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Understanding rosacea: It’s more than just a red face

Rosacea - papules and pustulesIt’s Rosacea Awareness Month. April has been designated Rosacea Awareness Month by the National Rosacea Society or NRS to urge those with the warning signs to see a dermatologist for diagnosis and treatment.

It’s estimated that more than 16 million Americans have rosacea. It tends to strike people in their 30s, 40s, or older.

“Although the occurrence of rosacea has been well documented over the centuries, virtually everything we now understand about the disorder in medical science has been discovered in the last 20 years,” said Julie Harper, M.D., clinical associate professor of dermatology at the University of Alabama-Birmingham. “As a result of these advances, dermatologists are now able to identify and prescribe specific therapies for the various signs and symptoms based on a thorough understanding of the underlying disease process.”

Rosacea affects an estimated 415 million people throughout the world. Among the most famous rosacea sufferers is former President Bill Clinton. Others reported to have had rosacea include Princess Diana, actresses Renee Zellweger and Naomi Watts, singer Sam Smith, and comedian Amy Schumer.

Rosacea's symptoms

Rosacea is a chronic disorder of the face’s skin that is often characterized by flare-ups and remissions.

It’s characterized by persistent facial redness or less common changes where the skin thickens. Other major signs include bumps and pimples, flushing, visible blood vessels, and eye problems. Secondary symptoms include burning or stinging, swelling, and a dry appearance.

In about half of rosacea patients, the eyes are also affected, including visible blood vessels on the eyelid margin and a watery or bloodshot appearance. Without treatment this condition, known as ocular rosacea, can lead to vision loss.

In some patients, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose.

A red face and in some cases a red bulbous nose are often associated with heavy drinking – even though rosacea can be just as severe in someone who doesn’t drink alcohol.

Rosacea's cause and triggers

Although the cause of rosacea is unknown, flare-ups of signs and symptoms may be triggered by lifestyle and environmental factors that can differ in individual cases.

Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, some skin-care products, and Demodex mites. These mites live in or around hair follicles, feeding on the dead skin cells, oils, and hormones that build up there. They usually live on the face, including the eyelids and eyelashes.

Rosacea treatments

“Today’s approach to rosacea treatment is different than in the past, when there was a tendency to view the disorder in terms of common presentations of signs and symptoms,” Harper said. “Because the disease can manifest in so many ways, however, we are now finding it is much more effective to address the individual signs and symptoms of each patient.”

She said, for example, advances in topical and oral therapy are now available for treating the inflammatory bumps and pimples, and topical therapies have now also been developed for persistent facial redness. Lasers and other light therapies are often used to remove visible blood vessels, while more aggressive lasers or surgery are used to correct thickening of the skin and nodules.

“Because of its effect on personal appearance, studies have demonstrated just how profoundly rosacea can damage the quality of people’s lives, as well as the positive impact of successful treatment,” Harper said.

In an NRS survey of 1,675 rosacea patients, 90 percent said rosacea had lowered their self-esteem and self-confidence, and 52 percent said they had avoided face-to-face contact because of it. In another survey, 51 percent of those with severe symptoms said they had missed work because of their condition.

When the signs and symptoms of rosacea are dramatically reduced or eliminated, however, the improvement in patients’ lives is often dramatic, she said.

In an NRS survey of more than 800 rosacea patients, 83 percent of those who had achieved clear or almost clear skin said their psychological well-being had improved. Seventy-three percent said it had also improved their social lives, and 63 percent reported improvement in their occupational well-being.

However, among those whose rosacea had only slightly or moderately improved, 26 percent reported improvement in psychological well-being, 22 percent in social well-being, and 21 percent in occupational well-being.

Relationship to other conditions

Although a direct relationship hasn’t been determined, recent research has found associations between rosacea and increased risk of serious illnesses. These include cardiovascular diseases, gastrointestinal disorders, neurological conditions, autoimmune diseases, and certain types of cancer. See “Living With Rosacea? How to Reduce Your Risks of Other Conditions.”

More information

Information on rosacea is available on the NRS website at rosacea.org. You can also follow the NRS on Facebook, Twitter, and Pinterest for tips on rosacea.


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I haven't had it but know it's a real problem for some. My skin sometimes gets red if I drink wine too many sulfites. When I used to sell skincare it was important to avoid exfoliating products like skin scrubs for people with sensitive skin or rosacea.

Carol Cassara

I had no idea about this. I know people who had the thickening but not that it was less infrequent. I thought that it was a given.


Hi Rebecca and Carol,

Rosacea certainly is a problem for a lot of people, myself included. I'm trying natural remedies before medication.

Thanks for the information about scrubs. That's good to know.


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