Rosacea risk factors: who gets it and what triggers flare-ups

What rosacea is

Rosacea is a long-term inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks, and it may also cause eye problems. Symptoms typically come and go, and many people report that certain factors, such as time in the sun or emotional stress, bring them on (NIAMS). MedlinePlus says rosacea is not dangerous; there is no cure, but treatments can help (MedlinePlus).

There is no score or calculator on this page; the factors below are the ones NIAMS and MedlinePlus name.

Who is more likely to get rosacea

Anyone can get rosacea, but NIAMS says it is more common in these groups (NIAMS):

• Middle-aged and older adults.
• Women. When men get it, it tends to be more severe.
• People with fair skin. It may be underdiagnosed in people with darker skin, because darker skin can mask facial redness.

People with a family history of rosacea may be at increased risk, but more research is needed to understand the role of genetics (NIAMS). MedlinePlus adds that you may be more likely to have it if you blush a lot or if rosacea runs in your family (MedlinePlus).

What causes it

Scientists do not know what causes rosacea. Inflammation drives some key symptoms, such as redness and rash, but why it happens is not fully understood. It may be partly due to more sensitive skin in people with rosacea, to environmental factors such as ultraviolet (UV) light, and to microbes that live on the skin. Both genetic and environmental factors likely play a role (NIAMS).

Common triggers

Many people find that certain factors make their symptoms worse. Triggers vary from person to person, and keeping a written record can help you find yours. Common ones NIAMS lists (NIAMS):

• Exposure to sunlight
• Emotional stress
• Hot or cold weather
• Strong winds
• Strenuous exercise
• Alcohol
• Hot baths
• Spicy foods
• Foods or drinks that are hot in temperature

Symptoms

Most people have only some of the symptoms, and the pattern varies. Rosacea often cycles between flare-ups and periods without symptoms (NIAMS). Symptoms NIAMS describes (NIAMS):

• Facial redness, which may start as a tendency to flush or blush and later last longer, sometimes with tingling or burning.
• Rash, with red or pus-filled bumps that look like acne.
• Visible blood vessels, thin red lines on the cheeks and nose.
• Skin thickening, especially on the nose, which can look enlarged. This is one of the more severe symptoms and mostly affects men.
• Eye irritation (ocular rosacea): sore, red, itchy, watery or dry eyes that may feel gritty, swollen eyelids, and styes.

It usually affects the center of the face, but in rare cases it can spread to the sides of the face, ears, neck, scalp and chest (NIAMS). MedlinePlus says it most often affects only the face (MedlinePlus).

Eye symptoms need a check. NIAMS says it is important to see a health care provider if you have eye symptoms, because untreated, they can lead to eye damage and loss of vision. If you develop eye irritation, see your doctor right away (NIAMS) (NIAMS).

Diagnosis and treatment

There is no specific test for rosacea. Doctors base the diagnosis on how your skin and eyes look and on your medical history, and may order tests to rule out conditions that look like it (NIAMS).

Treatment is tailored to each person and usually combines self-care with medicines. Most people respond well, but improvement is gradual and can take 3 months or longer. Options include creams, gels and ointments for redness and mild rashes, eye drops or ointments for eye irritation, oral antibiotics for moderate to severe rashes and more serious eye symptoms, retinoids for some severe cases, laser and light-based therapies to shrink visible blood vessels, and surgery to remove thickened skin (NIAMS). Dermatologists mainly treat rosacea; ophthalmologists and mental health professionals may also be involved (NIAMS).

Living with rosacea

NIAMS suggests learning your triggers, washing with cleansers made for sensitive skin, moisturizing regularly, avoiding exfoliants and products that contain alcohol, and using an SPF 30 or higher sunscreen made for the face every day (NIAMS).

A long-term condition like rosacea can raise the risk of anxiety and depression. NIAMS suggests seeing a mental health professional or joining a support group if emotional problems arise (NIAMS). See depression risk factors.

Common questions

Is rosacea genetic?

A family history may raise the risk, but NIAMS says more research is needed on the role of genetics; both genetic and environmental factors likely play a role (NIAMS).

Can people with darker skin get rosacea?

Yes. It is more common in people with fair skin, but NIAMS says it may be underdiagnosed in people with darker skin, because darker skin can mask facial redness (NIAMS).

Is rosacea the same as acne?

No. Rosacea can cause bumps that look like acne, along with redness, visible blood vessels and sometimes eye problems (NIAMS).