‘I’m a Dermatologist, and These Are the Most Common Questions People Ask Me About Rosacea’

Photo: Getty Images/Ani Dimi
Like many skin conditions, rosacea is a complexion concern that warrants many, many questions. After all, what is rosacea, and what causes it? Are there different types of rosacea? Is any facial redness a sign of full-blown rosacea?

All of these questions are among the seven most common ones that NYC-based cosmetic dermatologist Michele Green, MD gets asked on a regular basis. Fortunately for us, uncovering the answers won’t require an in-person visit—simply keep reading to learn about the misconceptions about rosacea and how to manage the inflammatory skin condition.

1. First things first: What is rosacea?

Rosacea is a common chronic skin condition that typically develops between the ages of 30 and 50, says Dr. Green. “Rosacea is considered a form of adult acne that is characterized by acne flare-ups, facial redness, flushing, and prominent facial blood vessels,” she explains, noting that flares typically appear on the cheeks, nose, forehead, chin, and chest. According to the American Academy of Dermatology, it affects as many as 14 million Americans, so know that if you’re dealing with it you’re most certainly not alone.

2. So, is rosacea a form of acne?

While rosacea is considered a form of adult acne, Dr. Green is quick to point out that there’s a big difference between acne vulgaris and acne rosacea. “Acne vulgaris, commonly referred to as acne, occurs when hair follicles become clogged with dead skin cells, debris, and oils resulting in inflammation,” she says, pointing out that causes of acne may include genetics, hormonal function, and bacterial growth. “Acne rosacea, commonly referred to as rosacea, is characterized by redness, papules, pustules, and swelling.”

In that way, some might say that it’s misleading to consider rosacea as a form of acne, but that’s just because most people assume that all acne is related to pus-filled breakouts, and that’s not the case.

“A common misconception with rosacea is that rosacea is a form of severe acne [vulgaris],” Dr. Green reiterates. “It is important to note that acne [vulgaris] and rosacea are completely different skin conditions that require different treatments. Rosacea is typically a lifelong condition that occurs during middle age. Acne [vulgaris] is typically a temporary skin condition that begins during puberty.”

What’s more, unlike acne vulgaris, which can occur anywhere, acne rosacea typically occurs in the central portion of the face and is characterized by flushing, broken capillaries, and spider veins, Dr. Green adds.

3. Is any type of facial redness considered rosacea?

Since rosacea’s number-one symptom is prominent redness, some people assume that any noticeable redness is a sign of the skin condition. In reality, Dr. Green says that it's characterized by persistent sunburn-like redness in the center of the face that won’t resolve. And she doesn’t mean within days or even weeks—because some contact dermatitis and inflammation from using the wrong product can last that long. Instead, she says that a person might be dealing with rosacea if the central redness lasts for at least three months.

“Rosacea can also occur on the eyes— called ocular rosacea—and is characterized by pruritic, dry, irritated, and red eyes,” says Dr. Green. “The eyes can also become photophobic and may experience blepharitis, or eyelid swelling.” So, if the center of your face isn’t red but your eyes persistently are, that should be cause for booking an appointment with your dermatologist to learn how to best proceed.

Of course, you should consult a doctor for your skin, too. “If you are experiencing redness on the face, it is important to consult with a board-certified dermatologist for a proper diagnosis of any skin conditions and the correct treatment plan,” Dr. Green says.

4. What causes rosacea?

Despite being an incredibly common skin concern, the exact cause of rosacea is unknown.

According to Dr. Green, there are several contributing factors that are currently being researched. “First, rosacea may be inherited, which suggests a genetic component. Those with a family history of rosacea have been observed to have an increased risk of rosacea,” says Dr. Green. “Second, rosacea can also be caused by an overactive immune system. Researchers found that the Bacillus oleronius bacteria stimulated an immune response in 79% of 22 patients with subtype two rosacea. Third, microscopic mites, called Demodex folliculorum, that normally live on the skin of 20% to 80% of adults can increase in population with changes to the skin due to age, stress, or illness. Lastly, the Helicobacter pylori bacteria, which naturally lives in our gut, can produce an enzyme that causes facial flushing and rosacea flare-ups.”

In layman’s terms, there are a number of potential causes for rosacea, but there’s not enough substantial research to definitely say the cause is one standalone factor.

5. Are there different types of rosacea?

Due to the complexity (and commonness) of rosacea, Dr. Green says that it has been categorized into four subtypes based on the appearance of the skin. “It is important to note that those suffering from rosacea often experience symptoms of more than one subtype at the same time,” she says.

Subtype 1: Erythematotelangiectatic Rosacea

Dr. Green says that this form of rosacea is “characterized by persistent facial redness (erythema) that is sometimes accompanied by broken blood vessels (telangiectasias). The skin may feel irritated, sensitive, and uncomfortable similar to a sunburn.”

Subtype 2: Papulopustular Rosacea

This form of rosacea is characterized by facial redness along with acne-like bumps and pimples,” says Dr. Green. “Subtype 2 rosacea tends to occur in those with oilier skin and can cause raised skin patches.”

Subtype 3: Phymatous Rosacea

“This form of rosacea is characterized by skin thickening and enlargement, especially around the nose,” Dr. Green shares. “When the nose is affected in this subtype, it is called a rhinophyma, and it tends to occur more commonly in men than women. As rhinophyma develops and worsens with age, patients may observe an increase in facial redness, thickening of the skin, a rough and waxy appearance to the epidermis, enlarged facial pores, and an increase in the number and size of sebaceous glands.”

Subtype 4: Ocular Rosacea

Remember: rosacea can occur in the eyes, too. “Ocular rosacea is characterized by redness, swelling, and discomfort in the form of dry eyes, cysts, inflammation, and infection,” Dr. Green says. “Ocular rosacea can occur either alone or in combination with skin rosacea. There is no permanent cure for ocular rosacea; however, treatment is available to manage the symptoms.”

6. What triggers flare-ups?

1. Dietary factors

Dietary factors include hot or spicy foods, caffeine, hot beverages, dairy products, spices and seasonings containing cayenne pepper or red pepper, and foods containing cinnamaldehyde, like citrus fruits, tomatoes, and chocolate,” says Dr. Green.

2. Lifestyle factors

“Lifestyle factors include stress, genetics, smoking, alcohol, exercise (i.e. hot yoga) and intense exercise, steam rooms, hot baths, hormonal or endocrine issues including thyroid diseases or menopause), hypertension, medications that dilate blood vessels including certain blood pressure medications, and certain skincare products like Retin-A creams or creams with fragrance or those that are alcohol-based,” she reveals.

3. Environmental factors

Additionally, Dr. Green says that the environment can also lend to rosacea flares. “Environmental factors include extreme heat or cold weather, wind exposure, and sun exposure,” she says.

In any case, Dr. Green says that it’s important to identify the triggers that can exacerbate your rosacea so that you can avoid them to avoid flare-ups. But, remember: Not everyone is triggered by the same things, so while alcohol might exacerbate one person’s rosacea, it may not affect another’s at all.

7. What are the best ways to treat rosacea?

The good news is that there are a handful of ways to soothe the discomfort and minimize the redness associated with rosacea. The bad news is that there’s no permanent cure for the skin condition.

“The first goal in treating rosacea is to control inflammation and irritation caused by rosacea,” Dr. Green says. “The second goal is to treat the appearance of flushed skin, redness, and broken blood vessels.” With that in mind, she says that treatment may include a combination of topical medications (like Metrogel, Soolantra, and Mirvaso, all of which require a prescription), oral medications (including antibiotics and Accutane) photodynamic treatments (which she says “uses a photosensitizing molecule with intense blue light to heal the skin”), and laser treatments (such as the V-Beam pulsed dye laser, which she says “absorbs and treats anything red”).

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