Rosacea

Signs and symptoms

The presentation varies widely between people and over time. The most common signs are:

• Persistent redness in the central area of the face (erythema).
• Sudden flushing episodes triggered by thermal or emotional stimuli.
• Visible blood vessels (telangiectasias) on the cheeks and nose.
• Papules and pustules — which look like "bubbles" but are not acne.
• Feeling of burning, stinging or very reactive skin.
• In advanced cases, thickening of the skin (more frequent in the nose — rhinophyma).
• Eye involvement in some patients — dry eyes, redness, sand sensation.

Rosacea subtypes

The rosacea can be presented in different patterns — they are not sequential phases and can coexist:

• Telangiectase erythematate — redness and telangiectasis predominates.
• Pustulous papules — papules and pustules, often confused with acne.
• Fimatous — thickening of the skin (nose rhinophyma).
• Ocular — associated ocular symptoms, with or without evident skin involvement.

Causes

The exact cause is multifactorial and is not yet fully understood. Several mechanisms are involved:

• Genetic predisposition — rosacea is grouped into families.
• Vascular regulation dysfunction in the face — vessels that dilate more and take longer to contract.
• Changes in innate immunity of the skin, with exaggerated inflammatory response.
• Possible role of the Demodex folliculorum mite, which exists naturally on the skin.
• Skin barrier alterations, with greater sensitivity to external stimuli.

Common triggers

Identifying and avoiding factors triggering outbreaks is an essential part of the control of rosacea. The most common are:

• Sun exposure and heat (sauna, hot baths).
• Intense cold and wind.
• Alcohol — especially red wine.
• Spicy foods and very hot drinks.
• Emotional stress and hormonal changes.
• Cosmetics with alcohol, strong fragrances or aggressive exfoliating.
• Some vasodilator medicines (to be discussed with your doctor).

Diagnosis

The diagnosis is clinical and is made by observing the lesions and by the history of the outbreaks. No specific tests are required.

In an online consultation, the dermatologist evaluates photographs of the affected areas and a questionnaire on the evolution of symptoms, identified triggers and treatments already experienced. With this information it classifies the subtype, evaluates gravity and defines a custom plan.

In cases with relevant ocular involvement, parallel ophthalmology evaluation may be recommended.

Options for treatment

The rosacea has no cure, but responds well to the appropriate treatment. The objective is to reduce the intensity of outbreaks, control inflammation and improve quality of life.

A smooth care routine (cleaning without irritants, hydration, daily sun protection) is an essential part of the plan — without it, the other treatments have limited results.

Outbreak prevention and control

Rosacea is not "predicted" in order to avoid appearance. But outbreaks can be controlled with strategies that reduce exposure to triggers:

• Daily sun protection, with high factors and formulations for sensitive skin.
• Identify your personal triggers (with an outbreak log, for example).
• Smooth care routine — no aggressive exfoliators, alcohol, or strong fragrances.
• Avoid extreme temperatures whenever possible.
• Moderate alcohol consumption and spicy foods.
• Manage stress with strategies that work for you.

Frequently asked questions