Rosacea
Rosacea is a chronic skin condition that causes persistent redness, flushing, and visible blood vessels on the face. Some people also develop small bumps and pustules that look like acne, skin thickening in different areas of the face, and swelling around the eyes. Although it can affect anyone, rosacea most often occurs in adults and can flare up for weeks or months before improving. Because the condition can resemble other skin issues, such as acne or allergic reactions, it is sometimes overlooked or misdiagnosed. Flares and remissions characterize it. There is no cure, but with appropriate education and treatments, it can be very well managed. Rosacea often causes distress and negatively affects patients’ quality of life until they effectively address their condition.
Rosacea is an inflammatory skin condition that primarily affects the central face, especially the cheeks, nose, chin, and forehead. It is not contagious and does not result from poor hygiene. Instead, it is a chronic condition influenced by a mix of genetic, immune, and environmental factors. Rosacea often appears in cycles, with periods of flare-ups followed by times when the skin improves.
Dermatologists used to classify rosacea into several subtypes, based on how it appears on the skin. These included erythematotelangiectatic (ETR) rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea. In 2017, the National Rosacea Society proposed a change to reflect the prior 15 years of observations, which supported the idea that rosacea patients can exhibit features of multiple subtypes and that these features can evolve.
Features of Rosacea include:
- Facial redness, swelling, flushing, visible blood vessels (telangiectasias), which may become more apparent with certain triggers
- Red or acne-like bumps, pustules, cysts, and nodules often in the central facial area
- Facial skin thickening and enlargement, most frequently seen on the nose
- Eyelid margin redness, blood vessels, irritation, dryness, swelling, or watery eyes.
- Burning, stinging, rough skin, and persistent facial swelling
Rosacea presents in different ways depending on the subtype, but common symptoms include:
- Persistent facial redness, especially on the cheeks, nose, or forehead
- Temporary flushing
- Visible, small blood vessels on the skin
- Bumps or pimple-like lesions that may contain pus
- Burning, stinging, or tightness on the face
- Dry skin looks and feels rough
- Facial swelling
- Thickened skin with an uneven texture (in advanced cases)
- Eye irritation, redness, or blurred vision when ocular rosacea is present
Signs and symptoms come and go. External and internal factors can trigger flare-ups. For many people, these symptoms can be unpredictable, leading to frustration or self-consciousness.
The exact cause of rosacea is not fully understood, but researchers believe it involves a combination of factors:
- Genetics – A family history of rosacea may increase risk.
- Immune system response – Overactive immune responses may contribute to skin inflammation.
- Microorganisms – Demodex skin mites live in hair follicles on the face, causing itchy, irritated skin. They are usually harmless but can overgrow, affect the eyelashes, and spread to hair follicles on the head and other areas, causing redness, itching, and scaling. This condition is called demodicosis. Certain bacteria may contribute to flare-ups.
- Blood vessel changes – Abnormalities in facial blood vessels may lead to visible redness.
Several risk factors can make rosacea more likely or worsen symptoms:
- Fair-skinned skin, especially those who flush easily.
- Age, most common in adults between 30 and 50
- Female sex, although men may develop more severe forms
- Family history of rosacea or similar skin conditions
- Environmental triggers such as sun exposure, wind, or cold weather
- Lifestyle triggers include hot beverages, alcohol, spicy foods, stress, and skin or hair products
- Recent studies also suggest a link between rosacea and inflammatory bowel disease.
- The skin microbiome may also contribute to the development of rosacea.
Rosacea can affect anyone, but it is most common in adults with lighter skin tones, particularly of Northern European descent. That said, people of all skin types and backgrounds can develop it. Because rosacea often causes visible facial symptoms, it can affect self-esteem and quality of life. Some people avoid social or professional situations due to embarrassment about their appearance, making medical care and management especially important.
Rosacea is diagnosed clinically by dermatologist Dr. Joshua Freedman rather than through a specific lab test. Diagnosis is based on a review of medical history, discussion of possible triggers, and a careful examination of the skin for common signs such as persistent redness, visible blood vessels, acne-like bumps, or thickened skin. If eye symptoms are present, ocular rosacea may also be considered.
Because rosacea can resemble conditions like acne, lupus, or allergic skin reactions, part of the process involves ruling out these other possibilities. Once confirmed, dermatologists may classify rosacea into one or more subtypes, which helps guide treatment. A professional diagnosis is important to ensure effective care and prevent the condition from worsening.
Rosacea is a progressive condition, meaning it may worsen over time if left untreated. While there is no permanent cure, proper care can help control symptoms, prevent flare-ups, and protect the skin. An accurate diagnosis from Dr. Freedman ensures the right management plan is created for everyone. Treatments may include topical medications, oral therapies, or laser and light procedures to reduce redness and visible vessels. Avoiding known triggers and using gentle skin care are also central to long-term control.
If you are experiencing persistent redness, frequent flushing, or skin changes that resemble acne but do not improve with over-the-counter treatments, you may have rosacea. Early evaluation by a dermatologist is essential to prevent progression and improve both comfort and confidence.
Dr. Joshua Freedman, a board-certified dermatologist in Swedesboro, New Jersey, offers comprehensive expertise in diagnosing and managing rosacea. With a personalized approach that addresses both the medical and aesthetic aspects of skin health, he helps patients regain clear, healthy-looking skin. To schedule your dermatology appointment and begin your journey to better skin, contact Dr. Freedman’s office today.
At a Glance
Dr. Joshua Freedman
- Double Board-Certified in Dermatology and Mohs Micrographic Surgery
- Providing Comprehensive Medical Dermatology for All Ages
- Expert in Mohs Micrographic Surgery and Reconstructive Techniques
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