Rosacea: symptoms, treatment, triggers and when to see a GP

The NHS says rosacea cannot be cured, but treatment from a GP can help control the symptoms, and it can get worse if it is not treated. A GP may suggest prescription creams and gels to put on the skin or antibiotics taken for 6 to 16 weeks, and may refer you to a skin specialist (dermatologist) if treatments are not working.

The British Association of Dermatologists (BAD) explains that the inflammation of rosacea can be treated with medicines applied to the skin or taken by mouth, but not all of these help the redness or blushing. Skin treatments may take at least 8 weeks for the effect to become evident. Your doctor may suggest that you use a cream and an oral treatment together.

Oral antibiotics are helpful for the inflammatory element of moderate or severe rosacea. BAD says the most commonly used belong to the tetracycline group, and erythromycin is another. It says the theory that rosacea is due to bacteria on the skin or in the gut has not been proven, and that antibiotics help because of their anti-inflammatory effect. The length of a course depends on how your body responds.

BAD describes rosacea as a common skin condition mostly affecting the face. It predominantly affects fair-skinned individuals but may appear in any skin type. It can start at any age from childhood onwards, but most commonly appears in young adults. It is more common in women; when it affects men it may be more severe. It is a long-term condition that fluctuates from mild to severe.

Rosacea mostly affects the cheeks, forehead, chin and nose, and more rarely the neck and chest. It appears as persistent redness caused by dilated blood vessels, small bumps and pus-filled spots similar to acne. BAD says it is classified into 4 subtypes that may overlap, and your doctor will advise you of the type you have.

The NHS says the first signs are redness (blushing) across the nose, cheeks, forehead, chin, neck and chest that comes and goes, usually lasting a few minutes each time, and that the face may feel warm, hot or painful. There may be a burning or stinging feeling when using water or skincare products. The redness may be harder to see on brown or black skin.

As rosacea gets worse the skin on the cheeks, nose and forehead may be red all the time. You may get small pink or red bumps, sometimes filled with a yellowish liquid. BAD says that after a while the central areas of the face become a permanent deeper shade of red, with small dilated blood vessels, bumps and pus-filled spots. NHS inform adds that symptoms can get better or worse at times.

• Dry skin.

• Swelling, especially around the eyes.

• Yellow-orange patches on the skin.

• Visible blood vessels (NHS inform).

• Sore eyelids or crusts around the roots of the eyelashes, which could be blepharitis.

• Thickened skin, mainly on the nose, usually appearing after many years.

• An enlarged, bulbous, red nose (rhinophyma), which BAD says is more common in men.

The NHS says it is not known what causes rosacea, but some things can make symptoms worse. BAD says factors that trigger rosacea cause the blood vessels in the facial skin to enlarge (dilate), that people with rosacea can be sensitive to the sun and that keeping a diary of what worsens it may help.

On diet, the NHS and NHS inform list alcohol, spicy foods and hot drinks as common triggers. The NHS says that if you know a trigger like alcohol or spicy food makes symptoms worse, try to avoid it as much as possible. The NHS does not describe a specific rosacea diet beyond avoiding known triggers.

• Alcohol.

• Spicy foods.

• Hot drinks.

• Sunlight.

• Hot or cold temperatures.

• Aerobic exercise, like running.

• Being stressed.

The NHS, NHS inform and BAD give a similar list. BAD says that unless specifically recommended by your dermatologist, it may be best to avoid some acne treatments, as these can irritate skin prone to rosacea, and not to use creams and ointments containing corticosteroids, as they may make rosacea worse.

• Wear a sunscreen of at least SPF 30 every day, and reapply frequently when outdoors (BAD).

• Try to avoid heat, sunlight or humid conditions if possible.

• Cover your face and nose with a scarf in cold weather and wind (NHS inform).

• Use gentle skincare products for sensitive skin; do not rub or scrub the face when cleansing.

• Avoid perfumed soap; use a soap substitute (emollient) and a non-perfumed moisturiser if your skin is dry or sensitive.

• Clean your eyelids at least once a day if you have blepharitis.

• Take steps to manage stress.

• Cosmetics can be used to cover rosacea, and some people benefit from skin camouflage.

• BAD cautions that emollients can catch fire more easily on fabrics, so be careful near naked flames and avoid smoking.

BAD says some people with rosacea develop eye problems such as painful inflammation of the front part of the eye (rosacea keratitis), which may cause blurred vision, and that you should consult a dermatologist or an optician if you have symptoms affecting the eyes.

The NHS says to ask for an urgent GP appointment or call 111 if you have rosacea and your eye is painful, your vision is blurred, you are sensitive to light, you have a red eye or your eye feels gritty. These could be signs of keratitis, which can be serious if not treated urgently. NHS inform gives the same advice: phone 111 or contact your GP practice urgently.

No. The NHS says rosacea is not caused by poor hygiene and is not contagious. BAD also says rosacea is not contagious. BAD adds that rosacea does seem to run in some families, but there is no clear genetic link.

There is no specific test for rosacea. NHS inform says your GP will look at your skin, ask about your symptoms and ask if anything triggers them, and may arrange other tests to find out if there is any other reason for your symptoms. BAD agrees that rosacea can be diagnosed by its appearance and that specific tests are not usually required.

The NHS notes that rosacea can look a lot like other conditions, including acne, contact dermatitis, seborrhoeic dermatitis and other types of dermatitis, lupus and keratosis pilaris. That overlap is the main reason to have a first assessment rather than guessing. The NHS says to see a GP if you have symptoms of rosacea.

BAD says the rash and blushing can lead to embarrassment, lowered self-esteem and self-confidence, anxiety and even depression. NHS inform says people with rosacea may become aware of others looking or commenting, which can affect self-confidence and mental health.

Support is available. The charity Changing Faces offers advice and guidance for adults and young people living with a visible difference and runs a skin camouflage service. NHS inform and the NHS give its helpline. Talking to a GP about low mood is as legitimate as asking about the skin symptoms.

On the NHS, a GP can confirm the diagnosis, prescribe creams, gels or antibiotics and refer you to a dermatologist if treatments are not working. Laser treatment and skin camouflage may be offered in some areas or available privately.

Private dermatology appointments are also available and the assessment is the same: examination of the skin and advice on triggers and treatments. Ask who will review your response to treatment, since BAD says some treatments take at least 8 weeks to show an effect.