Have you ever felt your cheeks burn after a hot shower or your face flush after a spicy meal? These could be signs of rosacea, a chronic inflammatory skin condition.
Rosacea affects an estimated 16 million Americans, or 4.8% of the population. It is most common in fair-skinned people between the ages of 30 to 60 who are of European descent, and it occurs more often in biological women than men.
Because a sudden rosacea flare-up is easy to see, it can lead to self-consciousness that impacts a person’s quality of life. Luckily, treatments exist that can greatly improve the appearance and incidence of rosacea.
Symptoms
Symptoms of rosacea include:
- recurring facial redness
- visible spider veins on the nose and cheeks
- dry, itchy, burning, or sensitive skin
- pimples or red bumps on the nose and cheeks (which may resemble acne)
- a rash that usually presents across the nose and cheeks (but may include the chin and forehead)
- thickening skin on the nose or cheeks
- eye irritation or redness
Rosacea may not show on the skin at all times, but when a flare-up occurs, a patient’s symptoms get worse and can be severe. Without appropriate treatment, rosacea can remain permanently visible on the face and cheeks, and often worsens over time.
Causes of Rosacea
It isn’t exactly clear what causes rosacea. But there are a number of factors thought to contribute, including:
Genetics – If you have a close family member with rosacea, you may be more likely to develop the condition.
Skin mites – Everyone’s skin has microscopic mites called demodex that are part of our normal skin biome. But in patients with rosacea, these mites are found in much greater quantities. There are differing opinions on how or if demodex (or a bacterium carried by demodex) is a causal factor, but evidence suggests that it may be.
Autoimmunity – While rosacea is not currently classified as an autoimmune disease, women with rosacea often have a higher incidence of autoimmune disorders such as celiac disease, multiple sclerosis, type 1 diabetes, or rheumatoid arthritis.
Gut bacteria imbalance – Emerging research suggests that there is also a tie between gut health and rosacea. Studies have shown that people with rosacea have higher rates of H. pylori infections and small intestinal bacterial overgrowth (SIBO).
Common Triggers
Several things can trigger a rosacea flare, including:
Environmental factors – In some individuals, sun or wind exposure, or exposure to hot or cold weather can trigger rosacea.
Medication – Certain medications can cause or worsen rosacea, such as topical steroid creams, opiate painkillers, beta-blockers, vasodilators (used to treat high blood pressure, migraines, and other conditions), and vitamin B3 (niacin).
Lifestyle – Various food and beverages such as spicy foods, alcohol, and hot drinks like coffee or tea can dilate blood vessels and trigger rosacea flares. Stress, exercise, and some hair and skin products are also known to be triggers in some patients.
Types of Rosacea
There are four main kinds of rosacea, although patients may experience symptoms of more than one type:
Erythematotelangiectatic rosacea (ETR)
This is the most common form of rosacea (57% of cases), characterized by flushing, facial redness, and visible blood vessels on the cheeks and nose. Some patients experience burning, swelling, or stinging of the affected skin.
Papulopustular rosacea
Most commonly affecting middle-aged women, this form of rosacea causes facial redness like ETR (see #1), but also includes red bumps and pus-filled pimples that may be mistaken for acne. It comprises 43% of rosacea cases. In some patients with papulopustular rosacea, exposure to the bacterium Bacillus oleronius (found in demodex mites) causes an immune response.
Phymatous rosacea
Affecting 7% of rosacea sufferers (and more common in men), phymatous rosacea causes a thickening of the skin, most often on the nose, which can deform the shape of the nose.
Ocular rosacea
This type of rosacea affects the eyes and eyelids, causing inflammation, redness, and burning or itching that may be accompanied by dry, flaky skin around the eyes. If rosacea affects your eyes, it is important to have regular check-ups with your ophthalmologist (eye care specialist).
Management and Treatment
Although there is no cure for rosacea, the good news is it can be managed. The first step is to identify your triggers and make a list of them. When a flare up occurs, make note of:
- the foods and drinks you recently consumed
- any medications you changed or started taking
- if you were exposed to sunlight, heat, or cold weather, or
- if you introduced new products into your hair or skincare routine.
New fitness routines or additional sources of stress should also be noted as possible triggers.
Review this list of triggers with your primary care provider to help determine if you have rosacea. Their assessment may also include a skin exam, symptom review, medical history, and lab tests. For severe cases, a referral to a dermatologist may also be provided.
If a diagnosis of rosacea is confirmed, the provider will work with you to develop a treatment plan, including steps to avoid future flare ups.
In some circumstances, you won’t be able to avoid triggers completely. But you may still be able to minimize rosacea flares by sticking to the prescribed treatment(s), combined with dedicated self-care.
Treatments for Rosacea
A medical treatment plan for rosacea may include:
- Topical medications – creams, gels
- Antibiotics – oral or topical, and/or
- Laser treatment – for more severe cases
Self-care activities to calm rosacea
To calm rosacea, patients should seek to maintain healthy lifestyle habits, and practice a gentle skincare routine that includes:
- fragrance-free cleansers and moisturizers
- a sunscreen with SPF 30+ (physical blockers are recommended), and
- avoidance of any harsh or abrasive skincare products.
In addition, joining a support group for emotional well-being may also be helpful to patients who experience stress and anxiety related to their rosacea flare-ups.
Conclusion
Rosacea can be a frustrating and embarrassing condition that flares up unexpectedly. However, with proper medical treatment and consistent self-care practices, patients can minimize flare-ups and feel more confident in their own skin. If you suspect that you or a loved one has rosacea, or are suffering from it and need support, contact our primary care team to request an appointment today. We’re here to help.
For more information on rosacea, as well as tips and resources, visit the National Rosacea Society website.