What Causes Rosacea? Treatments, Medications and More

Rosacea is a common yet misunderstood skin condition affecting millions worldwide. It causes persistent redness, pimples, and even eye irritation. Many adults struggle with rosacea, a chronic skin disorder that causes not only facial redness and swelling but also bumps similar to acne.

According to the Canadian Dermatology Association, rosacea typically appears between the ages of 30 and 50 but can also affect individuals outside this age range. Beyond mere cosmetic concerns, there are many ways rosacea can impact daily life. For example, ocular rosacea, characterized by soreness and a burning sensation in the eyes, may complicate everyday tasks like reading or driving.

This article will explore the symptoms, identify common triggers, and discuss effective treatments to manage this condition.

What is rosacea?

Rosacea is a chronic inflammatory skin condition that causes redness and flushing in the skin. Because it can also cause small, pus-filled bumps on the face, it’s sometimes confused with acne. Although rosacea can’t be cured permanently, its symptoms can be managed.

Despite this superficial similarity, rosacea and acne are quite different. Rosacea often affects the central parts of the face, like the cheeks and nose, and can accompany symptoms like eye irritation and a burning sensation on the skin. On the other hand, acne can occur in various parts of the body, including the face, back, and shoulders.

What are the differences between eczema, rosacea, and psoriasis?

Eczema, rosacea, and psoriasis are all chronic skin conditions, each with distinctive features and triggers.

Eczema typically presents as patches of dry, itchy skin that may become inflamed or infected due to scratching. It’s often associated with other allergic conditions like asthma or hay fever and can be triggered by environmental factors, allergens, or stress. 

Rosacea, on the other hand, primarily affects the face and is characterized by redness, flushing, and visible blood vessels, sometimes accompanied by acne-like bumps. It can be provoked by factors like heat, spicy foods, or alcohol.

Psoriasis is marked by thick, red patches covered by silvery scales, often found on the scalp, elbows, and knees. It’s an autoimmune condition, meaning it results from the immune system mistakenly attacking healthy skin cells, leading to rapid cell turnover.

Each condition requires a different treatment approach, emphasizing the importance of correct diagnosis by a healthcare professional.

What are common types of rosacea? 

Vascular rosacea: The most common form of the condition, vascular rosacea is characterized by redness and flushing in the face and visible blood vessels, especially around the nose.

Inflammatory rosacea: This type includes papules, pustules and redness and swelling.

Phymatous rosacea: Perhaps the most recognizable form of rosacea, phymatous rosacea involves a thickening of the skin and an increase in the size of the nose.

Ocular rosacea: Presents with or without skin symptoms, this type of rosacea results in redness and irritation in the eyes and swelling of the eyelids.

What causes rosacea?

Rosacea’s causes are multi-pronged and not fully understood. Theories have evolved and the research continues. It’s thought that the main contributors for causing rosacea include: 

1. Genetics. 
2. Immune system defects. 
3. Nervous system defects. 
4. Facial blood vessel defects. 
5. Microbes and skin mites (Demodex mites). 

While science can’t fully explain why, it’s becoming increasingly clear that what happens in your gut can affect the appearance of your skin. Changes in your balance of gut flora have a knock-on effect and can disrupt the mucosal lining of your intestines, resulting in a more permeable gut.

Essentially, this means that microscopic particles that would otherwise be flushed out of your system pass through your intestinal walls instead and into your circulatory system. Your body identifies these tiny particles as pathogenic, triggering your immune system to activate, causing inflammation.

This misdirected and chronic inflammation can lead to skin concerns, like acne and rosacea.

Additionally, because rosacea skin is so sensitive, a number of things can contribute to flare-ups. As a result, you’ll likely need to modify your skincare routine if you have rosacea, as certain ingredients like salicylic acid can cause flare-ups. 

First and foremost, be gentle on your skin. Avoid using harsh or drying products that contain alcohol, abrasives, or fragrances, and lower your water temperature. Hot water can dry skin out more than temperate water, and heat can also trigger rosacea. That means you’ll want to bathe, shower, and wash your face in warm water instead of hot water. While there’s no recommended temperature, if the water’s heat makes you flush or reddens your skin, it’s likely too hot.

Avoiding or limiting exposures that cause your skin to flush can help to reduce flare-ups. Some common flushing triggers include:

• Temperature extremes
• Spicy foods and alcohol
• Stress. To help manage your stress, prioritize getting enough sleep, regular exercise, eating a balanced diet, and relaxation techniques like breathwork or meditation.
• Menopausal hot flashes
• Some medications: Beta-blockers and niacin are examples of medications that can potentially trigger rosacea
• Intense exercise: to minimize this, break up longer workouts into shorter segments and exercise outside on cooler days or inside in air conditioning during hot weather
• Sunlight may also precipitate the condition, so apply a good quality mineral sunscreen with SPF 30 or higher daily and wear a hat when the UV index is 3 or higher.

Are there any treatments for rosacea?

Treating rosacea involves more than simply avoiding potential triggers. A dermatologist can prescribe both topical and oral medications to help control symptoms, usually improving symptoms within a few weeks. 

Primary care providers may refer to dermatologists if they are unsure about diagnoses or if more specialized treatments and maintenance are required.

If you want a personalized treatment plan, you can book an appointment with a Canadian-licensed dermatologist directly on Maple without a referral.  Dermatologists on Maple are the same specialists you’d see in person, but they also practice outside of their own clinic hours to see patients virtually. 

Dermatologists can provide laser treatment using light energy to collapse visible blood vessels and reduce redness. Side effects can include scarring and burns; however, you’re unlikely to experience anything beyond temporary redness and swelling with an experienced dermatologist. This form of treatment is done in a clinic, although, given the specialized equipment needed, it’s not done by every dermatologist.

If your rosacea is coupled with digestive issues and you think your gut microbiome may be to blame, you may want to consider modifying your diet to incorporate probiotics, prebiotics and fermented food. If you’re not quite sure how to go about this, seeing a naturopathic doctor can help rebalance your inner microbiome and help you work towards reducing your rosacea symptoms. You can ask a dietitian or naturopathic doctor about the best types of probiotics and prebiotics for your condition and how soon you might expect to see results from dietary adjustments.

Seeing a dietitian can also help you identify and remove any potentially triggering foods while ensuring that your nutritional needs are being met. Dietitians can also recommend anti-inflammatory foods or supplements that can help manage rosacea. 

Information presented here is for educational purposes, and not to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.