Rosacea: a patient guide to symptoms, triggers and treatment in the UK

The British Association of Dermatologists (BAD) describes rosacea as a common long-term skin condition that 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. It most often affects fair-skinned people but may appear in any skin type, can start at any age but most commonly appears in young adults, and is more common in women, though more severe in men.

BAD notes that rosacea fluctuates from mild to severe and is classified into 4 subtypes that may overlap, which a doctor will explain. The NHS says that as rosacea gets worse the skin on the cheeks, nose and forehead may be red all the time.

The NHS lists early signs as redness (blushing) across the nose, cheeks, forehead, chin, neck and chest that comes and goes, usually lasting a few minutes, with the face feeling warm, hot or painful, and a burning or stinging feeling when using water or skincare products. The redness may be harder to see on brown or black skin. Later signs include tiny broken blood vessels that do not go away, small pink or red bumps sometimes filled with a yellowish liquid, dry skin, swelling especially around the eyes, yellow-orange patches, sore eyelids or crusts at the roots of the eyelashes, which may be blepharitis, and thickened skin mainly on the nose after many years.

BAD adds that the face is often sensitive and may feel very hot or sting, that the rash and blushing can lead to embarrassment, lowered self-esteem, anxiety and even depression, and that occasionally an overgrowth of oil glands on the nose may make it enlarged, bulbous and red (rhinophyma), which is more common in men. It also describes eye problems such as painful inflammation of the front part of the eye (rosacea keratitis) which may cause blurred vision.

• Flushing and blushing that comes and goes.

• Persistent redness and visible small blood vessels.

• Bumps and pus-filled spots.

• Burning or stinging, dryness and sensitivity.

• Sore, gritty or red eyes and eyelids.

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.

BAD similarly says that if your eyes are affected, you should not ignore them and should consult your GP, a dermatologist or an eye specialist doctor. Lesser eye irritation, such as sore or crusty eyelids from blepharitis, is managed by cleaning the eyelids at least once a day, according to the NHS.

The NHS says it is not known what causes rosacea, but some things make symptoms worse, and it lists alcohol, spicy foods, hot drinks, sunlight, hot or cold temperatures, aerobic exercise such as running and being stressed. BAD explains that factors that trigger rosacea cause the blood vessels in the skin of the face to enlarge, that genetics, immune system problems and environmental factors may all play a part, and that the theory that it is caused by bacteria on the skin or in the gut has not been proven, although antibiotics help because of their anti-inflammatory effect. It does seem to run in some families, although there is no clear genetic link.

BAD suggests keeping a diary of what worsens rosacea. Both the NHS and BAD stress that rosacea is not contagious.

BAD says rosacea can be diagnosed by its appearance and specific tests are not usually required. The NHS notes that rosacea can look a lot like other conditions such as acne, contact dermatitis, seborrhoeic dermatitis and other dermatitis, lupus and keratosis pilaris, so a GP assessment is worthwhile, and it advises seeing a GP if you have symptoms of rosacea.

The NHS says a GP may suggest prescription creams and gels that you put on the skin, or antibiotics for 6 to 16 weeks, and may refer you to a dermatologist if treatments are not working. BAD says the inflammation can be treated with medications applied to the skin or taken by mouth, though not all will help the redness or blushing, and that it may take at least 8 weeks for the effect of a local treatment to become evident. Oral antibiotics, most commonly from the tetracycline group, are helpful for moderate or severe inflammation, and the duration depends on response.

BAD lists other treatments: an eye specialist for severe eye problems; reduction of a bulbous nose (rhinophyma) by a dermatologist or plastic surgeon; laser therapy for redness and dilated blood vessels; a beta-blocker tablet or clonidine for troublesome blushing; and isotretinoin tablets sometimes for severe rosacea. It advises not using creams and ointments containing corticosteroids unless specifically recommended by a dermatologist, as these may make rosacea worse.

The NHS suggests wearing a high SPF sunscreen of at least SPF 30 every day, avoiding heat, sunlight or humid conditions if possible, covering the face in cold weather, using gentle skincare products for sensitive skin, cleaning the eyelids at least once a day if you have blepharitis and managing stress. It advises avoiding alcohol, hot drinks, spicy food and too much aerobic exercise if they are triggers.

BAD adds not rubbing or scrubbing the face when cleansing and not using perfumed soap, using a soap substitute (emollient) to cleanse the face and a non-perfumed moisturiser if the skin is dry or sensitive, and avoiding some acne treatments unless recommended by a dermatologist because they can irritate skin prone to rosacea. Cosmetics and skin camouflage can help hide redness, and the NHS notes that the charity Changing Faces can offer advice and support if you are feeling anxious or depressed.

On the NHS, a GP can diagnose and treat most rosacea, with referral to dermatology for treatments that are not working, laser or rhinophyma surgery, and to eye services for keratitis. Skin camouflage services are available through organisations such as Changing Faces.

Private dermatology provides quicker access to laser treatment and specialist prescribing. Either way, early treatment matters because the NHS says rosacea can get worse if it is not treated.