Rosacea is a chronic skin condition that affects millions of people worldwide, most commonly manifesting as facial redness, visible capillaries, and skin sensitivity. Although not life-threatening, rosacea can significantly impact quality of life, particularly emotional and social well-being. Due to its complexity and various manifestations, timely recognition and treatment are crucial for symptom control and preventing complications. In this article, we will explain everything you need to know about rosacea, from its causes and symptoms to treatment options and daily skincare.
What is rosacea?
Rosacea is a chronic inflammatory skin condition that primarily affects the face, especially the central areas such as the cheeks, nose, chin, and forehead. This condition is characterized by redness that can be transient or permanent, dilated capillaries, and the appearance of papules and pustules that often resemble acne. In some cases, rosacea can cause thickened skin, most commonly on the nose. Although rosacea is more common in people with fair skin and middle age, it can affect people of all skin types and races. One of the key features of rosacea is its chronic nature—symptoms occur in phases, with periods of flare-ups and remission. Without appropriate treatment, symptoms can worsen over time, making this condition not just an aesthetic issue but also a significant challenge for the quality of life of those affected.
Types of rosacea
Rosacea is classified into four main types, depending on symptoms and severity. Each type has its own characteristics and requires different treatment approaches.
Erythematotelangiectatic rosacea (ETR)
This is the most common form of rosacea and often the first stage of the disease. It is characterized by persistent or occasional facial redness, sensitive skin prone to irritation, and visible capillaries (telangiectasia). People with ETR rosacea often experience a burning or itching sensation, especially after exposure to triggers such as heat, stress, or certain foods.
Papulopustular rosacea
This type of rosacea is often mistaken for acne due to the appearance of red bumps (papules) and pus-filled pimples (pustules). Unlike acne, papulopustular rosacea does not have blackheads. This condition can cause a feeling of tightness and skin sensitivity, usually affecting individuals with existing redness.
Phymatous rosacea
Phymatous rosacea is a rarer but more severe form of the disease. It is characterized by thickened and irregular skin texture, most commonly on the nose (rhinophyma). This type of rosacea is more common in men and, in addition to the nose, can affect the cheeks, chin, forehead, or ears. Without treatment, symptoms can become very pronounced, causing aesthetic and functional problems.
Ocular rosacea
Rosacea does not only affect the skin but also the eyes. Ocular rosacea manifests as redness, dryness, burning, and a sensation of a foreign body in the eyes. In severe cases, it can cause blepharitis (inflammation of the eyelids) or keratitis (inflammation of the cornea), requiring urgent medical intervention to prevent complications that threaten vision.
Combination of types
In many patients, rosacea symptoms do not belong exclusively to one type but combine features of several types. For example, a person may have persistent redness (ETR) and papules (papulopustular rosacea) or eye symptoms along with other forms of the disease. Therefore, an individualized treatment approach tailored to the patient’s specific symptoms is crucial.
Why is early recognition of rosacea important?
Rosacea is a condition that cannot be completely cured, but symptoms can be successfully controlled with timely treatment and appropriate skin care. If left untreated, rosacea can cause permanent changes in the skin and complications such as rhinophyma or eye problems. Early recognition and lifestyle adjustments are key to reducing the frequency and intensity of symptoms.
What are the causes of rosacea?
Rosacea is a complex skin condition whose causes are still not fully understood. However, experts believe it is a combination of genetic, immunological, and environmental factors that lead to an inflammatory skin reaction. This combination makes rosacea a specific and challenging condition to treat, as symptoms often worsen under the influence of various external and internal triggers.
Genetic predisposition
Individuals with a family history of rosacea are more prone to developing this condition. Genetic factors influence the sensitivity of blood vessels, causing them to overreact to stimuli. This genetic predisposition can also affect how the immune system responds to microorganisms and inflammatory processes in the skin. Although genetic predisposition alone does not cause rosacea, it increases the risk of symptoms when other triggers are present.
Association with microorganisms
An increased presence of Demodex folliculorum mites, which naturally live on human skin, is often associated with rosacea. In individuals with rosacea, the number of these mites is significantly higher than in those without the condition. Mites can irritate the skin and trigger an immune response, while the bacterium Bacillus oleronius, found in these mites, further promotes inflammation. This association highlights the importance of antimicrobial treatments in controlling rosacea symptoms.
Skin hypersensitivity
The skin of individuals with rosacea tends to overreact to everyday stimuli. This hypersensitivity is often the result of a compromised skin barrier, allowing irritants such as UV rays, heat, cold, and harsh cosmetic ingredients to penetrate more easily. People with rosacea frequently report burning, itching, or tightness of the skin after exposure to such stimuli, emphasizing the need for gentle and specifically tailored skincare.
Immune system dysfunction
An excessive immune response is a key factor in the development of rosacea. The skin of people with this condition often produces excessive amounts of antimicrobial peptides, such as cathelicidins, which promote inflammation. This leads to blood vessel dilation, redness, and tissue damage. Immune system dysfunction may also explain why rosacea often coexists with other inflammatory skin conditions, such as atopic dermatitis or seborrheic dermatitis.
Triggers
Many external and internal factors can trigger or worsen rosacea symptoms. Some common triggers include:
- Sunlight: UV rays damage the skin and increase blood vessel sensitivity.
- Stress: Psychological stress releases hormones that can worsen redness and inflammation.
- Food and drink: Spicy foods, alcohol (especially red wine), and caffeine often exacerbate symptoms.
- Extreme temperatures: Cold, wind, heat, and sudden temperature changes often cause blood vessels to dilate and redden.
- Physical exertion: Intense exercise can cause redness due to increased blood flow.
- Cosmetics and skincare products: Products with irritating ingredients such as alcohol, fragrances, and sulfates can provoke a skin reaction.
Identifying and avoiding triggers is crucial for controlling rosacea symptoms. Each person has different triggers, so it is important to keep a journal to recognize the causes of symptom flare-ups.
Hormonal influences
Hormonal changes, such as those occurring during pregnancy, menopause, or the menstrual cycle, can also affect the development or worsening of rosacea. Hormones such as estrogen and progesterone affect blood flow and skin sensitivity, which can cause redness and inflammation.
Why are the causes important for treatment?
Understanding the causes of rosacea is crucial for successfully managing its symptoms. While genetic and immunological factors cannot be changed, avoiding triggers, using appropriate skincare, and targeted treatment can significantly reduce the frequency and intensity of symptoms.
What are the symptoms of rosacea?
Rosacea symptoms can vary significantly depending on the type and severity of the condition. People with rosacea often notice symptom progression over time, with periods of flare-ups and remission. Early recognition of these symptoms is key to timely treatment and disease control. Below is a detailed overview of the most common rosacea symptoms:
Facial redness
One of the first and most common signs of rosacea is facial redness, also known as “flushing.” This redness typically starts as a temporary flush triggered by factors such as stress, sunlight, or spicy foods. Over time, the redness can become permanent, especially on the cheeks, nose, forehead, and chin. This persistent redness results from dilated blood vessels in the skin, caused by inflammation and damage.
Visible capillaries (telangiectasia)
Dilated and visible capillaries often accompany persistent redness in people with rosacea. These capillaries are most pronounced on the cheeks and nose and are caused by blood vessel dilation due to inflammation. Telangiectasia not only affects the aesthetic appearance of the skin but can also worsen sensitivity and reactions to stimuli. Laser treatments are often the most effective way to remove these visible blood vessels.
Papules and pustules
Papulopustular rosacea often includes the appearance of red bumps (papules) and pus-filled pimples (pustules) that resemble acne. These skin changes are often painful, sensitive to touch, and may cause a feeling of skin tightness. Unlike acne, rosacea does not involve blackheads, which is one of the key differences between these two conditions. Papules and pustules are often a sign of inflammation in the deeper layers of the skin.
Skin sensitivity
The skin of people with rosacea is often highly sensitive and prone to overreacting to everyday stimuli. Symptoms such as burning, itching, stinging, or tightness are common and may occur after using certain cosmetic products or exposure to UV rays. The skin may also be dry, flaky, or oily, further complicating proper care. This sensitivity requires the use of gentle products free of fragrances and irritating ingredients.
Ocular rosacea symptoms
Ocular rosacea often goes unrecognized, although it may affect up to 50% of people with rosacea. Symptoms include:
- Red eyes: Eyes become bloodshot, irritated, and sensitive to light.
- Dryness and burning: A burning and dry sensation is common and can cause discomfort while blinking.
- Sensation of a foreign body in the eye: Many patients report feeling as if “sand” is in their eyes.
- Inflammation of the eyelids (blepharitis): Eyelids may be red, swollen, and covered with scales.
If untreated, ocular rosacea can lead to more serious issues such as keratitis (inflammation of the cornea), which can threaten vision.
How is rosacea diagnosed?
The diagnosis of rosacea is based on a clinical examination of the skin and recognition of characteristic symptoms. A dermatologist will ask questions about the patient’s medical history, lifestyle, and potential triggers. In some cases, it may be necessary to rule out other conditions, such as acne, allergic reactions, or seborrheic dermatitis.
What are the treatment options?
Treatment for rosacea is tailored to each patient depending on the type and severity of symptoms. The goal is to reduce inflammation, control redness, and prevent the condition from worsening.
- Topical therapy
- Metronidazole: An antimicrobial cream or gel that reduces inflammation.
- Azelaic acid: Helps reduce redness and pimples.
- Brimonidine: A cream that temporarily constricts blood vessels and reduces redness.
- Oral therapy
- Antibiotics (doxycycline): Used to reduce inflammation in more severe cases of rosacea.
- Isotretinoin: Rarely used but effective for treating resistant forms of rosacea.
- Aesthetic treatments
- IPL (intense pulsed light): An effective treatment for reducing redness and visible capillaries.
- Laser treatments: Used to permanently remove dilated capillaries and improve skin texture.
How to manage rosacea in everyday life?
In addition to medical treatments, proper skincare and lifestyle adjustments play a key role in controlling rosacea. Here are some tips:
- Identify triggers: Keep a journal to identify factors that worsen symptoms.
- Use gentle products: Avoid harsh ingredients like alcohol and fragrances.
- Sun protection: Use sunscreen with SPF 30+ to protect sensitive skin.
- Hydration: Moisturizers help maintain the skin’s protective barrier.
Why choose Polyclinic Esthea?
Polyclinic Esthea specializes in facial aesthetic treatments. Our team of dermatologists uses the latest technologies and a personalized approach to ensure optimal results for every patient. With our help, you can find the best solution to control symptoms and enjoy healthy, balanced skin again. Contact us today to schedule a consultation!
Skin care with rosacea – Your first step to healthier skin
Rosacea is a chronic condition that requires professional care and commitment. Timely treatment and proper skincare are essential for reducing symptoms and preventing flare-ups. Don’t wait for symptoms to become severe—seek advice from a dermatologist and take control of your skin’s health.