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 affects approximately 1 in 10 adults in the UK. It is most common in fair-skinned people of northern European descent and peaks between age 30 and 60. Women are more frequently affected, though men tend to have more severe disease.
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 (erythematotelangiectatic type)
- 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, and irritation (ocular rosacea) in about 50% of patients
When to see a doctor
See a GP or dermatologist for persistent facial redness or spots not responding to over-the-counter skincare. Ocular rosacea requires ophthalmological assessment.
Diagnosis
Clinical diagnosis based on characteristic facial distribution and morphology. No specific blood tests or skin biopsies needed in typical cases.
Treatments
Topical treatments
Azelaic acid (15 to 20% gel or cream) and ivermectin 1% cream are first-line topical treatments for papulopustular rosacea, reducing both erythema and lesions. Metronidazole gel is also effective.
Oral antibiotics
Low-dose doxycycline 40mg modified-release (sub-antimicrobial dose) is most evidence-based — anti-inflammatory rather than antibiotic effect. Used for moderate-to-severe papulopustular rosacea. 12-week courses.
Brimonidine and oxymetazoline gels
Topical alpha-adrenergic agonists reduce facial redness by vasoconstriction within hours. Useful for immediate cosmetic improvement before events.
Laser and IPL
Pulsed dye laser and intense pulsed light (IPL) reduce persistent erythema and telangiectasia that do not respond to topical treatment. Several sessions needed.
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 be prevented but triggers can be minimised. Rigorous daily sunscreen use slows progression of telangiectasia and redness.