Rosacea

Overview

Rosacea is a chronic inflammatory skin condition causing persistent redness, flushing, visible blood vessels, and sometimes spots on the face, predominantly on the cheeks, nose, chin, and forehead. It follows a relapsing course with flares triggered by various factors. It is not contagious and does not scar, but can significantly affect self-confidence.

How common is it?

Rosacea is more common in women and people with lighter skin, although it can affect darker skin and may be harder to recognise. Symptoms can be more severe in men.

Causes and risk factors

Rosacea involves dysregulation of innate immunity in the skin, vascular reactivity, and abnormal responses to environmental triggers. Demodex mite overpopulation and dysbiosis of the skin microbiome are also implicated.

Common risk factors

• Genetic predisposition and fair skin
• Triggers: alcohol, hot drinks, spicy food, extremes of temperature, sun exposure, exercise, emotional stress, certain skin products
• Demodex folliculorum mite overgrowth
• H. pylori infection (weaker association)
• Abnormal kallikrein 5 and cathelicidin peptide levels in skin causing neurogenic inflammation

Symptoms

• Persistent facial redness, sometimes with warmth, burning or stinging; redness can be less visible on brown or black skin.
• Flushing triggered by specific stimuli
• Visible broken blood vessels (telangiectasia)
• Papules and pustules on the face (resembling acne but without blackheads) — papulopustular type
• Skin thickening and enlargement of the nose (rhinophyma) — phymatous type, predominantly in men
• Eye redness, dryness or irritation can occur. Pain, light sensitivity, blurred vision, or a red/gritty eye needs urgent assessment.

When to see a doctor

Arrange assessment for persistent facial symptoms. Seek urgent medical assessment for eye pain, blurred vision, light sensitivity, or a red or gritty eye; these can signal keratitis and should not wait for a routine dermatology appointment.

Diagnosis

Clinical diagnosis based on characteristic facial distribution and morphology. No specific blood tests or skin biopsies needed in typical cases.

Treatments

Self-care and lifestyle

• Identify and avoid personal triggers using a diary
• Use a high-SPF (30 to 50) broad-spectrum sunscreen every day
• Use gentle, fragrance-free skincare products
• Apply a green-tinted primer to neutralise redness cosmetically if needed

Prevention

Rosacea cannot reliably be prevented. Sun protection, gentle skincare and avoiding personal triggers can help control flares; they do not guarantee that the condition will stop progressing.