Rosacea

What is rosacea?

If you have rosacea, your face flushes and turns red more easily than most people's, often across your nose, cheeks and forehead. It is a long-term condition that cannot be cured, though your GP can help you control the symptoms.

What are the symptoms of rosacea?

Rosacea affects people differently, and signs often build up gradually. You might notice:

• redness across your nose, cheeks, forehead, chin, neck or chest that comes and goes, each episode lasting a few minutes
• a warm, hot or slightly painful feeling in the affected skin
• a burning or stinging feeling when you use water or skincare products
• small red bumps or pus-filled spots that can look like acne, though without blackheads
• tiny visible blood vessels on the surface of your skin
• dry skin, or swelling, especially around the eyes
• sore, red or crusty eyelids.

If you have brown or black skin, the redness can be harder to spot and may look more like a dusky or purplish mark. Left untreated, the redness can become permanent rather than coming and going, and in some men the skin on the nose can thicken and become bumpy.

What causes rosacea, and who is at risk?

Doctors do not know exactly what causes rosacea. Several factors are thought to play a part, including abnormal blood vessels in the face, a build-up of a tiny mite called Demodex folliculorum that lives harmlessly on everyone's skin, and a gut bacterium called Helicobacter pylori. Genetics may also play a role, since rosacea often runs in families.

You may be more likely to develop rosacea if you:

• have fair skin, especially skin that flushes or blushes easily
• are a woman, though the condition tends to be more severe in men
• are over 30
• have a close relative with rosacea
• have ancestry from northern or eastern Europe.

Rosacea itself is not caused by particular foods, drinks or weather, but these can trigger a flare-up or make symptoms worse once you have the condition. Common triggers include alcohol, spicy food, hot drinks, caffeine, sunlight, hot or cold temperatures, strenuous exercise and stress.

Are there different types of rosacea?

Yes. Doctors sometimes describe rosacea in patterns, depending on which signs are most prominent:

• redness and visible blood vessels, with flushing but few or no spots
• spots and swelling that look like acne, with flushing and breakouts
• thickened, bumpy skin, most often on the nose (called rhinophyma), which mostly affects men
• eye symptoms, such as redness, irritation and swollen eyelids (called ocular rosacea).

Many people have a mix of these features rather than fitting neatly into one type, and rosacea can change over time, sometimes moving from one pattern of symptoms to another.

How is rosacea diagnosed?

There's no blood test or scan that can diagnose rosacea. Instead, your GP will look at your skin and ask about your symptoms and possible triggers.

The presence of enlarged blood vessels or persistent redness helps your GP tell rosacea apart from similar conditions, such as acne, eczema or lupus. If they suspect an underlying condition might be causing your symptoms, they may arrange blood tests or refer you to a dermatologist.

How is rosacea treated?

There's no cure for rosacea, but a combination of medical treatment and everyday changes can keep symptoms under control. Your GP will suggest treatment based on which symptoms bother you most.

Non-surgical treatment

• creams or gels applied to the skin once or twice a day, to reduce redness and control spots
• antibiotic tablets, usually taken for four to six weeks, sometimes longer if spots are persistent
• a strong medicine called isotretinoin, kept for severe cases that have not responded to other treatment
• eye drops or ointment for sore or irritated eyes.

You may not see an improvement for several weeks, so it's worth sticking with a treatment for its full course before deciding whether it's working.

Surgical and laser treatment

If visible blood vessels or thickened skin bother you, your GP may refer you to a dermatologist for:

• laser or intense pulsed light treatment, which shrinks visible blood vessels – this can cause some bruising or swelling but rarely needs an anaesthetic
• laser treatment or surgery to remove excess tissue if the skin on your nose has thickened and become bumpy (rhinophyma).

The NHS does not usually offer laser treatment for rosacea, so this is often arranged privately.

When should I see a doctor?

See your GP if you have symptoms of rosacea, especially if they are affecting your confidence or daily life. Diagnosing and treating rosacea early can help stop it getting worse.

Ask for an urgent GP appointment, or call 111, if you have rosacea and develop:

• eye pain
• blurred vision
• sensitivity to light
• a red eye
• a gritty feeling in your eye.

These can be signs of keratitis, a serious inflammation at the front of the eye that needs prompt treatment. If you cannot reach your GP, go to your nearest A&E.