What is rosacea?
Rosacea is a chronic inflammatory skin condition affecting primarily the cheeks, nose, chin, and forehead. It results in erythema (redness), flushing, telangiectasia (spider veins), and inflamed bumps. Rosacea can also affect the eyes (ocular rosacea) or cause thickening of the skin (phymatous changes). People with rosacea often experience episodes of remission and flare-ups, and some experience worsening of symptoms over time.[1][2]
Unmanaged rosacea symptoms can negatively impact quality of life and psychological well-being, leading to low self-esteem, embarrassment, and an increased risk of anxiety and depression.[3][4] A 2018 meta-analysis estimated the global prevalence of rosacea to be 5.5%, with nearly all cases occurring in adults over 30. Historically it has been thought that women are more frequently affected, but this meta-analysis found no difference in rates between men and women.[5]
What are the main signs and symptoms of rosacea?
Common symptoms of rosacea include redness, flushing, visible blood vessels, and inflamed bumps (papules and pustules) on the skin of the face which may be accompanied by a burning or stinging sensation. These symptoms primarily affect skin on the cheeks, nose, chin, and forehead, and may be persistent or transient in nature. Flare-ups of flushing and/or erythema are common, and may occur following exposure to a trigger (e.g., heat, sun exposure, alcohol). Some people experience thickening of the skin, usually on the nose — a phenomenon called rhinophyma — which appears as nodular growths and bulbous enlargement of the nose.[3][1]
More than half of people with rosacea experience symptoms in and around the eyes, including dryness, burning, itching, redness, sensitivity to light, inflammation of the eyes or eyelids, and rarely, inflammation of the cornea; the latter can lead to vision loss.[3][1]
How is rosacea diagnosed?
A qualified healthcare professional diagnoses rosacea based on clinical observations and patient reporting of signs and symptoms. The global ROSacea COnsensus (ROSCO) panel and the National Rosacea Society have recently updated the classification and diagnosis of rosacea:[3][1]
Having one of the following features is considered diagnostic of rosacea:
- Persistent redness affecting the center of the face with periodic intensification
- Phymatous changes (thickening of the skin with irregular nodules and enlarged pores). In the absence of one of the above features, having at least two of the following features is considered diagnostic:
- Inflammatory papules/pustules
- Telangiectasia (small visible blood vessels)
- Flushing
- Ocular manifestations (symptoms affecting the eyes/eyelids)
What are some of the main medical treatments for rosacea?
Rosacea is a chronic condition, meaning that treatments are not curative but rather help to manage symptoms. Treatment should be managed by a health care practitioner, and tailored to the individual’s current symptoms. Given that symptoms of rosacea can vary between people and even within the same person over time, practitioners will generally focus on addressing the symptoms most bothersome to the individual at that time. Management options include both oral and topical (applied to the skin) medications and laser and light-based therapies.[3][1]
For managing erythema (facial redness), health care practitioners may prescribe topical medications that constrict superficial blood vessels, such as brimonidine and oxymetazoline. These medications work quickly, often within 30 minutes, with effects lasting for up to 12 hours.[1][6]
For reducing papules and pustules, health care practitioners may turn to medications with anti-inflammatory and anti-microbial properties. Topical medications like ivermectin, azelaic acid, metronidazole, and minocycline are often tried first. If topical medications fail to control symptoms, health care practitioners may prescribe oral medications such as tetracycline antibiotics or isotretinoin. All of these medications work slowly over time when used consistently.[1][6]
For eye irritation, health care practitioners may prescribe eye ointments containing cyclosporine or antibiotics, lubricating eye drops, as well as some of the oral therapies previously mentioned.[1]
Finally, health care practitioners may recommend lasers and intense pulsed light therapy to help reduce visible blood vessels, redness, and skin thickening (phyma), although skin thickening may sometimes require surgical correction.[3]
Have any supplements been studied for rosacea?
A trial including 130 people with ocular rosacea found supplementation with omega-3 fatty acids (720 mg EPA + 480 mg DHA daily) was effective in reducing symptoms of dry eye (itching, burning, blurred vision, gritty sensation) compared to an olive oil placebo. The effects were notable after 3 to 6 months of supplementation.[7] Further research is needed to strengthen these findings.
Two small trials have assessed the effectiveness of zinc supplementation in rosacea. While one trial found symptom improvements over three months of supplementation, another trial found no improvements compared to placebo.[8][9] Currently, more evidence is needed to support the use of zinc for rosacea.
How could diet affect rosacea?
Well-designed trials assessing the impacts of diet on rosacea are lacking. However, certain foods are frequently reported to trigger flares of rosacea symptoms. Common trigger foods include spicy foods, marinated meats, certain fruits and vegetables (e.g., avocado, banana, tomatoes, citrus fruits), and cheese. Some researchers propose these effects may be due to certain compounds in these foods, such as histamine, capsaicin, and cinnamaldehyde.[6][10][11]
A prospective cohort study in China found that higher adherence to dietary patterns similar to the Mediterranean diet (in this study, higher intake of plants, fish, and monounsaturated fats, and lower intake of animal products and saturated fats) was associated with a reduced incidence of rosacea in non-overweight people (BMI <24.5 kg/m2).[12] Otherwise, the potentially protective effect of diet on rosacea is largely unexplored.
Are there any other treatments for rosacea?
A daily skincare routine alongside medical treatment can help to improve rosacea symptoms by maintaining skin hydration and barrier integrity. This should include a gentle cleanser, an unscented moisturizer containing humectants and barrier lipids (e.g., ceramides, hyaluronic acid), and sunscreen. Skincare products that cause a burning sensation, or trigger symptoms, should be avoided.[13][10]
Some alternative treatments with a less substantial evidence base are being explored. Hydroxychloroquine is a common treatment for some autoimmune diseases, due to its ability to reduce inflammation through immune system modulation. One small trial found that people with rosacea who took oral hydroxychloroquine saw similar improvements in their rosacea symptoms as those who took doxycycline. This effect is supported by mechanistic studies in mice, but more human studies are needed to determine the role of this medication.[14][15]
Topical benzoyl peroxide, an established medication for acne, may also have a role in rosacea. More specifically, preliminary research has found that microencapsulated benzoyl peroxide — a less irritating formulation — may be beneficial for reducing the number of lesions and overall rosacea symptom severity.[3] However, studies using regular topical benzoyl peroxide have shown contradictory results.[1]
What causes rosacea?
Current evidence suggests that rosacea occurs due to some combination of genetic predisposition and environmental influences. People with rosacea are four times as likely to have a relative with rosacea, and a genome-wide association study identified two gene variants strongly associated with rosacea.[16]
The symptoms of rosacea are thought to be caused by immune and neurovascular mechanisms that become dysregulated and overactive, leading to inflammation, redness, and blood vessel remodeling.[3] The factors driving this dysregulation are less clear and likely multifactorial.
Disruptions to the skin microbiome have been observed, and certain skin microbes have been identified as possible triggers for immune activation including Demodex mites, Bacillus oleronius, and Staphylococcus epidermidis.[3][1] A 2017 meta-analysis found that people with rosacea were over 800% more likely to be infested by Demodex mites, and had a greater density of these mites on their facial skin. However, a causal relationship could not be established due to study design.[17]
Examine Database: Rosacea
Research FeedRead all studies
Frequently asked questions
Rosacea is a chronic inflammatory skin condition affecting primarily the cheeks, nose, chin, and forehead. It results in erythema (redness), flushing, telangiectasia (spider veins), and inflamed bumps. Rosacea can also affect the eyes (ocular rosacea) or cause thickening of the skin (phymatous changes). People with rosacea often experience episodes of remission and flare-ups, and some experience worsening of symptoms over time.[1][2]
Unmanaged rosacea symptoms can negatively impact quality of life and psychological well-being, leading to low self-esteem, embarrassment, and an increased risk of anxiety and depression.[3][4] A 2018 meta-analysis estimated the global prevalence of rosacea to be 5.5%, with nearly all cases occurring in adults over 30. Historically it has been thought that women are more frequently affected, but this meta-analysis found no difference in rates between men and women.[5]
Both rosacea and acne can cause inflamed bumps, pimples, and nodules on the skin of the face. Use the table below to identify some distinguishing features:
| Acne | Rosacea | |
|---|---|---|
| Redness | Found around lesions | Affects the entire central face |
| Age | Earlier in life (usually seen during the pre-teen and teenage years) | Later in life (usually seen in ages over 30) |
| Eye symptoms | Not usually present | Often present |
| Visible blood vessels | Not usually present | Often present |
| Blackheads | Often present | Not usually present |
Adapted from the American Academy of Dermatology Association
Lifestyle changes are an important part of rosacea management and involve the identification and avoidance of personal triggers. There are many lifestyle factors promoting blood vessel dilation and/or inflammation that may trigger a flare of rosacea symptoms.
Some of the most common triggers include heat (e.g., hot beverages and food, hot baths, sauna), alcohol, weather (e.g., sunlight, hot/cold weather, strong winds), dietary factors, emotional stress, heavy exercise, topical corticosteroids, and certain personal care products[6][10].
Importantly, triggers are often unique to the individual and it can be helpful to keep a symptom journal to identify personal triggers.[10]
Common symptoms of rosacea include redness, flushing, visible blood vessels, and inflamed bumps (papules and pustules) on the skin of the face which may be accompanied by a burning or stinging sensation. These symptoms primarily affect skin on the cheeks, nose, chin, and forehead, and may be persistent or transient in nature. Flare-ups of flushing and/or erythema are common, and may occur following exposure to a trigger (e.g., heat, sun exposure, alcohol). Some people experience thickening of the skin, usually on the nose — a phenomenon called rhinophyma — which appears as nodular growths and bulbous enlargement of the nose.[3][1]
More than half of people with rosacea experience symptoms in and around the eyes, including dryness, burning, itching, redness, sensitivity to light, inflammation of the eyes or eyelids, and rarely, inflammation of the cornea; the latter can lead to vision loss.[3][1]
A qualified healthcare professional diagnoses rosacea based on clinical observations and patient reporting of signs and symptoms. The global ROSacea COnsensus (ROSCO) panel and the National Rosacea Society have recently updated the classification and diagnosis of rosacea:[3][1]
Having one of the following features is considered diagnostic of rosacea:
- Persistent redness affecting the center of the face with periodic intensification
- Phymatous changes (thickening of the skin with irregular nodules and enlarged pores). In the absence of one of the above features, having at least two of the following features is considered diagnostic:
- Inflammatory papules/pustules
- Telangiectasia (small visible blood vessels)
- Flushing
- Ocular manifestations (symptoms affecting the eyes/eyelids)
Previously, a diagnosis of rosacea involved categorization into one of four subtypes:
- Erythematotelangiectatic (flushing, redness, visible blood vessels)
- Papulopustular (papules, pustules, redness, inflammation)
- Phymatous (nodular growths, bulbous nose, dilated follicles)
- Ocular (eye irritation/sensitivity, scaly/red eyelids, eye inflammation)
However, current recommendations have moved away from subtyping, as people with rosacea often experience overlaps between subtypes and progression from one subtype to another. [11][6]
Rosacea is a chronic condition, meaning that treatments are not curative but rather help to manage symptoms. Treatment should be managed by a health care practitioner, and tailored to the individual’s current symptoms. Given that symptoms of rosacea can vary between people and even within the same person over time, practitioners will generally focus on addressing the symptoms most bothersome to the individual at that time. Management options include both oral and topical (applied to the skin) medications and laser and light-based therapies.[3][1]
For managing erythema (facial redness), health care practitioners may prescribe topical medications that constrict superficial blood vessels, such as brimonidine and oxymetazoline. These medications work quickly, often within 30 minutes, with effects lasting for up to 12 hours.[1][6]
For reducing papules and pustules, health care practitioners may turn to medications with anti-inflammatory and anti-microbial properties. Topical medications like ivermectin, azelaic acid, metronidazole, and minocycline are often tried first. If topical medications fail to control symptoms, health care practitioners may prescribe oral medications such as tetracycline antibiotics or isotretinoin. All of these medications work slowly over time when used consistently.[1][6]
For eye irritation, health care practitioners may prescribe eye ointments containing cyclosporine or antibiotics, lubricating eye drops, as well as some of the oral therapies previously mentioned.[1]
Finally, health care practitioners may recommend lasers and intense pulsed light therapy to help reduce visible blood vessels, redness, and skin thickening (phyma), although skin thickening may sometimes require surgical correction.[3]
A trial including 130 people with ocular rosacea found supplementation with omega-3 fatty acids (720 mg EPA + 480 mg DHA daily) was effective in reducing symptoms of dry eye (itching, burning, blurred vision, gritty sensation) compared to an olive oil placebo. The effects were notable after 3 to 6 months of supplementation.[7] Further research is needed to strengthen these findings.
Two small trials have assessed the effectiveness of zinc supplementation in rosacea. While one trial found symptom improvements over three months of supplementation, another trial found no improvements compared to placebo.[8][9] Currently, more evidence is needed to support the use of zinc for rosacea.
Well-designed trials assessing the impacts of diet on rosacea are lacking. However, certain foods are frequently reported to trigger flares of rosacea symptoms. Common trigger foods include spicy foods, marinated meats, certain fruits and vegetables (e.g., avocado, banana, tomatoes, citrus fruits), and cheese. Some researchers propose these effects may be due to certain compounds in these foods, such as histamine, capsaicin, and cinnamaldehyde.[6][10][11]
A prospective cohort study in China found that higher adherence to dietary patterns similar to the Mediterranean diet (in this study, higher intake of plants, fish, and monounsaturated fats, and lower intake of animal products and saturated fats) was associated with a reduced incidence of rosacea in non-overweight people (BMI <24.5 kg/m2).[12] Otherwise, the potentially protective effect of diet on rosacea is largely unexplored.
A daily skincare routine alongside medical treatment can help to improve rosacea symptoms by maintaining skin hydration and barrier integrity. This should include a gentle cleanser, an unscented moisturizer containing humectants and barrier lipids (e.g., ceramides, hyaluronic acid), and sunscreen. Skincare products that cause a burning sensation, or trigger symptoms, should be avoided.[13][10]
Some alternative treatments with a less substantial evidence base are being explored. Hydroxychloroquine is a common treatment for some autoimmune diseases, due to its ability to reduce inflammation through immune system modulation. One small trial found that people with rosacea who took oral hydroxychloroquine saw similar improvements in their rosacea symptoms as those who took doxycycline. This effect is supported by mechanistic studies in mice, but more human studies are needed to determine the role of this medication.[14][15]
Topical benzoyl peroxide, an established medication for acne, may also have a role in rosacea. More specifically, preliminary research has found that microencapsulated benzoyl peroxide — a less irritating formulation — may be beneficial for reducing the number of lesions and overall rosacea symptom severity.[3] However, studies using regular topical benzoyl peroxide have shown contradictory results.[1]
Current evidence suggests that rosacea occurs due to some combination of genetic predisposition and environmental influences. People with rosacea are four times as likely to have a relative with rosacea, and a genome-wide association study identified two gene variants strongly associated with rosacea.[16]
The symptoms of rosacea are thought to be caused by immune and neurovascular mechanisms that become dysregulated and overactive, leading to inflammation, redness, and blood vessel remodeling.[3] The factors driving this dysregulation are less clear and likely multifactorial.
Disruptions to the skin microbiome have been observed, and certain skin microbes have been identified as possible triggers for immune activation including Demodex mites, Bacillus oleronius, and Staphylococcus epidermidis.[3][1] A 2017 meta-analysis found that people with rosacea were over 800% more likely to be infested by Demodex mites, and had a greater density of these mites on their facial skin. However, a causal relationship could not be established due to study design.[17]
Most consistently, rosacea has been found to be associated with an increased risk of inflammatory bowel diseases (IBD). This relationship is supported by two 2019 meta-analyses of observational studies and a nationwide cohort study in Denmark.[18][19][20] While the mechanisms underlying this connection are unclear, both disease states involve dysfunction of the immune system and chronic inflammation.[19]
Small intestinal bacterial overgrowth (SIBO) has been suggested by some, but not all, studies to be more common in people with rosacea. Despite these inconsistent findings, treatment of SIBO with the antibiotic rifaximin has been found in multiple trials to improve symptoms of rosacea, with effects persisting for months to years.[21][22][23]. Rifaximin acts locally in the gut, and is not thought to influence systemic inflammation, unlike the other antibiotics used in rosacea management.[23]
Rosacea may be associated with an increased risk of celiac disease, and this relationship is further supported by a genome-wide association study that found that rosacea and celiac disease share two genetic risk markers.[23]
While H. pylori infection has been suggested to contribute to rosacea, this is controversial and not strongly supported by the evidence. One meta-analysis of observational studies reported a small, but not statistically significant, positive association between rosacea and H. pylori infection, while another meta-analysis of observational studies and a nationwide cohort study did not find a significant relationship. Any improvement in rosacea symptoms following treatment for H. pylori infection could, in theory, be attributed to the anti-inflammatory effects of the antibiotics.[24][20][23]
Update History
FAQs added
Research written by
Edited by
Reviewed by
References
- ^van Zuuren EJ, Fedorowicz Z, Tan J, van der Linden MMD, Arents BWM, Carter B, Charland LInterventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments.Br J Dermatol.(2019-Jul)
- ^Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, Thiboutot DStandard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee.J Am Acad Dermatol.(2018-Jan)
- ^van Zuuren EJ, Arents BWM, van der Linden MMD, Vermeulen S, Fedorowicz Z, Tan JRosacea: New Concepts in Classification and Treatment.Am J Clin Dermatol.(2021-Jul)
- ^Chang HC, Huang YC, Lien YJ, Chang YSAssociation of rosacea with depression and anxiety: A systematic review and meta-analysis.J Affect Disord.(2022-Feb-15)
- ^Gether L, Overgaard LK, Egeberg A, Thyssen JPIncidence and prevalence of rosacea: a systematic review and meta-analysis.Br J Dermatol.(2018-Aug)
- ^Zhu W, Hamblin MR, Wen XRole of the skin microbiota and intestinal microbiome in rosacea.Front Microbiol.(2023)
- ^Bhargava R, Chandra M, Bansal U, Singh D, Ranjan S, Sharma SA Randomized Controlled Trial of Omega 3 Fatty Acids in Rosacea Patients with Dry Eye Symptoms.Curr Eye Res.(2016-Oct)
- ^Sharquie KE, Najim RA, Al-Salman HNOral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled studyInt J Dermatol.(2006 Jul)
- ^Bamford JT, Gessert CE, Haller IV, Kruger K, Johnson BPRandomized, double-blind trial of 220 mg zinc sulfate twice daily in the treatment of rosaceaInt J Dermatol.(2012 Apr)
- ^Thiboutot D, Anderson R, Cook-Bolden F, Draelos Z, Gallo RL, Granstein RD, Kang S, Macsai M, Gold LS, Tan JStandard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee.J Am Acad Dermatol.(2020-Jun)
- ^Alia E, Feng HRosacea pathogenesis, common triggers, and dietary role: The cause, the trigger, and the positive effects of different foods.Clin Dermatol.(2022)
- ^Chen P, Yang Z, Fan Z, Wang B, Tang Y, Xiao Y, Chen X, Luo D, Xiao S, Li J, Xie H, Shen MAssociations of adherence to Mediterranean-like diet pattern with incident rosacea: A prospective cohort study of government employees in China.Front Nutr.(2023)
- ^Hilary Baldwin, Andrew F Alexis, Anneke Andriessen, Diane S Berson, Patricia Farris, Julie Harper, Edward Lain, Shari Marchbein, Linda Stein Gold, Jerry TanEvidence of Barrier Deficiency in Rosacea and the Importance of Integrating OTC Skincare Products into Treatment RegimensJ Drugs Dermatol.(2021 Apr 1)
- ^Ben Wang, Xin Yuan, Xin Huang, Yan Tang, Zhixiang Zhao, Bin Yang, Baoqi Yang, Yue Zheng, Chao Yuan, Hongfu Xie, Ji LiEfficacy and safety of hydroxychloroquine for treatment of patients with rosacea: A multicenter, randomized, double-blind, double-dummy, pilot studyJ Am Acad Dermatol.(2021 Feb)
- ^Li J, Yuan X, Tang Y, Wang B, Deng Z, Huang Y, Liu F, Zhao Z, Zhang YHydroxychloroquine is a novel therapeutic approach for rosacea.Int Immunopharmacol.(2020-Feb)
- ^Chang ALS, Raber I, Xu J, Li R, Spitale R, Chen J, Kiefer AK, Tian C, Eriksson NK, Hinds DA, Tung JYAssessment of the genetic basis of rosacea by genome-wide association study.J Invest Dermatol.(2015-Jun)
- ^Chang YS, Huang YCRole of Demodex mite infestation in rosacea: A systematic review and meta-analysis.J Am Acad Dermatol.(2017-Sep)
- ^Han J, Liu T, Zhang M, Wang AThe relationship between inflammatory bowel disease and rosacea over the lifespan: A meta-analysis.Clin Res Hepatol Gastroenterol.(2019-Aug)
- ^Wang FY, Chi CCAssociation of rosacea with inflammatory bowel disease: A MOOSE-compliant meta-analysis.Medicine (Baltimore).(2019-Oct)
- ^Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JPRosacea and gastrointestinal disorders: a population-based cohort study.Br J Dermatol.(2017-Jan)
- ^Andrea Parodi, Stefania Paolino, Alfredo Greco, Francesco Drago, Carlo Mansi, Alfredo Rebora, Aurora Parodi, Vincenzo SavarinoSmall intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradicationClin Gastroenterol Hepatol.(2008 Jul)
- ^Drago F, De Col E, Agnoletti AF, Schiavetti I, Savarino V, Rebora A, Paolino S, Cozzani E, Parodi AThe role of small intestinal bacterial overgrowth in rosacea: A 3-year follow-up.J Am Acad Dermatol.(2016-Sep)
- ^Wang FY, Chi CCRosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut-Skin Axis of Rosacea.Adv Ther.(2021-Mar)
- ^Jørgensen AR, Egeberg A, Gideonsson R, Weinstock LB, Thyssen EP, Thyssen JPRosacea is associated with Helicobacter pylori: a systematic review and meta-analysis.J Eur Acad Dermatol Venereol.(2017-Dec)
Examine Database References
- Rosacea Symptoms - Bamford JT, Gessert CE, Haller IV, Kruger K, Johnson BPRandomized, double-blind trial of 220 mg zinc sulfate twice daily in the treatment of rosaceaInt J Dermatol.(2012 Apr)
- Rosacea Symptoms - Sharquie KE, Najim RA, Al-Salman HNOral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled studyInt J Dermatol.(2006 Jul)