Rosacea: What It Looks Like, Causes, and Treatment

Information and Pictures to Help You Identify and Manage Rosacea

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Rosacea is a chronic inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks, and can cause eye irritation. Pictures of rosacea can help you identify symptoms and learn how to manage them.

There are four types of rosacea that are thought to be caused by genetic and environmental factors. The condition can't be cured, but it can be managed with a skin care regimen, avoidance of triggers, prescription medication, and interventional procedures that can help reduce some of the effects.

This article discusses what rosacea looks like, the types of rosacea, what causes it, and how rosacea is diagnosed and treated.

What Rosacea Looks Like
Verywell / Nusha Ashjaee

Rosacea Symptoms

The most common symptoms of rosacea are flushing and erythema (redness) of the cheeks and forehead. It can also affect the chin, neck, and other parts of the body. 

The effects can vary, and occasional flare-ups can occur, but most people with rosacea have some persistent skin manifestations all the time. 

Rosacea symptoms vary from person to person, but most people have one of the following symptoms or a combination of these symptoms:

  • Redness and sensitive skin: Typically affecting the cheeks, forehead, and nose 
  • Flushing: Pink or red appearance of the skin, usually without changes in texture 
  • Papules: Solid red bumps, usually in clusters 
  • Pustules: Pus-filled bumps, usually in clusters 
  • Telangiectasia: Tiny visible blood vessels near the surface of the skin 
  • Rhinophyma: Thickened and bumpy skin on the nose
  • Eye irritation: itching, dry eyes, discomfort, swelling, or cysts in or near the eyes and eyelids
A person's face with rosacea

Reproduced with permission from © DermNet New Zealand and © Dr. Mashihul Hossain www.dermnetnz.org 2023.

Sensory Effects 

Generally, rosacea affects the appearance of the skin with few, if any sensory issues. But it can cause a feeling of skin irritation, discomfort, itching, stinging, or burning of the affected areas. 

Eyes and Eyelids 

Rosacea can affect the eyes, causing itching, dry eyes, discomfort, swelling, or cysts in or near the eyes and eyelids. Eyes can appear to be bloodshot. Cysts and severe swelling can cause long-term damage and may affect vision. 

Rosacea
Rosacea.  DermNet / CC BY-NC-ND

What Causes Rosacea?

Scientists do not know what causes rosacea. They know that inflammation contributes to skin redness and rash, but they do not fully understand why inflammation occurs. It may be due to heightened skin sensitivity, environmental factors, such as ultraviolet (UV) light, and/or microbes that live on the skin. 

Anyone can be affected by rosacea, but it is more common among adults between 30 and 50 years old, especially among those who have a light skin tone. That said, rosacea can begin during childhood and it can affect people of all skin shades and ethnic backgrounds. 

The condition is believed to have genetic and environmental causes. Risk factors include:

  • Family history of rosacea or severe acne
  • Having Celtic or Scandinavian ancestry
  • Personal or family history of autoimmune disease
  • A diagnosis of inflammatory disease 

Is Rosacea Caused by Stress?

Stress hasn't been shown to cause rosacea, but for many people with rosacea, emotional stress can trigger a flare-up. This may lead to more stress and worsening symptoms.

Triggers

If you have rosacea, several factors can make the skin effects worse. You can experience worsening of your symptoms immediately or days after exposure to any of your rosacea triggers. Sometimes, triggers can induce skin changes that don’t competently resolve.

Common triggers include:

  • Sun exposure
  • Alcohol
  • Spicy food
  • Cigarette smoke
  • Hot or cold temperatures

You may also develop worsening symptoms in response to medications, food, detergents, soaps, or fabrics. 

Pathophysiology

The process at play in rosacea involves inflammation and dilation (widening) of the blood vessels. The inflammation may produce redness, bumps, or sensory discomfort.

Some experts suggest that infection may have a role in rosacea as well. 

The condition is associated with several other illnesses, including:

  • Type 1 diabetes
  • Celiac disease
  • Multiple sclerosis
  • Inflammatory bowel disease (IBD)
  • Irritable bowel syndrome (IBS)
  • Gastroesophageal reflux disease (GERD)
  • Rheumatoid arthritis

How Is Rosacea Diagnosed?

Rosacea is a clinical diagnosis based on the appearance of the skin and the pattern and timing of the symptoms. The skin’s appearance can resemble other conditions. Rosacea can look like acne, the butterfly facial erythema of lupus, or allergies.

Generally, the person's medical and symptom history and triggers can help differentiate these skin reactions. But when the diagnosis is not clear, tests such as blood tests can help identify inflammatory conditions such as allergies or lupus.

There are four types of rosacea: 

  • Type 1: Erythematotelangiectatic rosacea is described as vascular rosacea. It is predominated by skin redness with blood vessels that are visible directly underneath the skin. 
  • Type 2: Papulopustular rosacea, also called inflammatory rosacea, is characterized by clustered papules or pustules.
  • Type 3: Phymatous rosacea exhibits hardened bumps and thickened skin. Rhinophyma—a condition in which there are hardened nodules on the nose—is a common aspect of this type of rosacea.
  • Type 4: Ocular rosacea describes symptoms affecting the eyes and eyelids. This type may also affect the skin.

Treatment for Rosacea

If you have been diagnosed with rosacea, you will need to avoid the common triggers as well as any other factors that make your condition worse. Skin care is important too. To manage redness:

  • Use a mild cleanser to wash your face every day.
  • Rinse with warm water.
  • Avoid astringents and toners.
  • Use moisturizer sparingly.

Your healthcare provider will likely recommend using sunscreen to protect your skin from sun exposure. Avoiding heat and sweat can help prevent flare-ups too. 

Prescription treatments include oral medications and topical products to apply directly to your skin or eyes. Most prescriptions used in the treatment of rosacea are anti-inflammatories or antibiotics. Depending on the severity, you may be given a prescription to use every day or a prescription to use as needed.

For a long-term solution to visible blood vessels or constant redness, talk to your healthcare provider about laser and light-based treatments. Laser treatment procedures can reduce some of the cosmetic effects of rosacea.

Although rosacea doesn't ever go away, you can ease flare-ups and manage symptoms. Wearing sunscreen and avoiding triggers such as heat, wind, spicy food, and alcohol can help prevent redness and irritation.

Coping With Rosacea

Strategies for coping may include:

  • Connecting with others who have rosacea (through support groups)
  • Learning how to optimize your use of makeup, if desired

These strategies may help you feel better about the appearance of your skin and how to manage it. 

Living with rosacea can present some emotional challenges. Skin flare-ups can worsen when you are under stress or in response to other emotions such as depression. Being unsatisfied with your facial appearance can lead to depression and anxiety, which may result in a cycle of mood and skin problems. 

If your skin condition is taking a toll on your well-being, discuss your feelings with your healthcare provider. You may also benefit from counseling or mindfulness training.

A Word From Verywell

Rosacea is a chronic skin condition, which means that there is technically no cure for it. As such, therapy is an ongoing process and works best with consistent use of treatments and trigger avoidance.

Summary

Rosacea is a chronic inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks, but can also involve the eyes. Symptoms include flushing, sensitive skin, papules, pustules, and eye irritation. The causes of rosacea are thought to be genetic and environmental.

Although there is no cure, treatment may include using mild skin cleansers, avoiding triggers, and taking oral or topical prescription medications.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Heidi Moawad, MD

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.