Fact Sheet: Rosacea

What is rosacea?

Rosacea is a chronic condition that especially affects the face. It can cause episodes of redness, flushing, pimples and spidery red veins. It usually starts over the age of 20, and it affects up to one in 10 fair-skinned young adults, although many do not realise that they have a skin condition. It can affect the eyelids and eyes, and swollen lumpy areas can develop, especially on the nose.

There are four different subtypes of rosacea: the first involves mostly redness, the second pimples and other blemishes, the third thickening and bumps on the nose and the fourth involves the eyes. Each type can get worse, but having one type does not necessarily mean that you will go on to develop the others as well.

Rosacea can be disabling if it affects the eyelids or eyes. Inflammation around the eyelids, dryness in the eyes and corneal inflammation can become painful. The swelling and lumpiness that can affect the nose can also be unpleasant. This is called rhinophyma. Even if rosacea is usually harmless, like all conditions that affect the appearance of the face, rosacea can be very difficult to handle emotionally.

What causes rosacea?

The exact cause of rosacea is not clear. It is known, though, that rosacea is not contagious. Although the symptoms include pimples, rosacea is not acne. Acne is caused by too much oil in the skin, but this is not what causes rosacea. Researchers think that rosacea might be caused by several things: problems in the very small blood vessels in the skin, sun damage, and a reaction to fluids which leak out in the skin when the red flushes happen. Rosacea is a chronic condition that lasts for years, but it may never go away without treatment for many people.

What can I do to avoid outbreaks of rosacea?

Some things can trigger outbreaks in individuals, such as particular foods or drinks, alcohol, sunlight, cosmetics and medications. The triggers can be different from person to person. In general, though, anything that makes the face flush might make rosacea worse. Getting to know what these triggers are and avoiding them may help, although it is not known if any particular dietary changes work.

Avoiding sunlight and wearing a hat can prevent sunburn and possibly reduce further skin damage from the sun. Sunscreens might help, but there is no proof about this.

What are the treatment options?

The treatments with the most evidence of benefit so far are creams and gels with either azelaic acid or the antibiotic metronidazole. They can help relieve the symptoms of rosacea. Antibiotic tablets of metronidazole or tetracycline are also used, but more research is needed to assess their effects.

A very powerful drug is the hormone isotretinoin. This has only been approved for use against acne in Germany. This drug causes serious side effects, and it can itself cause skin problems and dryness. It cannot be used by anyone who might get pregnant because it can harm unborn babies.

Other drugs and laser treatment are also sometimes tried, but there is no strong evidence to show whether or not they work.

It is not known whether any particular treatment is effective for rosacea involving the eyes. If lumps and swelling in the nose become very serious, surgery and laser therapy are options.

© IQWiG (Institute for Quality and Efficiency in Health Care)