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DermatologicalICD-10: L71Affects an estimated 16 million Americans; up to 10% of fair-skinned populations

Rosacea

Also known as: Acne Rosacea, Adult Acne (colloquial)

Rosacea is a chronic inflammatory skin condition primarily affecting the central face, characterized by recurrent episodes of facial flushing, persistent redness, visible blood vessels, and sometimes acne-like bumps and pustules. It most commonly affects fair-skinned adults between ages 30 and 50 and can significantly impact self-esteem and quality of life. Without treatment, rosacea tends to worsen over time.

Symptoms

Persistent facial redness (erythema), especially on the cheeks, nose, chin, and forehead
Visible blood vessels (telangiectasia)
Flushing episodes triggered by heat, alcohol, spicy food, or stress
Red, acne-like bumps and pustules (but no comedones/blackheads)
Burning or stinging sensation on the face
Dry, rough facial skin
Thickened skin on the nose (rhinophyma) in severe cases
Eye irritation (ocular rosacea): dry, gritty, burning eyes with blepharitis

Causes

  • Exact cause unknown; likely a combination of genetic and environmental factors
  • Dysregulation of innate immune system and neurovascular pathways
  • Overproduction of cathelicidin (antimicrobial peptide) in the skin
  • Possible role of Demodex mites and Bacillus oleronius bacteria

Risk Factors

  • Fair skin, light eyes, and Celtic or Northern European ancestry
  • Age 30–50
  • Female sex (though men develop more severe forms including rhinophyma)
  • Family history of rosacea
  • History of frequent flushing

Diagnosis

  • Clinical diagnosis based on characteristic facial findings
  • No specific diagnostic test for rosacea
  • Skin biopsy rarely needed (only to exclude other conditions like lupus)
  • Eye examination for suspected ocular rosacea

Treatment

  • Topical treatments: metronidazole, azelaic acid, ivermectin (Soolantra)
  • Topical brimonidine or oxymetazoline for persistent redness (vasoconstrictors)
  • Oral antibiotics: doxycycline at anti-inflammatory dose (40 mg modified release)
  • Isotretinoin for severe papulopustular rosacea resistant to other treatments
  • Laser and light therapy (pulsed dye laser, IPL) for telangiectasia and redness
  • Gentle skincare routine with fragrance-free, non-irritating products and daily sunscreen

Prevention

  • Identify and avoid personal triggers (common: sun, heat, spicy food, alcohol, stress)
  • Use broad-spectrum SPF 30+ sunscreen daily (mineral/physical sunscreens are best tolerated)
  • Use gentle, non-irritating skincare products
  • Protect the face from wind and cold

When to See a Doctor

  • Persistent facial redness or frequent flushing
  • Acne-like bumps on the face that do not respond to acne treatments
  • Visible blood vessels on the face
  • Eye irritation, dryness, or redness with skin symptoms (ocular rosacea)

Frequently Asked Questions

Related Conditions

Acne Vulgaris

Dermatological

Eczema

Dermatological

Psoriasis

Dermatological

Melanoma

Cancer

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Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

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