Is It Blushing or Rosacea?
Learn more about the causes, treatment and symptoms of this common skin condition
I grew up a redhead with freckles and a ruddy complexion. I sunburned easily and turned beet red when I had to speak in class. Oral book reports were a nightmare because I was shy to begin with, and embarrassed by the flushing.
The National Rosacea Society (NRS) reports that nearly 90% of patients surveyed say rosacea has "lowered their self-confidence and self-esteem." And 41% reported it has "caused them to avoid public contact or cancel social engagements."
The redness often comes and goes and can increase in frequency.
At 41, I visited a dermatologist and was diagnosed with mild rosacea. While anyone can get rosacea, according to the Mayo Clinic, it's most common in white women in their 40s and 50s, the peak ages for onset.
My rosacea has not progressed beyond ruddiness on my chin and cheeks. So when I turned 50, I began using a unique facial cleanser and green-tinted foundation for the redness. Those products and sunscreen have kept my redness at bay.
However, in 2022, I was diagnosed with ocular rosacea, which affects my eyes. And while my facial rosacea remains mild, I know that's not the case for everyone.
What Is Rosacea?
Rosacea is a chronic skin condition mainly affecting one's face. The National Rosacea Society (NRS) reports that about 16 million Americans have rosacea, which usually begins as flushing or redness on the cheeks, nose, chin or forehead.
The redness often comes and goes and can increase in frequency. People with fair skin who tend to flush or blush easily seem to be at the most significant risk for developing rosacea, and the condition is diagnosed more often in women, although it tends to be more severe in men.
What Causes Rosacea?
"The exact cause of rosacea is not known," says Dr. Rebecca Kazin, director of clinical research at Icon Dermatology in North Bethesda, Maryland, "but it is believed to be a combination of genetic, environmental and lifestyle factors."
Many things can trigger rosacea, and the most common triggers include sun exposure, hot and cold weather, emotional stress, humidity, wind, heavy exercise, hot baths, overheating, excessively warm indoor heat, alcohol consumption, spicy foods and some medications.
Is All Rosacea The Same?
Rosacea has four subtypes. "It is possible for an individual to have more than one subtype at the same time," Kazin explains, "and the symptoms may also vary in severity and frequency over time."
- Bumps or pimples
- Thickened skin
- A burning or stinging sensation
- Dry or sensitive skin
- Watery or bloodshot eyes
Here are the subtypes, according to Kazin:
- Erythematotelangiectatic Rosacea – characterized by persistent redness and visible blood vessels on the face. It may also cause flushing and a feeling of heat in the affected areas.
- Papulopustular Rosacea - acne-like bumps and pus-filled pimples on the face. In addition to redness, the affected areas may have swelling and tenderness.
- Phymatous Rosacea – this subtype is less common than the others and is characterized by the thickening of the skin on the nose, chin, forehead or cheeks. The skin may also develop a bumpy texture, and the pores may enlarge.
- Ocular Rosacea – affects the eyes and may cause dryness, itching and a burning sensation. It may also cause redness and swelling of the eyelids and, in some cases, vision problems.
Does Aging Affect Rosacea?
"Aging can potentially exacerbate symptoms for some individuals," Kazin notes. "As the skin ages, it becomes thinner and more fragile, which can increase the visibility of blood vessels and make skin more prone to redness and irritation."
Aging can potentially exacerbate symptoms for some individuals.
Another issue is that our bodies produce less oil as we age, which can cause our skin to be drier and more sensitive. "This can make it more difficult for individuals with rosacea to manage their symptoms and avoid triggers that may worsen their condition," Kazin adds.
Kazin suggests those with rosacea be "mindful of their skincare routine as they age, and adjust their regimen as needed to account for changes in their skin." In general, it's helpful to use non-irritating, gentle products and avoid abrasive scrubs.
Can COVID-19 Affect Rosacea?
"There is currently limited research on the direct relationship between COVID-19 and rosacea," Kazin says. "However, some reports suggest that COVID-19 infection may potentially worsen pre-existing rosacea symptoms, particularly in those with severe or uncontrolled cases."
This may be due to increased stress and anxiety associated with the illness, which may trigger flare-ups in some people.
"Additionally, the use of masks or face coverings to prevent the spread of the virus may cause skin irritation, further exacerbating rosacea symptoms," Kazin says.
While rosacea is a chronic condition with no cure, topical treatments and avoiding flare-ups can help manage it. "Topical or oral medications, as well as laser therapy, may be prescribed by a dermatologist to reduce redness and inflammation," Kazin explains.
Carefully cleaning your face and protecting it from sun damage is essential.
The National Rosacea Society recommends the following:
- Clean your face with a mild and non-abrasive cleanser; rinse with lukewarm water, and blot dry with a soft, thick cotton towel.
- Protect your skin from the sun using a product with an SPF of at least 30.
- Kazin claims that skin care products with aloe vera or green tea may be helpful.
"Gentle skincare products, such as moisturizers and cleansers, can help to minimize irritation and reduce the likelihood of triggering a rosacea flare-up," Kazin says, adding that laser therapy can reduce redness and visible blood vessels, and oral antibiotics may help reduce inflammation.
Topical treatments (like azelaic acid, metronidazole, and ivermectin) reduce redness and inflammation; corticosteroids can relieve short-term symptoms.
The NRS reports that approximately 50% of people with rosacea may have ocular rosacea.
"Managing symptoms of dry eye in individuals with rosacea may involve a combination of treatments, including the use of artificial tears, prescription eye drops, and lifestyle modification," Kazin says, "such as maintaining a humid environment, reducing screen time and avoiding triggers that exacerbate symptoms."