Do you feel like you’re always blushing or breaking out in pimples? You may have rosacea, a skin condition that affects more than 16 million Americans.
Fortunately, doctors have tools to help.
“Your dermatologist has a lot of options to help keep this under control,” says UNC Health dermatologist Margaret Coates, MD. “Treatment will depend on the type of rosacea and the symptoms, so it’s really tailored to the person.”
Dr. Coates explains some of the symptoms dermatologists consider as they plan treatment.
Rosacea Types and Symptoms
There are several types of rosacea, which can cause different symptoms. You might have one or more of these types.
Erythematotelangiectatic rosacea, or vascular rosacea, is due to changes in the blood vessels.
“The blood vessels on the cheek and nose dilate, typically because of factors like sun exposure, hot weather, spicy foods, caffeine or other triggers,” Dr. Coates says. “It will cause you to look red or rosy, but the repeated dilation can contribute to broken blood vessels on the face, so that you always look red.”
These episodes of redness, or flares, typically persist much longer than an average blush or flush, and they may be accompanied by a feeling of burning. Your skin may feel sensitive, swollen or dry.
Papulopustular rosacea looks similar to acne. You’ll see red, swollen bumps on the face, and some may be filled with pus. These bumps can be accompanied by red or uneven skin.
There are a few ways your dermatologist can distinguish papulopustular rosaces from acne.
“While there’s overlap in how some specific spots look, age helps with differentiation,” Dr. Coates says. “Children and teens are more likely to have acne, while you’re more likely to have rosacea if you’re seeing these symptoms in middle age or older.”
Acne doesn’t cause the warm, flushed or tingly feeling that can be present with this type of rosacea, whereas rosacea typically doesn’t present with blackheads the way acne does. You can have both rosacea and acne.
When untreated, papulopustular rosacea can progress to a form of rosacea known as rhinophyma, which is when oil glands on the nose become inflamed so that your nose looks puffy and has a bumpy texture, like cobblestones.
Another type of rosacea, ocular rosacea, causes symptoms in the eyes.
“The eyes might be red, or you might have what feels like grit in the eye,” Dr. Coates says. “You might notice some crusting around the eyelids and eyelashes.”
While there isn’t a specific test to diagnose rosacea, your dermatologist will evaluate your symptoms, consider if they appear in the wake of any triggers and rule out other conditions that could cause redness, such as dermatitis, psoriasis or lupus. If your symptoms are primarily in your eyes, an ophthalmologist can help.
Doctors aren’t sure exactly what causes rosacea. Dr. Coates says it’s likely a combination of factors, including an overactive response by your immune system or blood vessels or extra sensitivity to the sun. We all have some skin mites naturally present on our skin, and some people may have more than normal or an overreaction to these mites.
How to Treat Rosacea
There is no cure for rosacea, but a dermatologist (or an ophthalmologist, in the case of ocular rosacea) can help to treat your symptoms and prevent flares of redness.
For mild flushing, you might apply a cream or gel that can constrict the blood vessels. You might also use a topical product for pimples or pus bumps.
For more severe blemishes, you might be prescribed an oral antibiotic or an oral acne medicine.
If you have ocular rosacea, eye drops or oral medications can help reduce inflammation and make your eyes more comfortable.
The broken blood vessels on your face that cause redness aren’t a threat to your health, but they can make you feel self-conscious about your appearance.
“If the redness bothers you, we can use laser that targets blood vessels to improve it,” Dr. Coates says. “It’s typically a series of two to four treatments, a month apart, which may last five to 15 minutes. Usually, it requires yearly touch-ups.”
The light from the laser is aimed at visible blood vessels and causes them to constrict and shrink. In addition to minimizing redness, it can also reduce burning and tingling that you may experience with flares. Despite managing this symptom, Dr. Coates says laser treatment is currently considered a cosmetic procedure by insurance companies, who typically do not cover it.
Resurfacing lasers can help with other effects, such as bumpiness or scarring.
Whether you’re on a medication, pursue a treatment or not, you can try to prevent rosacea flares by making lifestyle changes. While it may take time to determine your specific triggers, and it can sometimes feel like flares happen unexpectedly, avoiding caffeine, alcohol, spicy food, extreme temperatures and stress can help. Ask your dermatologist about gentle cleansers and skin products that won’t further aggravate skin.
It’s also important to be careful in the sun—use sunscreen, wear a hat and avoid time outside when the sun is at its brightest.
“Sun protection is really important for everyone, but especially people with rosacea,” Dr. Coates says.
If you’re concerned about your skin, talk to your doctor. Need a doctor? Find one near you.