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Resources :: Health Info :: Face



Rosacea is a common inflammatory condition of the skin of the face that causes redness that looks like a flush or blush. It is initially characterised by outbreaks and periods of improvement. Rosacea is sometimes called acne rosacea, which is misleading because rosacea and acne are two totally different conditions, although they can appear together.

Rosacea often progresses from intermittent to persistent facial redness with pimples without blackheads and telangiectasia (red lines where the tiny blood vessels of the cheeks, nose, chin and forehead become quite prominent).

Rosacea occurs in both men and women and, and although it may occur at any age, onset usually begins after the age of 30.

People with rosacea often find that certain lifestyle and environmental factors trigger a flare-up or aggravate their individual conditions. Common triggers include certain foods (especially hot or spicy foods) and drink, (especially alcohol and caffeine), exercise, temperature changes, exposure to the sun, rain or wind, and stress.

Rosacea responds to treatment but cannot be cured. Left untreated, the redness becomes more permanent and the tiny blood vessels may become more visible. Pimples often develop and in a few people, especially older men, the nose may become bumpy, red and swollen (Rhinophyma).


The cause of rosacea is unclear, and there may be more than one cause. Tiny blood vessels under the skin of the face enlarge and dilate. These blood vessels may become hyper- sensitive to certain triggers.

It is believed that some people have a genetic predisposition to developing it as tends to run in families.

Although treated with antibiotics, bacteria have not been proved to cause rosacea. Immune reactions in the skin may be involved. Women are more likely to get rosacea generally on the face, but men are more likely to get rhinophyma.


Rosacea causes erythema (redness) that looks like flushing or blushing of the face or neck. The flushing occurs when blood flow increases the amount of blood flow through small blood vessels and the vessels expand to accommodate this flow. The redness initially may come and go but becomes more permanent as the disease progresses.
Telangiectasia (red lines) - Many people also have enlarged blood vessels under the skin, which are noticeable as red lines through the skin, especially when the overall redness fades.
Facial Burning, Stinging or Itching -flushing attacks can cause uncomfortable physical symptoms, such as facial burning, stinging or itching.
Oedema (facial swelling). Sometimes soft facial swelling may last for days when the erythema flares up. Persisting hard facial oedema can also occur.
Dome shaped small lumpy red pimples (papules) - The pimples of rosacea, which often occur as the disease progresses, are different from those of acne because blackheads and whiteheads are not present. Some of these pimples contain pus (pustules) and appear as small white bumps. Left untreated larger nodules can develop.
Many people develop related problems affecting the eye- ocular rosacea. This can affect over 50% of people and can range from mild to severe. Eye problems are unlikely to develop in people taking antibiotic tablets for rosacea.

Symptoms include:

Blepharitis, (inflamed, dry and crusty eyelids), and
Conjunctivitis, (Gritty feeling eyes)

More serious problems arise, if left untreated including:

Iritis, (painful inflammation of the iris), and
Keratitis, (ulceration of the cornea).

In a few people, especially older men, the nose becomes enlarged, bumpy, red or purple and swollen (Rhinophyma).

As rosacea affects the face, it can be associated with anxiety and lack of confidence and may lead to psychological problems and depression.

The cause of rosacea is unclear, and there may be more than one cause. Tiny blood vessels under the skin of the face enlarge and dilate. These blood vessels may become hyper- sensitive to certain triggers.

It is believed that some people have a genetic predisposition to developing it as tends to run in families.

Although treated with antibiotics, bacteria have not been proved to cause rosacea. Immune reactions in the skin may be involved. Women are more likely to get rosacea generally on the face, but men are more likely to get rhinophyma.


You should see your doctor as soon as you suspect the first signs and symptoms so that they can make the correct diagnosis and give you the most appropriate treatment It is important to treat this condition early to prevent longer-term effects such as telangiectasia, rhinophyma, persistent oedema of the face and eye problems.

It is important to get a correct diagnosis as other skin disorders and illnesses may appear like rosacea. There are no specific tests for rosacea. The diagnosis is usually made by the appearance alone. No special tests are needed.


Pustules (pus-filled pimples) and papules (red pimples)

A topical (applied to the skin) antibiotic, metronidazole is commonly given as a gel or cream for the treatment of mild rosacea. You may see a slight improvement within the first month but it usually takes about two months to see a more definite improvement. Apply a thin layer of the gel or cream once or twice a day to the affected area(s), according to the label and patient information leaflet that is provided with your medicine. You will need to use it for two to three months or longer depending on the type of preparation used and the severity of the rosacea. If you are given topical metronidazole and you use a moisturiser, apply the moisturiser after the medication has dried. The moisturiser will also help to soothe the skin.

Topical metronidazole preparations sometimes cause irritant dermatitis, so the skin becomes more inflamed and itchy. If this happens, you should see your doctor, you may need to change to another treatment.

If you donít understand how to use your medicines, talk to your GP, your local pharmacist (chemist) or ring NHS Direct on 0845 4647.

Antibiotic tablets or capsules, taken by mouth (orally), are used if your skin does not respond to topical metronidazole or if you have a more severe form of the condition. You may be given antibiotic tablets or capsules in addition to a topical treatment. The antibiotics normally used are oxytetracycline or tetracycline or erythromycin. Doxycycline is sometimes used if oxytetracycline or tetracycline are considered not suitable for you e.g. if you have kidney failure. Oral antibiotics clear the spots on the face and prevent eye complications and rhinophyma (enlargement of the nose) before they develop.

Oral antibiotics usually work well, but it is not clear why they work, as a bacteria that causes rosacea has not been found. Some antibiotics reduce inflammation in the skin as well as kill germs and this may contribute to the way they work. Some improvement may be noticed after two to three weeks of treatment but you would normally have to take a course of between six and twelve weeks for them to work well.

The exact dose and when you should take it depends on the individual antibiotic. This is usually once or twice a day, depending on the antibiotic used. Read the label and patient information leaflet, provided with your medicine, carefully and always follow the instructions. Unless you experience some severe side effects and feel it necessary to stop treatment, complete the full course of antibiotics even if you think that the rosacea has cleared up. If you do not, the treatment may fail.

If you think you are experiencing particular side effects or donít understand how to use your medicines, talk to your GP, your local pharmacist (chemist) or ring NHS Direct on 0845 4647. See your GP before you run out of tablets, to discuss any further steps needed for your treatment.

These steps may include:

Extending the length of the course.
A smaller maintenance dose after you have completed the course to take over a long period of months or even longer, to keep rosacea from recurring.
A repeat course of antibiotics at a later date to keep the condition under control.
Referral to a dermatologist (skin specialist)

Isotretinoin belongs to a group of medicines known as retinoids, which are chemically related to vitamin A. It works by reducing the production of the skin's natural oil (sebum) and reducing the horny protein (keratin) in the outer layers of the skin. It can only be prescribed by, or under the supervision of, a consultant dermatologist and is reserved as an alternative when other treatments have failed. It has some potentially serious side effects such as liver damage and bowel inflammation. It may also cause abnormalities in the unborn child so effective contraception must be used during treatment and for at least a month before and after. The consultant dermatologist or doctor under his supervision will need to carry out a full clinical assessment and will explain benefits and harms to you about this medicine before it is prescribed.

Eye problems

If you develop eyelid inflammation (blepharitis) or any eye discomfort or stickiness, you should see your GP for the most appropriate treatment. Regular eyelid hygiene is the most important part of treatment and prevention of blepharitis. Eye problems are unlikely to occur in patients taking antibiotic tablets for rosacea.

Redness and flushing

Medicines used to treat pustules do not clear the redness or reduce the appearance of dilated blood vessels below the skin. Clonidine is sometimes used as a non-hormonal treatment for facial flushing during and around the menopause and so may help to reduce flushing attacks in rosacea during this period. However, there is little evidence to support its usefulness in the treatment of flushing in rosacea.

Over the counter medicines

Over the counter medicines are not effective for the treatment of rosacea and sometimes they may even make it worse.

For example, topical corticosteroid creams (such as hydrocortisone) would initially appear to help because they reduce inflammation but, when you stop using them, you could experience a severe flare up as they can mask the other symptoms.

However, discuss your condition with your pharmacist as they can provide advice on the use of moisturisers, sunscreens and soaps.

Cosmetic options

Your GP can prescribe camouflage creams to mask disfigurement of the skin. The British Red Cross offers a Cosmetic Camouflage Service, available nationally, to assist with the use of these creams, using simple cosmetic camouflage techniques.

Laser treatment for telangiectasia

Lasers use light energy, which is absorbed by the haemoglobin in blood and converted to heat, which causes the dilated red veins to shrink.

Surgery for rhinophyma

Rhinophyma can be treated surgically. The nose can be planed and shaped under anaesthetic. The nose is then dressed and forms a new layer of skin. A carbon dioxide laser can also be used to shrink the rhinophyma tissue.


Prevention of redness and flushing. Common trigger factors of facial flushing are emotional stress, hot drinks and alcohol. These factors even trigger flushing in some people who do not have rosacea.

Other trigger factors may include:

Spicy foods
Some prescribed medicines including ACE inhibitors e.g. ramipril and statins e.g. simvastatin. Ask your GP to consider any medicines you are taking as being possible triggers, do not stop taking them without their advice.
Exposure to the sun or cold

What may cause a flare up in one person, may not in another. Keeping a diary over a few weeks can help to identify foods and other triggers that appear to make the flushing worse so they can be avoided wherever possible.


No info

source NHSDirect 151204

Product code:sym-rosacea

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