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Rosacea: symptoms, treatment, care

by Josephine Andrews
Published: Last Updated on 346 views

Rosacea (rosacea) is an inflammatory, chronic disease of the facial skin that progresses in phases. It starts with reddening of the skin. Vascular dilatations, blisters, nodules and new tissue formation can occur later. Those affected suffer from itching and pain, and the cosmetic impairment is also a burden. Find out everything you need to know about rosacea here – symptoms, causes, diagnostics, treatment and prognosis.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.


quick overview

  • What is rosacea? Chronic inflammatory skin disease that progresses in flares and varying degrees of severity. The face is usually affected, rarely other parts of the body.
  • Symptoms: Initially, fleeting reddening of the skin (erythma), later often vasodilatation, inflammatory blisters and nodules, and new tissue formation (phymas). In addition, burning, itchy skin and stabbing pain. The special form of ophthalmorosacea affects the eye and, if left untreated, can lead to severe visual disturbances .
  • Triggers and risk factors: strong, long-lasting UV radiation (sunbathing, solarium ), heat, hot baths and showers, certain cosmetics, washing lotions with an alkaline pH value (>7), certain medications, coffee and tea, alcohol and nicotine , stress.
  • Treatment: drugs (ointments, creams, lotions, antibiotics), laser treatment, sclerotherapy, photodynamic therapy, surgery; Avoiding typical triggers such as UV radiation, heat, spicy food, alcohol and certain care products and cosmetics
  • Causes: Still unclear. A genetic predisposition in interaction with various immunological, microbacterial and neurological factors is suspected.
  • Prognosis: Chronic course, not completely curable. With proper treatment, care and an adapted lifestyle, the symptoms can be well controlled and the flare-ups reduced. Sometimes the disease comes to a sudden standstill.

Rosacea: symptoms

Rosacea (rosacea, “copper rose”) is a skin disease (dermatosis). It classically affects the face and rarely other parts of the body.

Rosacea progresses in phases and varying degrees of severity, which are accompanied by typical symptoms. In addition, the symptoms can vary from patient to patient, so that they cannot always be clearly assigned to a degree of severity.

Preliminary stage: rosacea diathesis

Typical for the onset of rosacea are sudden, fleeting reddening of the skin (erythema). They mainly affect the cheeks, nose , chin and mid-forehead area. Rarely does rosacea appear on other parts of the body, such as around the eyes, scalp, chest or neck.

Severity I: Rosacea erythematosa-telangiectatica

In addition to the reddening of the skin, there are also vascular dilations (telangiectasias) in the facial skin. The skin is dry and occasionally flakes easily. In addition, those affected suffer from itching and burning, stabbing pain .

Severity II: papulopustular rosacea

In this stage form, inflamed, reddened blisters (pustules) and nodules (papules) also appear as rosacea symptoms. They usually only disappear after several weeks. Lymphedema (accumulation of fluid) in the facial tissue sometimes also develops .

Because rosacea causes acne-like inflammatory skin changes, the disease used to be called “acne rosacea”.

Grade III: Glandular hyperplastic rosacea

This is the most severe form of rosacea. Connective tissue and sebaceous glands enlargement, causing bulbous growths ( phyma ) , such as a bulbous or potato nose ( rhinophyma ). For cosmetic reasons, those affected usually suffer greatly from these skin changes.

Unlike acne , rosacea does not produce blackheads. If you notice typical rosacea symptoms and blackheads at the same time, you are probably suffering from a mixed form.

Special forms of rosacea

In addition to classic rosacea, there are some special forms that occur comparatively rarely.

Ophthalmorosacea is observed in about every fifth affected person. It affects the eye, either in addition to the classic skin disease rosacea or in isolation. Typical symptoms are dilated blood vessels in the eyes and inflammation of the eyelids (inflammation of the eyelid margin = blepharitis ) and conjunctiva ( conjunctivitis = conjunctivitis). The eyes are usually dry and often burn. Ophthalmorosacea should be monitored particularly closely. If left untreated, it can cause inflammation of the cornea (keratitis), which in extreme cases can lead to blindness.

In rosacea fulminans, the typical symptoms are particularly pronounced within a few days or weeks. Young women are predominantly affected, while men are almost never affected. Once rosacea fulminans has been overcome, it usually does not reappear.

Gram -negative rosacea occurs when the disease has been treated with antibiotics for several weeks without lasting success. Then only certain pathogens were destroyed. Others, called gram-negative bacteria , have survived. They multiply and subsequently cause further skin reactions.

If rosacea is treated with glucocorticoids (steroid hormones such as cortisone), steroid rosacea can develop after the medication is stopped . This is often much more difficult than the rosacea that was actually intended to be treated. For this reason, rosacea is only treated with these drugs in exceptional cases.

Typical manifestations of rosacea
The inflammatory skin disease rosacea is mainly characterized by severe reddening of the face. In a special form, the eyes can become ill and damaged.

Rosacea: Treatment

Rosacea symptoms can often be significantly alleviated with special medication and the right cosmetic care. If left untreated, rosacea usually gets worse in stages.

In addition to or as an alternative to drug treatment, other therapy methods can be used. These include sclerotherapy, photodynamic therapy , and surgery. In addition, people with rosacea should keep an eye on their diet and avoid typical triggers of the symptoms as far as possible.

Some patients use homeopathy to treat rosacea (often in addition to conventional medical therapy). An effectiveness of the alternative healing method has not yet been scientifically proven. However, some patients report an improvement in symptoms.

Rosacea treatment with medication

Drug treatment is the most important component of rosacea therapy. A distinction is made here between local and systemic therapy. Experience has shown that the combination of local and systemic rosacea therapy is particularly effective.

Local (topical) rosacea treatment

Here, the drug is applied directly to the affected areas of the skin as an ointment, gel or lotion. Which dosage form is the most effective and best tolerated depends on the individual case. The external treatment of rosacea is usually carried out over a very long period of time (as a topical maintenance therapy). The two main active ingredients used are:

Both active ingredients are said to have an anti-inflammatory effect on rosacea. They may also slow down the immune system, which typically overreacts in rosacea. The azelaic acid also ensures that certain skin cells (keratocytes) do not grow too much.

In addition, other substances can be used for local rosacea therapy:

  • Permethrin : When dosed correctly, the actual poison has a positive effect on rosacea.
  • Clindamycin : The antibiotic is also used locally in exceptional cases.
  • Retinoids : Like permethrin, they are also used for acne.
  • Calcineurin inhibitors : They mainly help with steroid rosacea.

The active ingredients mentioned primarily combat the nodules and blisters. However, they usually do not help against the typical reddening of the face. In contrast, a special gel containing the active ingredient brimonidine was developed in the USA. It has also been approved in the EU since 2014. The drug causes the blood vessels in the skin of the face to constrict. This will fade the redness.

Systemic rosacea treatment

Local treatment is sufficient for some milder forms of rosacea. In more severe cases, however, systemic rosacea treatment is also necessary. The drug is used internally, for example in the form of tablets. This is how the active ingredient gets through the bloodIn this way, the active ingredient reaches the entire body On the one hand, this makes systemic rosacea therapy more effective than local ones. On the other hand, there are often more severe side effects.

Antibiotics are mostly used for systemic rosacea therapy , in particular two groups:

  • Tetracyclines : Doxycycline and minocycline are the names of the most commonly used drugs in this group of drugs. They are the first choice in the antibiotic treatment of rosacea because they are better tolerated by the stomach and intestines than macrolides.
  • Macrolides : This group of active ingredients includes, for example, erythromycin and clarithromycin . Macrolides are used when patients cannot tolerate tetracyclines.

Antibiotics are actually used to fight bacteria. In the treatment of rosacea, however, a different mechanism of action of these substances is used: in low doses, the antibiotics have a predominantly anti-inflammatory effect and dampen the overreacting immune system – similar to metronidazole and azelaic acid in local rosacea treatment.

In addition to antibiotics, the systemic treatment of rosacea sometimes also uses agents that are normally used for local treatment – for example tablets containing metronidazole .

Studies show that retinoids such as isotretinoin can also relieve rosacea symptoms when used internally. However, isotretinoin is only approved in Germany for the treatment of severe acne. It is therefore used in severe rosacea only in exceptional cases outside of official approval (“off label”). Great caution is required because taking isotretinoin capsules can have many side effects (including serious ones), such as irritation of the skin and mucous membranes. In addition, isotretinoin must not be taken by women who could become pregnant (risk of birth defects!).

Unlike many other skin diseases, rosacea is only treated with glucocorticoids (“corticosteroids”) in exceptional cases, since these agents usually worsen the clinical picture. Even after an initial improvement, the symptoms usually return even more severely after stopping the cortisone preparation.

Laser treatment and sclerotherapy

With a laser treatment, the persistent redness and vascular dilation (telangiectasia) can usually be easily eliminated. For this purpose, the affected areas of the skin are treated with bundled, high-energy rays of light. Phymas can also be removed in this way.

Vascular enlargements can also be sclerosed with the help of an electric current.

Photodynamic Therapy (PDT)

In photodynamic therapy, rosacea patients first receive a substance that makes the skin more sensitive to light. This so-called photosensitizer attaches itself to the affected areas of the skin. Then these areas are irradiated with light of a certain wavelength. This changes the structure of the photosensitizer. As a result, the substance destroys defective skin structures.

surgical therapy

Rosacea can also be treated surgically, for example with dermabrasion or dermashaving. These methods are mainly used for phymas. They are therefore described in more detail in the article ” Rosacea: Rhinophyma “.

Change your diet & avoid triggers

It is also very helpful when people with rosacea change their diet. There is no specific rosacea diet. However, since experience has shown that hot spices , very hot food and drinks and alcohol can lead to vasodilatation in the face, it is better for you as a patient to avoid them. Eat a healthy, balanced diet . In particular, reduce your fat and sugar consumption in favor of lots of fruit and vegetables. So you can prevent clogging of the pores of the facial skin. This in turn has a positive effect on the complexion.

In addition, you should test how your rosacea reacts to different foods. Consciously avoid individual foods from time to time and observe whether and how the rosacea symptoms change as a result.

It is also important that you avoid the typical triggers of a rosacea attack:

  • strong, long-lasting UV radiation (sunbathing, solarium)
  • Heat, hot baths and showers, sauna visits
  • Wash lotions and soaps with alkaline pH (>7)
  • certain cosmetics
  • certain medications
  • coffee and tea
  • alcohol
  • nicotine
  • stress

Hormonal changes, such as during pregnancy, can also trigger a flare-up. Talk to your doctor about it.

Rosacea patients react differently to the various possible triggers. Therefore, observe exactly which stimuli your skin reacts to and adjust your lifestyle accordingly.

Rosacea: care

Rosacea skin should be properly cared for. This can support treatment with medication and/or other therapy methods. Because certain ingredients and improper use of care products can irritate the skin and thus increase the symptoms.

Proper skin care

When it comes to skin care, keep the following tips in mind:

  • Clean the facial skin only with lukewarm water. Extreme water temperatures and rapid temperature changes can lead to sudden skin reddening (flushing).
  • Avoid facial scrubs, as they irritate the rosacea skin further.
  • Only use care and washing products without menthol, camphor, sodium lauryl sulfate and astringents.
  • Avoid water with a high degree of hardness.
  • After washing, gently pat facial skin dry with a towel instead of towel rubbing.
  • Use soaps and washing lotions with a slightly acidic pH value (< 7).

When it comes to facial cleansing, so-called washing syndets are well suited for rosacea patients. These are artificial washing-active substances with a relatively low pH value (4.5 to 5.5) that are much gentler on the skin than classic soaps.

The fine blood-vessels in the skin dilate
The skin on the cheeks reddens because the smallest blood vessels dilate (telangiectasia) – the veins are clearly visible.

Watch out, sun!

UV rays are an important risk factor for rosacea sufferers. Therefore, you should conscientiously protect your skin from (strong) UV radiation:

  • Avoid direct sunlight between spring and autumn.
  • Avoid going to the solarium.
  • Use sun protection products with a high sun protection factor (50+) and apply them several times a day. Prefer physical sunblock with titanium dioxide or zinc oxide (pharmacy). In the case of rosacea, these are considered to be better tolerated by the skin than chemical sunscreens .

Rosacea: Cream, Ointment or Lotion?

The products differ in terms of water and fat content. An ointment contains no water at all, only fat . A cream, on the other hand, has a certain water content. A lotion even contains more water than fat. It is therefore also referred to as an oil-in-water emulsion.

Products with a high water content, ie creams and lotions, are ideal for rosacea patients. Because they do not form a pore-closing greasy film on the skin, but allow the skin to breathe without drying it out. The same applies to preparations based on glycerin or silicone oil (cyclomethicone, dimethicone).

You should completely avoid products with added fragrances or dyes, as these irritate the skin unnecessarily.

Tip: Before you buy your care products, get detailed advice from the pharmacy.

Makeup for Rosacea

In principle, you can also use makeup with rosacea. However, you should make sure that the products are free from skin-irritating ingredients such as menthol, camphor, sodium lauryl sulfate and astringents. In addition, the cosmetics should not clog the sebaceous glands, ie they should not be comedogenic.

Avoid very heavy makeup. Because this is difficult to remove, which in turn can cause skin irritation. On the other hand, it makes sense to use special rosacea make-up that covers up the redness on the face well and is also easy to remove.

Rosacea sufferers can react very individually to cosmetics. If you find that you do not tolerate a product, you should stop using it immediately and try an alternative.

Rosacea: Rhinophyma

Rhinophyma is a symptom of rosacea that can develop when the disease is severe . It is an overgrowth of connective tissue and sebum glands (phymes). Rhinophymas usually occur on the nose. This so-called bulbous nose or potato nose is observed particularly in older men.

Phymas are treated with medication or surgery. Especially in the surgical field, good optical treatment successes can be achieved today. However, there is a possibility that a new bulbous nose will form later.

You can read more about “rhinophyma” in rosacea in the article Rosacea: Rhinophyma .

Rosacea: causes and risk factors

Depending on which study is used as a basis, between 2 and 20 percent of the population in Germany suffer from rosacea. People over 30 are most commonly affected. In exceptional cases, children can also develop rosacea. There are no major differences between the sexes – rosacea occurs only slightly more frequently in women. In addition, light skin types are affected more often than dark ones.

The typical symptoms of rosacea are based on permanent widening of the blood vessels and chronic inflammation of the skin. The reasons for this have not yet been fully clarified. A genetic predisposition is suspected. Experts believe that, in combination with various factors, it could lead to the development of rosacea.

How does rosacea develop?

Among other things, the body’s immune system probably plays a role. It produces certain antimicrobial substances in the skin that are designed to fight incoming pathogens. Some of these substances trigger inflammation and also cause new blood vessels to form (angioneogenesis). This is normal and useful to destroy invading pathogens. However, significantly increased concentrations of these antimicrobial substances have been detected in the blood of rosacea patients. That could explain the pathological skin inflammation and tissue regeneration.

Certain microorganisms are suspected to trigger the immune reaction. The skin of people affected by rosacea is often over-colonized with so-called hair follicle mites (Demodex folliculorum). The microscopically small animals are indeed on the skin of every human being. However, they appear to be more prevalent in rosacea patients and trigger the inflammatory immune response described above.

In addition, there is evidence that in rosacea receptors of the immune system are not working properly. These receptors recognize foreign organisms and produce specific substances to fight them. In the event of a dysregulation , however, the receptors overreact and thus trigger persistent skin inflammation.

Last but not least, inflamed nerves in the face seem to play a role in the development of rosacea. The nerves control the blood vessels by expanding them when it is hot and contracting them when it is cold. However, in rosacea patients, the communication between nerves and blood vessels in the face does not work properly because the nerves are inflamed. This leads to malfunctions – even with weak stimuli such as spicy food, the blood vessels dilate without then completely contracting again.

Rosacea: investigations and diagnosis

The dermatologist can usually recognize rosacea based on the typical symptoms (redness of the skin, dilated vessels, etc.). Special examinations are therefore usually not necessary.

Sometimes the doctor takes a skin sample ( biopsy ) if rosacea is suspected. It is examined more closely under the microscope. In this way, visually similar skin diseases can be ruled out, such as the rarer butterfly lichen or stewardess disease (cosmetic acne). The examination also helps to assess the severity of rosacea.

Rosacea: disease course and prognosis

Rosacea is usually chronic and flares up – phases with more severe symptoms alternate with times when the symptoms subside or at least improve. While there is no complete cure for the condition, it is easily controlled with the right treatment, skin care, and lifestyle. Sometimes rosacea even comes to a standstill without progressing.

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