ROSACEA – More Than Just a Blush!

What is Rosacea?

Rosacea is a common skin condition which causes the face to become red and inflamed, with enlarged and broken blood vessels and often with spots or bumps which look similar to acne.

Clinical manifestations

The presence of at least one of the following features indicates rosacea:

  • A red, flushed face, particularly on the cheeks, nose, forehead and chin
  • Small red spots and bumps (papules) that may be filled with pus (pustules)
  • Visible small blood vessels on the face, particularly the cheeks and the nose
  • A stinging or burning feeling on the face, or the face feels hot
  • Sensitive skin that is dry and flaky and easily irritated by skincare products, sunscreen or strong sunlight
  • Dry, red, itchy or burning eyes and inflamed eyelids
  • A red, swollen nose with thickened skin that looks like orange peel.

Rosacea usually follows a pre-rosacea stage that involves flushing only!

Risk factors and Triggers

Rosacea is more common in fair-skinned people with blue eyes who have an English or Celtic background, particularly if there is a family history of rosacea.

Rosacea usually affects people between the ages of 30 to 60, with women more often affected than men!

Known triggers include:

  • Emotional stress
  • Extremes of temperature (including hot baths/showers or heated pools/ saunas);
  • Exposure to sunlight
  • Strenuous exercise
  • Hot drinks, Alcohol consumption, Spicy foods, Dairy products
  • Hot baths or showers
  • Certain skin care products and cosmetics
  • Certain drugs that cause blood vessels to expand (dilate), such as some blood pressure medicines
  • Corticosteroid medicines (either applied to the skin or taken as tablets)


  1. Erythematotelangiectatic Rosacea: This condition is characterised by flushing and persistent central facial erythema. Redness may also involve the peripheral face, ears, neck and upper chest, but skin around the eyes is typically spared. Telangiectases are also common, but not required for diagnosis (Fig 1)
  2. Papulopustular Rosacea: This subtype includes patients who develop papules or pustules in a central facial distribution. In severe cases, these episodes of inflammation can lead to chronic facial swelling (Fig 2 and 3)
  3. Phymatous Rosacea: It is characterised by thickened skin with enlarged pores and irregular surface nodularities. These changes are most commonly found on the nose (rhinophyma), but can occur on the ears, chin and forehead. More common in men than women (Fig 4)
  4. Ocular Rosacea: Ocular rosacea is characterised by a watery or bloodshot appearance of the eyes, foreign body sensation, burning or stinging. Blepharitis, conjunctivitis, dryness, itching, light sensitivity, blurred vision and telangiectasia of the conjunctiva or eyelids also occur. Chalazia and styes are found to be common here



Rosacea is usually diagnosed without needing any tests. Your GP or a skin specialist (dermatologist) should be able to make a diagnosis by examining the skin on your face.

Managing Rosacea

There is currently no cure for rosacea. Although the condition tends to worsen over time, there are a number of ways to manage symptoms:

  • Avoiding trigger factors
  • Soothe sensitive skin – Use gentle soap-free cleansers and oil-free skincare products
  • Protecting skin from sunlight – Wear low-irritant/oil-free sunscreen and a hat.

Treatment options

  1. Lotions or creams may be prescribed by your GP. These may include: Rozex gel, Mirvaso gel or Soolantra Cream
  2. Antibiotics can reduce skin inflammation and redness,  the duration of treatment depending on the severity of rosacea . Eg: Doxycycline, erythromycin and minocycline. Isotretinoin, alpha-2 receptor agonists (e.g. clonidine) or beta-blockers (e.g. carvedilol) are other options.
  3. Medical procedures such as Laser, IPL can help reduce swollen blood vessels, but multiple treatments are usually required. Cosmetic surgery may be needed to treat a swollen or bulbous nose.

As ever, if you have any queries or concerns contact your local doctor!

Until the next time….



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