UNIVERSITY STUDENT HEALTH SERVICES • Fact Sheet
ROSACEA
WHAT IS IT?
Rosacea is a poorly understood, chronic skin condition that undergoes periods of relapse and remission.
It commonly causes redness and pimples on the “blush” areas of the face (particularly the nose, cheeks,
chin, and forehead). For this reason, it is sometimes called “adult acne”. Rosacea is a benign skin
condition but can be potentially life-disruptive if symptoms are severe. Symptoms involving the eyes must
be treated to prevent complications.
WHAT CAUSES IT?
The exact cause is still unknown, and research is ongoing. The main underlying problem seems to
involve abnormal dilation of the small blood vessels of the face, which leads to frequent flushing or
blushing. Suspected causes include:
• Genetics, possibly in combination with sun exposure
• Changes in normal skin bacteria
• Co-infection of the stomach with the H. pylori bacteria (a bacterium associated with acid reflux
symptoms and ulcers)
• Infection with microscopic mites found in hair follicles
WHAT ARE SOME TRIGGERS?
A variety of factors are known to trigger rosacea flares:
• Sun exposure
• Changes in the weather, like extremes in temperature, strong winds, or a change in humidity
• Strenuous exercise or heat
• Alcohol, smoking, hot beverages, and spicy foods
• Emotional factors, such as stress, fear, anxiety, embarrassment, etc.
• Holidays, particularly Christmas and New Year's
HOW COMMON IS IT?
Rosacea affects about 5% of the US population, usually adults aged 30-50. It is more common in women
but tends to be more severe in men. Those who are fair-skinned are more likely to suffer from this
condition. Persons of Irish, English, Scottish, Scandinavian, or Eastern European descent have a greater
incidence of the disease.
WHAT ARE THE SYMPTOMS?
• In the early stage, it is characterized by frequent flushing in the central portion of the face.
• As it progresses, rosacea causes prolonged redness, and the face may become swollen and warm.
• Over time, dilated surface blood vessels (telangiectasias) can develop, as well as red bumps
(papules) and pustules.
• 50% of people can experience dry, burning, itchy, or “gritty” eyes. They may also experience redness
of the eyelids and sensitivity to light. Untreated eye symptoms can lead to damage of the cornea and
impaired vision.
• In the most advanced stages, painful firm nodules develop. Men can experience a condition called
rhinophyma, in which the nose becomes enlarged, red, and bulbous. This is caused by the
enlargement of oil-producing glands under the skin’s surface. Rhinophyma is rarely seen in women.
Some people may develop this same thickening on the chin, cheeks, and forehead.
HOW IS IT DIAGNOSED?
The diagnosis of rosacea is based primarily on your symptoms. No specific diagnostic tests are available.
(over)
WHAT IS THE TREATMENT?
There are various treatments available for rosacea. While there is no cure, regular treatment can lead to
fewer relapses and less severe disease.
General Facial Care
• The first step is to avoid triggers that lead to symptoms.
• Treat your face gently. Never use rough washcloths. Avoid pulling or stretching the skin.
• Use a gentle cleanser to wash the face twice a day. Over-washing may cause irritation.
• Use sunscreen (at least 30 SPF) consistently. Apply it 15 minutes after topical medicines.
• Avoid facial products containing alcohol.
• Use “noncomedogenic” products on your face.
• If you wear make-up, use green-tinted creams prior to your foundation, as this counteracts the
redness in your skin.
• Protect your face from the cold by wearing a scarf or ski mask.
Medications
Initial Therapy
• The initial treatments of choice are topical benzoyl peroxide or antibiotics.
o Benzoyl peroxide (2.5% to 10%) used once or twice daily can help with inflammation. It is also
commonly used for acne.
o Topical antibiotics include metronidazole, erythromycin, clindamycin, and sulfa-based creams.
Antibiotics (both topical applications and pills) are believed to be effective because of their antiinflammatory effects as opposed to their anti-infective qualities. As a rule, if topical antibiotics
help, they are preferred over antibiotic pills because of the decreased likelihood of developing
antibiotic resistance. It often takes 4-6 weeks after starting treatment to notice an improvement.
Topical metronidazole used once a day is effective for maintaining remission in many patients.
• Finacea is another cream that can be used for mild to moderate rosacea.
• Steroid creams may reduce redness but should only be used for short periods of time. Strong steroid
creams should be avoided on the face. Long-term use of topical steroids can worsen rosacea.
Persistent Symptoms
• Retin-A cream can be used in patients with pimple-like or pustular lesions that are not responding to
the above treatments. It can be used in combination with topical antibiotics if needed.
• Oral antibiotics are useful in patients with nodular lesions or patients with eye symptoms. They
include tetracycline, minocycline, erythromycin, and doxycycline. They may be used initially with
topical antibiotics, then should be slowly tapered off or to the lowest effective dose. They may be
restarted with flares.
• Eye symptoms should be evaluated by an ophthalmologist. Treatment usually consists of careful
eyelid hygiene, warm compresses, and antibiotics. More severe cases may require steroid eye
drops.
• Isotretinoin (Accutane) can be prescribed by a dermatologist in severe cases to decrease the oil
production of the sebaceous glands. However, close physician monitoring and blood testing are
necessary due to the risk of serious side effects.
Procedures
• Laser and intense-light treatments can be used to treat redness and noticeable blood vessels on the
face, neck, and chest. Laser treatment may cause some discomfort, and multiple treatments are
usually necessary. Treatments may be combined with photodynamic therapy (light-activated
chemicals) for improved results.
• Scalpel, laser, or electro surgery can be used to remove excess tissue in patients with rhinophyma.
RECOMMENDED WEBSITES:
• www.rosacea.org
• www.aad.org
• www.niams.nih.gov
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Published by VCU Division of Student Affairs and Enrollment Services
University Student Health Services (804) 828-8828 - Monroe Park Campus clinic
(804) 828-9220 - MCV Campus clinic
Wellness Resource Center
(804) 828-9355 - 815 S. Cathedral Place
Reviewed 8/11