Rosacea: Types, Symptoms, Causes and Tips

April 22, 2020
Rosacea: Types, Symptoms, Causes and Tips

Rosacea Awareness Month

Rosacea classically presents flushed cheeks, tiny visible blood vessels, with pimples and pustules.  The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month to help educate people on this condition. Rosacea is one of the more common skin conditions that affect around 16 million people in the US alone (NRS). It causes a weakened skin barrier resulting in rosacea flare-ups that can affect people by lowering self-confidence, self-esteem and increasing sensitivity and irritation on the skin. Although this common skin condition affects millions of people worldwide it is often very misunderstood.

What is Rosacea?

Rosacea is a recurring inflammatory skin condition affecting both men and women. The main areas of the face that are affected are the nose, cheeks and chin area. Rosacea can have a genetic component making it more likely to run in families. However, rosacea commonly occurs in people between the ages of 30-50 with fair skin. Previously branded as “Irish Acne”, rosacea was given this name because it often appears for people of northern or eastern European descent with very light-colored skin. The appearance and severity of rosacea can vary vastly from person to person which is why it is essential to understand the types and symptoms of the different kinds of rosacea.

Rosacea Types and Symptoms

There are four types of rosacea:

  • Erythematotelangiectatic Rosacea: This type of rosacea results in visible blood vessels (telangiectasia) appearing on the skin. Additional symptoms include flushing and persistent redness, sensitivity, sense of heat or burning sensation accompanied also by dry, flaky skin.
  • Ocular Rosacea affects your eyeball (yes, your eyeball!). It results in blood shot, water eyes with a feeling of grittiness, stinging sensation, dry, itchy and irritated eyes. Those with ocular rosacea can also have a higher sensitivity to light and in more serious cases, can affect vision.
  • Papulopustular Rosacea: This type of rosacea is more severe and occurs when you get bumps, pimples and pustules on your skin. Symptoms also include oily skin, sensitive skin, acne-like pimples, and raised patches on cheeks, forehead and chin.
  • Rhinophyma Rosacea: Most commonly seen in older men, it mainly affects the nose. This type of end-stage rosacea can cause the nose to change shape due to the sebaceous gland thickening. This is a result of the oil glands being so enlarged that it begins to alter the form of the tissue. It can also thicken the skin of the chin, forehead, cheeks and ears, creating a bumpy, cratered texture.
  • Perioral Dermatitis: A cousin of rosacea, this condition is very common and difficult to treat. Perioral dermatitis occurs when you get sensitive rashes around your mouth or nostrils. Many people think it is a consequence of rosacea, however, it is a very important distinguishing feature that separates it from traditional forms of rosacea. It is often times resistant to treatment and comes in waves.

Rosacea Causes 

The exact cause of rosacea is still unknown however, the best way to describe what is happening, is to think of it as inflammation of the oil glands which are concentrated on the nose, cheek and chin.  This inflammation at the sebaceous gland level causes vasodilation (which means the blood vessels are dilated) so visible cords of blood vessels or superficial redness from the blood flow appear prominent at the surface. Think of it like the “arthritis” of the oil gland.

The second component is skin barrier disruption. The epidermis acts as a fierce barrier to the outside world and the top layer called, the stratum corneum, is essential. When our skin is inflamed, that important barrier is broken down. As a result of a compromised skin barrier, people experience flakiness, dryness and sensitivity in the skin.  Many people with rosacea state that every cream or topical product causes irritation or a stinging sensation. In summary the common features of rosacea include oil secretion, barrier disruption, and vasodilation. This is a multi-factorial problem and one must address all features to see improvement.

Rosacea Treatment

Topical prescription medication is first-line for rosacea and can be highly effective.  The next step in therapy is oral antibiotics like doxycycline and other tetracyclines. These antibiotics are used long-term; and they have potent anti-inflammatory properties that can significantly improve rosacea and peri-oral dermatitis.  Laser therapies, like ones that target blood vessels, are also great for telangiectatic rosacea because if you eliminate the blood vessel bed you can improve the overall condition.

Tips to Control Rosacea

There is no known cure for rosacea but there is way to help reduce flares.

  • Moisturize: Moisturization is an absolute must as it helps to not only protect but restore the skin barrier. It also helps keep irritants off the skin. Try to search for hydrating products with gentle formulas safe for sensitive skin. I like ceramide-containing products, they are easy to find at any drug store. 
  • Be Gentle: Rosacea patients should not use traditional acne products (like benzoyl peroxide or retinols) on rosacea-like acne because it can worsen the irritation due to highly sensitive skin. Ensure the products you use are oil-free and water based. Limit the use of products that contain alcohol, witch-hazel, and exfoliants – all these can inflame the skin and worsen rosacea.
  • Foods and Drinks: Certain foods and drinks can act as a trigger for rosacea. Spicy food, alcohol, and hot beverages can increase vasodilation and therefore potentiate rosacea flares.  
  • Extreme Weather: Any forms of extreme hot, cold, dry, or windy weather can affect rosacea because the harsh conditions affect your skin.
  • Stress: Stress is well-known trigger for acne and rosacea. With rosacea, lowering your stress levels can help reduce rosacea flare-ups.
  • Avoid Direct Sun: UV radiation is a well-known trigger for rosacea and SPF it is the most important therapeutic intervention. Always use a mineral sunscreen (zinc/titanium) every single day - not just when you plan on being in the sun for outdoor activities. Chemical sunscreens are more likely to irritate your skin.

Rosacea affects millions of Americans and people around the world. It is one of the most common and frustrating skin disorders with their multiple treatment modalities.  Although there is no cure, Rosacea can be controlled and minimized with the proper symptom-targeted skin care.If you have any further questions, regarding rosacea please let us know on our Ask Dr. Z page or talk to your dermatologist to learn more about this skin condition and discuss ways in which you can best tailor treatment to help you control rosacea.