Rosacea

Dr. Wu's analysis

What is rosacea?

The name rosacea comes from Latin and means something like “reddish” or “rose-colored”. It is derived from the word “rosa”, which means rose, and the suffix “-acea”, which indicates a property.

The name is not chosen by chance: people with rosacea often have a permanent redness in the face. It is a chronic skin condition that is accompanied by periods of worsening and improvement of symptoms. These symptoms include redness, bumps, and pustules on the face and can last for years. Although rosacea occurs in all races, people with light skin are more often affected. It is a non-contagious skin condition that typically manifests between the ages of 30 and 60 and is especially common in women.

What causes rosacea?

Although the exact cause of rosacea is still not fully known, it is believed that a combination of genetic, immunological, and environmental factors play a role.

Genetic predisposition

Research shows that rosacea is more common in people with a family history of the condition, indicating a genetic component. Studies have shown that certain genes involved in inflammatory responses, vascular regulation, and immune responses are overexpressed in rosacea patients. Specific genetic variants in the HLA-DRA gene and TLR2 gene (Toll-like receptor 2) have been associated with increased sensitivity to inflammation and immune activation, which may contribute to the development and severity of rosacea.

Immune responses

In rosacea, the skin is often overactive in terms of defense. People with this condition produce more of a body's own defense substance called cathelicidin. This substance normally helps to fight bacteria and viruses. But in rosacea, things go wrong: the skin produces too much cathelicidin, and this actually causes extra inflammatory reactions. As a result, the skin becomes red, sensitive, and irritated more quickly. This also explains why people with rosacea often react strongly to certain skin care products.

Environmental factors

UV radiation and extreme weather conditions, such as cold wind, heat or rapid temperature changes, can worsen rosacea. They affect the blood circulation and damage the skin, leading to additional redness, irritation or a burning sensation. In rosacea, the skin is more sensitive to these stimuli due to a disturbed skin barrier and overactive inflammatory responses.

Microorganisms

In rosacea, an increased presence of the Demodex mite on the skin is often seen. This mite feeds on sebum and can provoke an immune response. In addition, it carries the bacterium Bacillus oleronius, which can further activate inflammation in the skin. It is likely that the interaction between the mite and the bacterium contributes to the development or worsening of rosacea.

Neurovascular dysregulation

In rosacea, there is an abnormal regulation of nerves and blood vessels, leading to persistent redness and flushing. Neurotransmitters such as vasodilators (substance P and calcitonin gene-related peptide) are produced in increased amounts in rosacea, leading to excessive vasodilation and sensitivity to external stimuli such as stress, alcohol, and spicy food.

Nutrition

Certain foods are known as triggers for rosacea, as they dilate blood vessels or stimulate inflammatory reactions. Hot and spicy dishes, alcohol (especially red and white wine), tomatoes, chocolate, and dairy can cause flare-ups in some people. This is because these foods contain substances such as histamine, capsaicin, and certain acids, which increase the sensitivity of the skin.

Who are susceptible to rosacea?

Rosacea can occur in anyone, but certain groups are at higher risk due to genetic, environmental, and medical factors. Both age, skin type, and lifestyle play a role in susceptibility to rosacea.

Age and gender

Rosacea mainly affects adults between the ages of 30 and 60, with women being diagnosed more often than men. However, this does not mean that men do not suffer from it. On the contrary, the condition can often be more severe in men, with symptoms such as thickening of the skin around the nose (rhinophyma).

Skin type and ethnicity

Rosacea is more common in people with light skin, especially from Northern Europe, because their skin is more sensitive to stimuli such as sun and temperature changes. However, people with dark skin can also get rosacea, although it is sometimes harder to recognize due to less visible redness. Therefore, the condition can occur in all skin types.

Environmental factors and lifestyle

People who are regularly exposed to known triggers such as sunlight, stress, alcohol, spicy food or intensive physical exertion, can more quickly suffer from flare-ups. A disrupted skin barrier can also contribute to the onset or worsening of rosacea. This can be the result of excessive use of aggressive skin care products, over-cleansing or exposure to irritating substances such as perfume and alcohol in cosmetics.

Medical conditions

Recent studies suggest a link between certain medical conditions and rosacea. People with gastrointestinal problems such as irritable bowel syndrome (IBS) or an increased presence of the Helicobacter pylori bacteria in the stomach, often show symptoms of rosacea. This indicates a possible connection between gut health and skin inflammation.

How do you recognize and distinguish pigmentation spots?

How can you recognize rosacea?

Rosacea has various characteristics that can aid in diagnosis:

Persistent redness

A chronic red discoloration on the nose, cheeks, forehead, and chin that does not disappear on its own. This redness may initially only flare up with excitement, heat, or certain foods, but becomes permanent over time.

Bumps and pimples

Small, red bumps and pus-filled pimples that resemble acne, but without blackheads. This subtype of rosacea is often confused with regular acne, but responds differently to treatments.

Thickening of the skin

In some patients, especially men, the skin can thicken in certain areas, particularly on the nose. This leads to a condition called rhinophyma, where the nose gets an enlarged, bumpy structure.

Visible blood vessels

Fine red or blue blood vessels become visible on the surface of the skin, especially on the cheeks and nose. This phenomenon is known as telangiectasias and is caused by chronic vascular dilation.

Eye irritation

Burning or stinging eyes, dryness, itching, and swollen eyelids can indicate ocular rosacea. In severe cases, inflammation of the cornea can occur, which can affect vision.

Which skin problems resemble rosacea?

Not all skin complaints that cause itching, redness, and pimples fit with rosacea. There are various skin conditions that can resemble rosacea, but have a different cause. Recognizing the differences can help to make the correct diagnosis and find the right approach. Below you can read which skin problems are sometimes confused with rosacea.

Seborrheic eczema

Seborrheic eczema shows redness and yellowish scaling around the nose, eyebrows, and hairy head, but without the characteristic papules, pustules, or visible dilated blood vessels seen in rosacea. The skin is typically oilier with seborrheic eczema. Cause: an inflammatory response to Malassezia yeasts, which are naturally present on the skin.

Contact allergies

Characteristics: Redness, itching, swelling or blisters at the point of contact. Difference from rosacea: Clear link with a certain substance or product. Cause: Allergic reaction to, for example, cosmetics, perfume or metal.

Acne vulgaris (youth pimples)

Characteristics: Pimples, blackheads (black and white dots), often on the face, chest and back. Difference with rosacea: Rosacea does not have blackheads. Acne often starts at a younger age. Cause: Clogged pores, excessive sebum production and bacteria.

Perioral Dermatitis (Clown's Eczema)

Characteristics: Redness, small bumps and flakes around the mouth, nose or eyes. Difference with rosacea: No blushing or visible vessels; often occurs after using greasy creams or corticosteroids. Cause: Skin hypersensitivity, often due to skin products or hormones.

Lupus erythematosus

Characteristics: Butterfly-shaped redness over nose and cheeks, sometimes scaling. Difference with rosacea: Can be accompanied by symptoms such as fatigue and joint pain. Cause: Autoimmune disease where the immune system attacks its own body cells.

What types of rosacea are there?

The diagnosis is made based on symptoms: at least one diagnostic feature (such as persistent redness or skin thickening) and at least two main features, such as:

pimples (papules/pustules)
hot flashes (flushing)
visible blood vessels
eye problems

Complaints such as burning or dry skin do not count as a diagnostic criterion. In practice, these forms often occur simultaneously.

Erythematous telangiectatic rosacea

This form is characterized by persistent redness in the center of the face (forehead, cheeks, nose, chin), often with visible dilated blood vessels (telangiectasias). The skin may also feel burning or tingling.

Papulopustular rosacea

In this variant, there is redness in combination with inflammation: small red bumps (papules) and pus-filled pimples (pustules). This form is often confused with acne, but rosacea does not have blackheads and is accompanied by blushing and sensitive skin.

Fibromatous rosacea

This form is less common and is recognizable by a thickening of the skin, especially on the nose (rhinophyma). The skin structure changes, pores become coarser and the skin gets a bumpy, thickened appearance. This is also known as the so-called 'drinker's nose', although alcohol is not a cause of it.

Ocular rosacea

Ocular rosacea affects the eyes and eyelids. Symptoms include a burning or stinging sensation, dry or tearing eyes, redness of the white of the eye, and a gritty feeling. It can occur together with skin complaints, but also as the only manifestation of rosacea.

How do you effectively treat rosacea?

What can I do about it myself?

Rosacea is a chronic skin condition that usually progresses in phases of relative calm and periods of flare-ups. Although it cannot be completely cured, you can often do a lot yourself to keep your skin calm and reduce new complaints. With the right care, lifestyle, and avoiding triggers, you can support the skin and restore balance.

Step 1: Use mineral sunscreen.

SPF 30 sun protection or higher - preferably combined with zinc oxide and titanium dioxide, which provide broad protection against UV radiation and are well tolerated by the sensitive rosacea skin.

Step 2: Search and avoid skin triggers.

The most well-known triggers for rosacea are: spicy food, alcohol, temperature changes, and stress - this helps to limit flare-ups.

Step 3: Avoid irritating substances

Use a mild cleanser that respects the skin. Avoid products that contain alcohol, fruit acids (such as AHAs or BHAs) or coarse scrub particles. These ingredients can dry out, irritate or even provoke inflammation in sensitive rosacea skin. Instead, opt for gentle, fragrance-free cleansers that remove impurities and excess sebum without damaging the skin barrier.

Step 4: Hydrate daily with a soothing cream.

This helps the skin barrier and helps reduce redness. A rosacea skin is often sensitive and quickly out of balance. By using a moisturizing cream daily that is specifically tailored to sensitive skin, you can help reduce redness, dryness, and irritation. Preferably choose products with ceramides, niacinamide or ectoine, which strengthen the skin barrier and help protect the skin against external stimuli.

Step 5: Keep your lifestyle in balance.

Pay attention to diet, lifestyle, and possible triggers - Stress and poor sleep can worsen rosacea. Therefore, ensure sufficient relaxation, a regular sleep pattern, and balance in your daily rhythm. Diet also plays a role: some people react to spicy food, alcohol, hot drinks, or certain dairy products. Keeping a food diary can help to recognize your personal triggers.

What other treatments are there?

When rosacea is accompanied by more pronounced symptoms, it is often necessary to involve a dermatologist to calm the skin down. In addition to an appropriate skincare routine and avoiding known triggers, there are also medical treatment options that can help to better control rosacea.

Medicinal creams and gels

Metronidazole, azelaic acid, or ivermectin (Soolantra) can reduce inflammation and redness. They are usually applied once or twice a day to the affected skin.

Oral antibiotics

For persistent inflammations, low doses of doxycycline or minocycline are often prescribed. These work anti-inflammatory, not just antibacterial.

Vessel laser

Effective for visible veins (telangiectasias) or persistent redness. Works by cauterizing small blood vessels and reducing redness. The most suitable period to have it done is in the autumn and winter months.

Brimonidine gel (vasoconstrictor)

Is used for persistent redness as an alternative to vascular laser. It temporarily narrows the superficial blood vessels. The effect starts quickly, but is temporary (a few hours).

Treatment of ocular rosacea

Eye complaints are treated with artificial tears, warm compresses, and sometimes oral antibiotics. If complaints persist, a visit to an ophthalmologist may be necessary.

What are the rosacea triggers?

With rosacea, the skin is often extra sensitive to certain stimuli from outside and inside. Certain factors can worsen the redness, bumps, or burning sensation. These are also called triggers. Recognizing and avoiding these triggers as much as possible is an important part of dealing with rosacea. Here are five common triggers that can cause rosacea to flare up:

Sunlight (UV radiation)

UV radiation damages the skin barrier and activates inflammatory processes. In rosacea, the blood vessels are already sensitive, and sunlight makes them even more reactive, which can lead to more redness and irritation.

Hot drinks and spicy food

Heat from within (such as hot tea or spicy food) stimulates blood circulation. This causes the blood vessels in the face to dilate, which in rosacea leads to blushing, a feeling of warmth, and sometimes bumps.

Alcohol

Alcohol consumption can exacerbate rosacea. Research shows that white wine is more often associated with rosacea symptoms than red wine. Possible causes are the lack of protective substances such as flavonoids, and the presence of sulfites.

Temperature fluctuations (cold → warm and vice versa)

Sudden transitions, such as from cold outdoor air to a warm room, or even after showering, cause rapid changes in the blood flow of the skin. This can trigger blushing and flare-ups in rosacea.

Stress

Emotional stress affects the nervous system and blood vessels. This can lead to blushing and inflammatory activity, which is particularly noticeable in rosacea patients due to their hypersensitive skin reactions.

Product recommendations

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🛈 These products are cosmetic and intended for the care of the healthy, sensitive or unbalanced skin. They are not intended as a medical treatment or to replace professional medical advice. For personalized skin advice, we recommend consulting a skin therapist or doctor.

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Product

Description

Calming Cream

14.95

External influences can disrupt the skin’s balance, making it feel sensitive or unsettled. This cream contains a combination of ectoine, oat extract, and marshmallow root, ingredients known for their soothing and caring properties. The formula is designed to support the skin barrier, hydrate the skin, and improve overall skin comfort.

In shopping cart

Natural Moisturizer Cream

14.95

Good skin hydration is the foundation for a smooth, well-cared-for skin. This body cream combines plant-based balm, glycerin, and ceramides to nourish the skin and support its natural moisture level. The hydrating formula helps prevent dehydration and ensures a hydrated soft skin.

In shopping cart

Sensitive Cream

14.95

Some skin types are more sensitive to external influences and may benefit from extra mild care. This cream contains, among other things, oat extract, jojoba oil, and coconut oil – ingredients known for their nourishing and hydrating properties. The light texture absorbs quickly and is designed to care for the skin without leaving a greasy or sticky feeling. The product supports the natural balance of the skin and contributes to a comfortable skin feeling.

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Spotreducer (AWARD WINNING)

14.95

This cream is formulated with niacinamide and ectoine. Niacinamide is known for its nurturing properties and is widely used in products for sensitive skin. Ectoine helps to hydrate and protect the skin from dehydration. The formula is designed to support the skin without drying it out and is suitable for all skin types. In 2016, this product received a Beauty Award in Hong Kong.

In shopping cart

Tinted Mineral Sunscreen SPF30

14.95

A sensitive skin quickly reacts to sunlight, making protection essential. This mineral sunscreen with titanium dioxide, zinc oxide and iron oxide is known for its mild properties and is specially developed for sensitive skin. The formula with independently tested and certified SPF30 protects against harmful UV rays and visible light without weighing down the skin. The moisturizing, lightly tinted texture provides broad protection against sunlight.

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Tips when you have rosacea

Tip 1: Be careful with certain care products.

Research shows that rosacea can worsen. Women: fruit acid peelings, aggressive toners/cleansers, soap, makeup, perfume, hairsprays. Men: Soap, after shave cologne, shaving lotion, chemical sunscreen. Opt for mild, fragrance-free formulas that are tailored to sensitive skin.

Tip 2: Omega-3 supplement for dry eyes

If you suffer from rosacea and dry, burning, itchy irritated eyes, blurred vision and a gritty feeling, it may be worthwhile to take an omega-3 supplement. Research has shown that taking an omega-3 capsule (360 mg EPA/240mg DHA) twice a day for three months improved dry eyes. You can possibly combine the supplement with artificial tears for extra relief.

Tip 3: Apply skincare gently.

Use your fingers to gently dab products in, instead of rubbing. Rubbing can unnecessarily irritate the sensitive skin with rosacea.

Tip 4: Be slightly acidic for your skin

The natural pH of healthy skin is around 5, which is slightly acidic. This helps the skin retain moisture and perform its protective function well. In rosacea, this balance is often disturbed and the skin becomes less acidic, causing it to dry out or become irritated more quickly. A skincare product that helps the skin maintain a slightly acidic pH can contribute to a calmer, better hydrated skin that is more balanced. Therefore, choose mild formulas that are tailored to the natural pH of your skin.

Tip 5: Keep a trigger diary.

If you have rosacea, triggers can vary greatly from person to person. By keeping a diary of food, skin care, weather, and stress moments, you can recognize personal patterns and better avoid what worsens your skin.

Read our articles about rosacea here

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