Acne Rosacea

Types, Symptoms and Treatments

What is Acne Rosacea?

Acne rosacea (or just Rosacea as its more commonly known), is a chronic skin condition that typically affects the face. Primarily rosacea is most evident on the cheeks, nose, chin and forehead. It displays symptoms similar to acne — and is characterised by redness, swelling, and small, red, pus-filled bumps. Whilst it can affect anyone, it most commonly surfaces in middle-aged women with fair skin. Its exact cause is currently unknown, but it’s believed to stem from a combination of genetic and environmental factors. In this guide to rosacea acne we explore the different types, symptoms, causes and triggers and treatments for rosacea.

Types of Rosacea

Rosacea is usually divided into four subtypes. Each of these has its own distinct set of symptoms:

Erythematotelangiectatic Rosacea (ETR)

ETR is characterised by persistent redness (erythema) and visible blood vessels or telangiectasia on the face. People with ETR rosacea might experience episodes of flushing and blushing. Their skin might also be sensitive, dry and stinging.

Papulopustular (or Acne) Rosacea

As its name suggests, this subtype resembles acne. Typically sufferers experience redness, swelling and breakouts in the form of papules and pustules. This subtype mostly affects middle-aged women.

Phymatous Rosacea

The phymatous form of rosacea causes the skin to thicken and develop a bumpy texture. This often results in an enlargement of the nose, a condition known as rhinophyma. This subtype is more common in men.

Ocular Rosacea

Generally, Ocular rosacea causes a range of symptoms associated with the eye area. These include dry eye, tearing, redness, burning and the sensation of having something in the eye. Ocular rosacea can be severe in some cases, potentially leading to rosacea keratitis. This is a condition that can damage the cornea and affect vision if left untreated.

Symptoms of Rosacea

The symptoms of rosacea depend on the subtype but they can also vary significantly from person to person. Typically, they include one or more of the following:

  • Facial redness: this persistent erythema is a common sign. Small blood vessels on the nose and cheeks often swell and become visible.
  • Swollen red bumps: many people with rosacea also develop pimples on their face that resemble acne. These bumps sometimes contain pus and they may make the skin feel hot and tender.
  • Eye problems: some people with rosacea experience experience conjunctivitis which manifests as dry, irritated, swollen eyes and red, swollen eyelids. Ocular rosacea can even impair vision if it progresses.
  • Enlarged nose: in severe cases, especially in men, rosacea can cause the nose to grow swollen and bumpy from excess tissue.

Causes and Triggers

The exact cause of rosacea remains unknown. It is likely due to a combination of hereditary and environmental factors. Various things can trigger or exacerbate it by increasing blood flow to your skin’s surface. These include:

  • Hot drinks and spicy foods
  • Alcohol
  • Temperature extremes
  • Sunlight or wind
  • Stress, anger or embarrassment
  • Intense exercise
  • Certain medications, like blood pressure drugs. These dilated blood vessels hence trigger rosacea.

Who Gets Rosacea?

Rosacea is a common condition that affects millions of people worldwide. While it can occur in anyone, it most frequently affects middle-aged women who have fair skin. There’s also a genetic component to it, and those with a family history of the condition are more likely to develop it themselves.

Despite the common demographic, this disease can also affect men and people of all age groups and skin tones. In men, it often appears more severe because they delay medical treatment until the condition reaches an advanced stage. Young people, even children, can develop rosacea. This is often diagnosed due to persistent redness and acne-like symptoms.

Rosacea in Skin of Colour

This condition affects people of all skin tones. However, people of colour typically have a harder time getting diagnosed due to general ignorance in the medical field regarding how rosacea and other common dermatology conditions present in skin of colour. People with darker skin types may exhibit symptoms differently. Rather than redness, it may present as dark brown or purple spots, primarily on the forehead, cheeks and chin.

Another common symptom of rosacea in skin of colour is an increased skin sensitivity. Those with the condition often report that their skin stings or burns when applying certain skincare products. This sensitivity may be a clue to diagnosis in people with skin of colour, even in the absence of visible redness.

Inflammatory papules and pustules, similar to those seen in acne, are often more noticeable than erythema in darker skin types. These can lead to post-inflammatory hyperpigmentation, causing further changes in skin colour and potential scarring, making it even more crucial to manage and treat rosacea appropriately in skin of colour.

Rosacea Treatments

Unfortunately, there is currently no definitive cure for rosacea. However, there are treatments that can help manage the symptoms and prevent flare-ups.

Topical Treatments

Topical treatments are first-line therapy for rosacea. They include medications such as metronidazole, azelaic acid, and ivermectin. These treatments can help reduce inflammation and redness. They are typically applied to the skin once or twice a day.

Oral Antibiotics

Doxycycline and other oral antibiotics are often used for their anti-inflammatory properties. They can be particularly effective for moderate to severe rosacea or for times when it has not responded to topical treatments.

Prescription Retinoids

Vitamin A derivatives like topical Tretinoin and oral Isotretinoin are sometimes used in acne rosacea but with extreme care as they can irritate the skin and make it even more sensitive. This is always done on a case by case basis to balance the risks and benefits to the patient. For moderate Rosacea low dose Tretinoin is sometimes used with gradual increase in frequency to help combat acne symptoms and hyperpigmentation. For severe rosacea that doesn’t respond to other therapies, doctors may suggest Isotretinoin. This powerful drug is typically used to treat severe acne, but it can also help by reducing the production of sebum.

Laser, Ablative Treatments & Surgery

These are often reserved for severe cases of rosacea where other treatments may have not worked and for rhinophyma.

Intense pulsed light or lasers to can minimise the redness and visible blood vessels. This is also a common treatment for rhinophyma. On the other hand, electrosurgery uses a thin needle to apply a weak electrical current to the skin, which destroys the blood vessels that cause redness. Radiofrequency ablation uses radio waves to destroy the blood vessels that cause redness.

Dermabrasion can be used to improve the appearance of skin that is thickened or scarred. It is a procedure that uses a rotating brush to remove the top layer of skin. Chemical peel can also achieve similar results but instead use an acid or enzyme solution to remove the top layer of skin.

Surgical resection maybe required in severe cases of rhinophyma. This involves cutting excess tissues with a scalpel under local or general anaesthetic.

Living with Rosacea

Rosacea can be challenging but it is manageable. The key is understanding what triggers flares and how to avoid these triggers. Using gentle skincare products, protecting your face from the sun, managing stress, and sticking to your prescribed treatment regimen can all help control symptoms. Most importantly, regular checks with a dermatologist or skin specialist can ensure your treatment is working and can be adjusted as needed.

This is a condition that affects people throughout the world. Anyone can have rosacea regardless of age, gender or skin colour. As such, it is important to consult with a dermatologist or skincare professional if you suspect you have rosacea. They can provide you with an accurate diagnosis and individualised treatment plan, helping to manage symptoms and prevent problems.


Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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