What Is the Main Cause of Rosacea?

Light-skinned people with Scandinavian or Celtic heritage tend to get rosacea more frequently. It has a genetic aspect, but also may be exacerbated by skin mites.

The cause of rosacea is unknown, but risk factors that may be involved include: 

• Genetics: rosacea runs in families
• Immune system reactions: most people with acne-like rosacea react to a bacterium (singular for bacteria) called Bacillus oleronius
• Demodex skin mites: these mites live on everyone’s skin, and it has been found that people with rosacea have large numbers of this mite on their skin
• H. pylori: this bacterium is common in people with rosacea but the role it may play is unproven
• How the body processes a certain protein (cathelicidin) may cause redness and swelling

Certain risk factors that may trigger rosacea symptoms and worsen facial redness include:

• Drinking alcohol
• Eating hot or spicy foods
• Drinking hot beverages
• Being too hot or cold
• Exposure to sunlight
• Stress and other strong emotions

Rosacea is a common, chronic skin condition that causes redness and raised, red bumps on the cheeks, nose, chin, forehead, or eyelids.

• Rosacea is estimated to affect over 16 million Americans,
• occurs most frequently in adults ages 30 to 60, and
• affects women slightly more often than men.
• It most commonly affects fair-skinned individuals, who have blonde hair and blue eyes, and people of Celtic or Scandinavian ancestry.

Symptoms of rosacea affect the cheeks, nose, chin, forehead, or eyelids and include:

• Redness 
• Blushing or flushing easily
• Raised, red bumps with or without pus in them 
• Bumps from rosacea may resemble acne, but they aren't acne
• Tiny, visible, swollen blood vessels on the skin of the face (telangiectasias)
• Burning, irritation, or gritty feeling in the eyes
• Watery eyes
• Red, swollen, rounded nose (rhinophyma)
• Large pores
• Thickening skin (phyma)

Rosacea can also have a psychological impact. The redness and swelling on the face can affect people’s self-esteem and result in:

• Lower self-confidence
• Embarrassment
• Anxiety
• Depression
• Anger
• Social isolation

A dermatologist can usually diagnose rosacea by examining the skin. However, tests may be suggested to rule out other medical conditions that can resemble rosacea.

Medical tests that may be indicated to help rule out conditions include:

• Tests for lupus 
• Allergic skin reaction testing

Patients with significant signs of eye involvement should see an eye doctor (ophthalmologist) for evaluation.

There is no cure for rosacea. Treatment for rosacea involves medications and lifestyle changes to control symptoms and prevent flare-ups. 

Lifestyle changes to help control symptoms and prevent flare-ups include:

• Avoid triggers that worsen symptoms
• Use mild, unscented face cleansers 
• Wear sunscreen daily
• Avoid using products on the face that contain alcohol, acid, or other ingredients that could irritate the skin 

Treatments used to treat skin redness of rosacea include: 

• Laser or other light-based treatment
• Brimonidine gel and oxymetazoline hydrochloride cream
• Treatments used to treat acne-like breakouts of rosacea include: 
• Azelaic acid topical 
• Metronidazole gel or cream
• Sodium sulfacetamide and sulfur are ingredients found in over-the-counter (OTC) treatments such as cleansers, and topical prescription medications
• Topical retinoids, a form of vitamin A 
• Oral antibiotics
  • Tetracycline
  • Minocycline
  • Doxycycline
  • Erythromycin
  • Low-dose doxycycline: This is an antibiotic but at low doses, it reduces rosacea breakouts
• Laser or light therapy
• Treatments used to treat thickening skin (phyma) of rosacea include: 
• Isotretinoin
• Surgical removal of phyma
• Treatments used to treat eye symptoms of rosacea include: 
  • Applying warm compresses
  • Cleansing with a gentle, eye cleanser
  • Using eye drops and eye medications
  • Antibiotics in some cases

Complications of rosacea include: 

• Red, swollen, rounded nose (rhinophyma)
• Inflammation of the conjunctiva of the eye (conjunctivitis)