which constricts blood vessels to reduce redness; and ivermectin, which reduces inflammation and kills parasites.
• Oral antibiotics like doxycycline to reduce inflammation.
• Light or laser therapy that uses different wavelengths of light to help shrink blood vessels to decrease redness.

There are other medicines or procedures your doctor might recommend to treat specific types of rosacea. Your doctor will consider how severe your rosacea is and what symptoms you have to choose a treatment that will work best for you.

Always take your medicine as prescribed. Don’t stop taking your medicine without talking to your doctor first, even if your symptoms go away or you have side effects. Your doctor will work with you to find a medicine, or combination of medicines, that works for you.

Your rosacea may never go away completely, but you can treat flare-ups and take small steps to prevent them. Find out what you need to do, why you need to it, and a few simple ideas on how to get started.

Avoid triggers

WHY: The best way to manage rosacea is to stop flare-ups before they start.

HOW TO START:  Use a diary or calendar to track what causes your flare-ups and talk to your doctor about how to avoid these triggers in the future. Common triggers include stress, changes in the weather, exercise and certain medicines.

Get enough sleep

WHY: Getting 7 to 9 hours of sleep a night will help prevent stress and fatigue that can lead to a flare-up.

HOW TO START: Set a regular sleep schedule and stick to it (even on weekends). Create a relaxing nighttime ritual to prepare your body for sleep, like sipping a cup of herbal tea or writing in a journal. And make sure your bedroom is dark by using heavy curtains on the windows.

Use sunscreen every day

WHY: Sunlight is a major rosacea trigger.

HOW TO START: Choose a broad-spectrum sunscreen with a minimum 30 SPF. Avoid products with added fragrance or alcohol because they can irritate sensitive skin. Look for titanium dioxide or zinc oxide as active ingredients. Sunscreens that include silicone (also called dimethicone or cyclomethicone) might cut down on any stinging or irritation.

Moisturize your skin

WHY: Using a special moisturizer called a barrier-repair emollient can help your skin to look and feel better. They are available over-the-counter and by prescription.

HOW TO START: Ask your doctor to recommend a barrier-repair product that’s right for you. Apply it twice a day (or as directed by your doctor).

Bathe with care

WHY: Hot water and harsh cleansers can irritate your skin.

HOW TO START: Take short, lukewarm showers for no more than 10 minutes. Choose a cleanser for sensitive skin and apply it with your hands, rather than a rough washcloth or body sponge. Pat skin dry gently instead of rubbing.

Let skin dry before applying medicines or other products

WHY: Skin is most absorbent when it’s wet, which means it can become irritated easily.

HOW TO START: Gently pat skin dry with a soft cotton towel, and then wait at least 5 to 10 minutes before applying anything to your skin. If your skin still burns, try waiting for up to half an hour the next time.

Choose cosmetics and other skin products carefully

WHY: Many products contain ingredients that can make rosacea worse.

HOW TO START: Always read labels carefully. Ingredients that may make your rosacea worse include alcohol, mint oils, glycolic acid, lactic acid, urea and sodium lauryl sulfate. Stop using any product that causes burning or stinging.

Take care of your mental health.

WHY: Studies show that people with rosacea often feel self-conscious about their skin and are at increased risk of having depression and anxiety.

HOW TO START: Talk to your doctor if you experience ongoing feelings of sadness or worthlessness, or loss of interest activities you used to enjoy.