Rosacea is a chronic inflammatory disease that can manifest as recurrent flushing, redness, telangiectasia (very tiny small vessels become visible), papules (a raised growth on the skin), or pustules (a raised growth on the skin with pus) on the nose, chin, cheeks, and forehead.

The estimated global prevalence of rosacea is greater than 5%. It is more common in people with fair complexion, people between the ages of 30 and 50, and women.

The exact cause of rosacea has yet to be fully understood but this condition has been linked to genetics, immune reactions, microorganisms, the environment, and nervous and cardiovascular disorders. Furthermore, ultraviolet (UV) exposure is known to worsen rosacea, but it may also have something to do with how the disease starts. Patients with a family history of rosacea are more likely to get the disease, which suggests a genetic link.

Demodex mites appear to have a role in the development of rosacea but it is still unclear whether their presence on the skin is a cause or effect of rosacea. Helicobacter pylori is another microorganism that has been linked to rosacea.

Rosacea can look very different in every patient since not all signs and symptoms show up at the same time. Rosacea always has at least one of the following primary symptoms that can be accompanied by secondary ones. 

The primary signs of rosacea are:

• Eye redness that can come and go;
• Face flushing and redness that doesn’t go away. Redness on the face that doesn’t go away might look like a sunburn or blush;
• Small red bumps or pus-filled pimples that are painful often form small blood vessels on the face and become visible.

Other possible symptoms and signs of rosacea are:

• Itchy eyes;
• Dry skin;
• Plaques (raised red patches);
• Skin gets thicker;
• Swelling;
• Signs and symptoms could appear in places other than the face, like the neck, chest, scalp, or ears.

Rosacea is diagnosed through history taking and physical examination. Doctors do not necessarily order any laboratory tests to diagnose a patient with rosacea. 

Treatment

The first step in treating rosacea is to identify what makes the skin changes occur, like UV light, spices, changes in the weather, or drinking alcohol. 

All people with rosacea should regularly use pH-balanced skin cleansers, broad-spectrum sunscreen with an SPF of 30 or higher, and moisturizers.

The signs and symptoms of each patient help decide what kind of treatment to use but generally, the different kinds of treatment are meant to reduce swelling.  However, topical steroids are not recommended to treat rosacea since they can worsen the condition or cause perioral dermatitis.

Persistent erythema and telangiectasias are not always caused by inflammation. They often need treatment that targets the blood vessels in the skin, like brimonidine, oxymetazoline, or vascular laser. 

Phymatous (meaning disfiguring) rosacea can cause permanent changes to the skin that, when necessary, needs to be treated by surgery.

Since the direct cause of rosacea is unknown, there is little that can be done to stop it from developing in a patient. However, people with rosacea have a better chance of preventing flare-ups if they figure out and avoid the lifestyle and environmental factors that worsen their condition. Some possible triggers for rosacea attacks are:

• Exposure to heat or wind
• Extremely warm or cold weather
• Emotional stress
• Excessive exercise
• Drinking alcohol and hot beverages
• Hot baths 

References

Farshchian M, Daveluy S. Rosacea. [Updated 2022 Sep 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557574/

Cleveland Clinic (2023). Rosacea. Retrieved January 14, 2023, from https://my.clevelandclinic.org/health/diseases/12174-rosacea-adult-acne