What Is Rosacea? Symptoms, Treatment, Images, and Prevention

If you’ve ever had facial flushing that doesn’t seem to go away, or if the skin on your face burns and itches, you may have rosacea. This skin condition, pronounced “roh-zey-sha,” is relatively common among adults.

Rosacea is also commonly confused with other skin conditions. Here we’ll review the signs and symptoms of rosacea, as well as its many treatment options.

What is rosacea?

Rosacea is a chronic skin condition that affects about 1 in 20 people worldwide. It causes a pimple-like rash with red or purple skin discoloration on the cheeks and nose. The rash usually itches and burns. Rosacea symptoms often come and go, but triggers like stress, alcohol, and sunlight, can make things worse. 

Rosacea can also affect the eyes — this is called ocular (eye) rosacea. Eye rosacea causes swollen, itchy eyes that can feel gritty and sensitive to light. 

A group of experts developed a classification system for rosacea based on common symptoms. Various combinations of the rosacea symptoms that affect the skin and eyes can help diagnose the unique rosacea pattern for each person.

Types of rosacea

Historically, rosacea was divided into four subtypes depending on different symptoms:

• Erythematotelangiectatic rosacea includes flushing and redness. People with darker skin tones may only feel flushing and not see a color change.
  

  

• Papular-pustular rosacea includes pimple-like bumps that come and go. In darker skin tones, this type of rosacea may not be as obvious, as the bumps can look more like the color of the skin.
  

  

• Phymatous rosacea includes thickening of the skin (most commonly on the nose). 
  

  

• Ocular rosacea affects the eyes and causes redness, burning, stinging, and light sensitivity. The sclera (white part of the eye) can look inflamed and red (conjunctival injection). Ocular rosacea can also cause irritated pink bumps along the eyelids.
  

  

Rosacea symptoms

Rosacea can start with frequent facial flushing or a warm feeling that takes time to go away. Over time, the symptoms last longer and longer, and they often progress into skin bumps or thickening.

Rosacea signs and symptoms can vary from person to person, and they may look different in different skin tones.

Here are some common features: 

• In lighter skin, easy and frequent blushing, flushing, or lasting redness like a sunburn that doesn’t go away

• In darker skin tones, a warm feeling that doesn’t go away, or a dusky brown discoloration 

• Facial burning, stinging, dryness, or itching 

• Thickening of the skin, more common in men and on the nose

• Red or yellowish-brown bumps or pimples

• Dry, irritated eyes and the feeling like there’s sand in your eyes

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• Have a flushed face? Rosacea isn’t the only cause. Read about the top causes of a red face. 

• Not all face bumps are acne or rosacea. From cysts to infections, learn the most common cause of facial bumps — with pictures.

• What’s the best treatment for rosacea? Understand your treatment options, including the best creams, gels, and laser therapies.

Regardless of which combination of symptoms you have, rosacea can significantly affect your quality of life. Surveys suggest that as many as 9 out of 10 people report having rosacea lowered their self-esteem. 

Is it rosacea or something else?

The symptoms of rosacea aren’t unique to rosacea. This can make it hard to tell if it’s rosacea or something else, like acne, eczema, or even lupus. 

Symptoms of rosacea vs. acne vs. lupus vs. eczema

Here are common symptoms of other rashes that can look like rosacea. An expert exam by a dermatologist may be helpful to make a diagnosis.           

Rosacea

Rosacea leads to lasting redness and burning as well as smooth bumps, often on the forehead, cheeks, and chin. In darker skin, rosacea appears pink to purplish, while in fair skin it looks pink and red.

Acne 

Acne can lead to whiteheads, blackheads, and some red or brown bumps on the face, chest, and back that eventually become whiteheads or blackheads. Acne in darker skin causes brown to violet pimples. In fair skin, the pimples look pinkish.

Eczema

Eczema leads to skin that’s red or brown, itchy, scaly, rough, and flaky. This mostly occurs in the folds of the skin (neck, arms, behind the knees), but it can also appear on the face. Eczema doesn’t cause pus bumps. It looks red in lighter skin, and in darker skin it can cause darker patches.

Lupus 

Lupus can lead to lightly red or violet patches on the cheeks that worsen with sun exposure. It doesn’t cause acne bumps. In fair skin, lupus appears like bright red patches on the face that can look like a sunburn. In darker skin, lupus can cause scaly patches that range from pink to brown in color.

Comparison chart

What causes rosacea?

Scientists don’t know exactly what causes rosacea. So far, research suggests that it’s probably a combination of different factors, such as:

• An overactive immune response that causes inflammation

• Hereditary factors (meaning it can run in families)

• Your environment (like repeated unprotected sun exposure)

• Widening of small blood vessels in the skin, which can make flushing more noticeable and also create a background of redness

• Demodex mites, microorganisms that live on everyone’s skin but can overgrow in some people

Who is most prone to rosacea?

Rosacea is more likely in people who:

• Are age 30 years or older

• Are born female

• Have fair skin and blond hair

• Have a history of acne 

That said, anyone of any age or background can develop rosacea.

Rosacea treatment

There are many good treatment options for rosacea, including different creams, pills, and lasers. The treatment you use depends on your symptoms and needs. In general, creams and gels are a first step. Pills can be a second, add-on step if symptoms persist.

There isn’t a one-size-fits-all treatment, and your medical provider can help you figure out the best treatment combination that’s right for you.

Creams that treat rosacea pimples

These creams and gels help treat and prevent the pimples associated with rosacea: 

• Azelaic acid (Finacea) helps lower inflammation and is available in over-the-counter (OTC) and prescription strengths. 

• Metronidazole (Metrogel) is a prescription antibiotic available as a cream, lotion, or gel, and it helps lower inflammation. 

• Ivermectin (Soolantra) is a prescription antiparasitic cream that kills demodex and helps lower inflammation. 

• Sodium sulfacetamide / sulfur is an antibiotic that helps lower inflammation and is available in OTC and prescription strengths. 

• Retinoids are prescription medications related to vitamin A. They can help treat rosacea pimples, and they’re available in different strengths and formulations. 

Creams that reduce redness and flushing

These prescription creams help lower the redness and flushing associated with rosacea by causing small blood vessels to constrict (narrow): 

• Brimonidine (Mirvaso)

• Oxymetazoline (Rhofade)

Some people can experience rebound flushing when they stop these medications, and they may need additional treatment. 

Pills that treat rosacea pimples

For more serious rosacea pimples, prescription pills can work to get symptoms under control quickly — while continuing with the creams. People can usually stop taking the pills after a few months once symptoms have lessened — and then continue with just the creams.

Pills that can treat rosacea pimples include:   

• Oracea (low-dose doxycycline) is the only FDA-approved antibiotic used to treat rosacea. 

• Minocycline, azithromycin, and trimethoprim / sulfamethoxazole are other antibiotics that are sometimes used off-label to treat rosacea. 

• Isotretinoin is an oral retinoid that can be used when rosacea is very severe and other treatments don’t work. 

Lasers and light devices

Cosmetic laser treatments help destroy widened blood vessels and reverse lasting redness. They are often combined with prescription medications for better results.

Does rosacea go away on its own? 

No, rosacea doesn’t usually go away on its own. But with consistent treatment and lifestyle changes, you can improve rosacea symptoms and avoid flare-ups.

Rosacea triggers: How to prevent or reduce the chances of a rosacea flare-up

In addition to prescriptions, there are plenty of do-it-yourself solutions. This involves avoiding triggers to help prevent and relieve your rosacea flare-ups. 

Here are some common rosacea triggers:

• Sunlight: Sun exposure can worsen rosacea. So it’s important to protect yourself from the sun. Whenever going out in the sun, use sunscreen, hats, and protective clothing to avoid a flare-up. 

• Hot and spicy foods: Diet can play a big role in rosacea flares. Avoid hot and spicy foods, which lead to increased heat and also swollen and irritated blood vessels. 

• Lack of fiber: Research suggests that a diet high in fiber can improve gut health and also help prevent rosacea.

• Alcohol and hot beverages: Hot drinks, like coffee and tea, can cause rosacea flare-ups. So try to avoid them, or wait for them to cool down to room temperature. Alcohol has also been reported as a trigger for many people with rosacea.

If you’re avoiding triggers, but you’re still struggling with symptoms, be sure to speak with your medical provider. They can help you understand treatment options and come up with a skin care plan that works for you.

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Written by:

Alina Goldenberg, MD, MAS, FAAD

Alina Goldenberg, MD, MAS, FAAD, is a board-certified dermatologist in private practice. She is also an assistant clinical professor in the Department of Internal Medicine at the University of California, Riverside School of Medicine.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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Images used with permission from VisualDx (www.visualdx.com)