Rosacea in adults

Overview

Rosacea is a common, long-term skin condition that mainly affects the face. It causes redness, visible blood vessels, and sometimes small, red bumps or pus-filled spots. The condition can come and go, with flare-ups followed by periods of clearer skin.

Yes, rosacea is very common. It affects about 1 in 10 adults in the UK and is seen worldwide. Many people have mild symptoms and may not realise they have it.

Rosacea most often affects adults between the ages of 30 and 50, especially those with fair skin, light hair, and light eyes. However, it can occur in people of any skin type. Women are slightly more likely to get it, but men often have more severe symptoms.

Symptoms

Common symptoms

• Persistent redness on the central part of the face – cheeks, nose, forehead, and chin.
• Visible small blood vessels (telangiectasias) that look like spider veins.
• Small red bumps or pus-filled spots that may resemble acne.
• Skin that feels warm, tender, or sensitive.
• Flushing or blushing easily and for longer periods.
• A burning or stinging sensation when using skin products.
• Dry, rough, or scaly patches of skin.

Symptoms in older adults

• In older adults, rosacea can become more severe and cause thickening of the skin, especially on the nose (rhinophyma).
• Eye symptoms like dryness, irritation, and swelling of the eyelids (blepharitis) are more common in older adults.
• Older adults may also have more persistent redness and less response to treatments.

Causes

Main causes

• The exact cause is not fully understood, but it likely involves a combination of genetic factors and problems with the immune system reacting to common microbes.
• A microscopic mite called Demodex folliculorum, which lives on everyone's skin, may play a role in triggering rosacea in some people.
• Overactivity of blood vessels near the skin surface leads to flushing and redness.

Risk factors

• Family history of rosacea.
• Fair skin, light hair, and light eyes.
• Being over 30 years old.
• Having a history of acne or blushing easily.
• Exposure to triggers such as sunlight, hot weather, wind, hot drinks, spicy foods, alcohol, stress, and certain skincare products.

When to see a doctor

See a doctor urgently if:

• If you have eye symptoms like pain, redness, swelling, or changes in vision.
• If the redness on your face is suddenly much worse and painful.
• If you develop a high fever along with facial symptoms.

Book a routine appointment if:

• If you have persistent redness on your face that does not go away.
• If you have breakouts of bumps or spots that look like acne but do not respond to over-the-counter products.
• If you notice your skin becoming thickened or bumpy on your nose or cheeks.
• If facial redness is affecting your self-confidence or quality of life.

Diagnosis

There is no specific test for rosacea. A doctor or nurse will usually diagnose it by looking at your skin and asking about your symptoms and triggers. They may also ask about your medical history and any family history of skin conditions.

Tests that may be done

• In most cases, no tests are needed.
• Sometimes, a skin sample (biopsy) is taken to rule out other conditions like lupus or allergic reactions.
• If eye symptoms are present, you may be referred to an eye specialist for a detailed eye exam.

What to expect at your appointment

Your appointment will likely involve a brief physical exam of your face and eyes. The doctor may ask you questions about your diet, skincare routine, and lifestyle to identify possible triggers. They will discuss treatment options with you, which may include prescription creams, oral medications, or lifestyle changes. Follow-up appointments may be needed to monitor progress.

Treatment

Treatment for rosacea focuses on controlling symptoms and reducing flare-ups. A combination of self-care, prescription treatments, and sometimes medical procedures can help. It is important to work with your doctor to find what works best for you, as rosacea affects everyone differently.

Self-care at home

• Use a gentle, non-soap cleanser and moisturiser designed for sensitive skin.
• Protect your face from the sun every day with a broad-spectrum sunscreen of at least SPF 30.
• Avoid known triggers such as spicy foods, hot drinks, alcohol, and extreme temperatures.
• Keep a diary to identify what causes your flare-ups and try to avoid those triggers.
• Be gentle with your skin – avoid scrubbing, harsh exfoliants, and products with alcohol or fragrance.
• Manage stress through relaxation techniques like deep breathing or meditation.

Medical treatments

Doctors may prescribe topical creams or gels to reduce redness and inflammation. They may also prescribe oral medications (antibiotics or anti-inflammatories) for more severe cases. Laser or intense pulsed light (IPL) treatments can help reduce visible blood vessels and persistent redness. For thickening of the skin, such as on the nose, special laser treatments or minor surgery may be options. Always follow your doctor's advice about the right treatment for you.

When is surgery considered?

In rare cases where the skin becomes very thickened (especially on the nose, called rhinophyma), surgery may be used to remove excess tissue and reshape the nose. This is usually done by a dermatologist or plastic surgeon and is not an emergency procedure.

Living with this condition

Living with rosacea means being mindful of your skin and your triggers. Most people can manage well by following a consistent skincare routine, avoiding what bothers their skin, and treating flare-ups early. It is also important to protect your skin from sun and wind, and to keep it moisturised.

Lifestyle tips

• Wear a wide-brimmed hat and use sunscreen daily.
• Choose mild, fragrance-free skin and hair products.
• Avoid overheating – take cool showers, use a fan, and stay in air-conditioned spaces when possible.
• Avoid rubbing or massaging your face.
• If you wear makeup, choose products labelled as non-comedogenic and for sensitive skin.

Diet and exercise

There is no special diet for rosacea, but some people find that avoiding spicy foods, hot drinks, alcohol, and foods high in histamine (like aged cheese and red wine) helps. Exercise is good for overall health, but intense exercise that causes heavy sweating may trigger a flare-up. Try to stay cool during exercise and rinse your face with cool water afterwards.

Mental health and emotional wellbeing

Rosacea can affect how you feel about your appearance. The visible redness and bumps may make some people feel self-conscious, anxious, or depressed. It is normal to feel this way, and you are not alone. Talking to a healthcare provider, a counsellor, or a support group can help. There are also makeup techniques (camouflage) that can hide redness and help you feel more confident.

Prevention

Rosacea cannot be prevented or cured, but you can help reduce the number and severity of flare-ups by avoiding your personal triggers and with consistent skincare and medical treatment. Early diagnosis and treatment may prevent the condition from getting worse.

Complications

If left untreated

• Worsening redness and more visible blood vessels.
• Thickening of the skin, especially on the nose (rhinophyma), which can change the shape of the nose.
• Eye problems: dry eyes, swollen eyelids, conjunctivitis, and in some cases, damage to the cornea (keratitis) which can affect vision.
• Permanent redness and bumpiness may develop if flare-ups are frequent and not controlled.

Long-term outlook

With proper care, most people with rosacea can keep their symptoms under good control. While there is no cure, treatments have improved a lot. Many people live with rosacea without it causing major problems. Staying on top of your skincare, avoiding triggers, and seeing your doctor when needed can help you look and feel your best. If you experience complications, they can often be treated successfully.

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