Rosacea is a chronic, inflammatory skin condition that causes redness, visible blood vessels in the face, the feeling of “heat,” and sensitivity. It may also produce small, red, pus-filled bumps. These symptoms may flare up for a few weeks to months at a time, or it may continue into a full progression of the 4 subtypes (or stages) of rosacea. Rosacea typically becomes more visible in our 30s, and continues to advance in severity with age if it goes unmanaged.
The Experience of Rosacea
Typically, the beginning stages of rosacea are marked by redness caused by superficial broken capillaries under the skin (erythema and telangiectasia). When left unmanaged, the condition can progress to include inflamed papules and worsen to the point of skin thickening — a result of prolonged inflammation scar tissue. While not every sufferer will experience all of these symptoms or the full progression of rosacea, clients with these symptoms will likely identify it as their primary skin concern.
That’s because rosacea sufferers consistently experience both the signs and symptoms of the condition.
Signs: what can be seen?
Symptoms: what can be felt?
This differs from many other common conditions, like hyperpigmentation or premature ageing, in that there is a physical discomfort associated with rosacea — which takes an emotional toll on those who experience it.
To help you identify the severity of your clients’ rosacea and choose the proper treatments, we’ve overviewed the signs and symptoms of each subtype of rosacea below.
The 4 Subtypes of Rosacea
Subtype 1: Erythematotelangiectatic Rosacea
Erythematotelangiectatic rosacea is a mouthful. To help you remember it, you can break it down into two of its main characteristics:
Erythema refers to redness of the skin caused by hyperemia or increased blood flow in superficial capillaries. It can appear “rash-like” and ranges from mild to severe.
Telangiectasia refers to dilated or broken blood vessels located near the surface of the skin, appearing as fine pink or red lines. Both of these symptoms typically present in the middle of the face (cheeks and nose) in this subtype of rosacea. Signs and symptoms can include:
- Redness and broken capillaries (erythema and telangiectasia)
- Flushes easily from internal and external triggers
- May have a higher tendency to blush
- Disordered barrier function or sensitization
- Visible dryness or flakiness
- Feeling of “tightness” in the skin
- Occasional swelling
- Warmth present in the skin
- May experience stinging or burning sensations
- Can be touch-sensitive
Subtype 2 | Papulopustular Rosacea
As the name suggests, papulopustular rosaceacan present with acne papules and pustules where the skin is exhibiting redness. It will also present with all or many of the symptoms associated with subtype 1, however often to a more significant degree.
Though papules and pustules will be visible, papulopustular rosacea doesn’t typically exhibit comedones (aka blackheads and whiteheads). This can help differentiate this subtype of rosacea from acne vulgaris.
Along with those listed in subtype 1, signs and symptoms include:
- Very sensitive skin, accompanied by a stinging or burning sensation
- High level of transepidermal water loss and barrier dysfunction present
- Acne papules and pustules where skin exhibits redness
- Rough or “built-up” areas of reddened skin (referred to as plaque)
- Skin can be both oily and flaky at once
Subtype 3 | Phymatous Rosacea
Phymatous rosacea is typically a later stage of rosacea, meaning the sufferer has most likely experienced earlier subtypes of rosacea for a period of time without getting adequate treatment.
Phymatous rosacea is characterized by all of the visible signs of erythematotelangiectatic rosacea, but again, typically to a higher degree. Other signs and symptoms can include:
- Thickened, bumpy skin
- Skin can become nodular and irregular (most commonly on the nose – referred to as rhinophyma)
- Enlarged pores
Subtype 4 | Ocular Rosacea
And finally, subtype 4 is referred to as ocular rosacea.
Ocular means of or relating to the eye — which can make this a particularly dangerous form of rosacea that may require medical attention. Signs and symptoms to look out for include:
- Eyes can feel gritty (as though there’s sand in them)
- Watery, bloodshot eyes
- Blurry and/or compromised vision
- Broken capillaries on the eyelid
- Cysts on the eyelid
- Light sensitivity
Although a definitive cause of rosacea has yet to be identified by researchers and physicians, there are some patterns that show who may be predisposed to develop the condition.
Firstly, rosacea is known to be largely genetic, and frequent flushing in younger years can be a precursor to a more prominent condition of rosacea later in life. Typically, visible signs of rosacea begin between the ages of 30 and 50, and it tends to be more common in women than in men.
3 Primary Causes of Rosacea:
- UV exposure: No surprise here — as skin pros, we know that UV exposure can cause or contribute to almost any skin condition we treat. In the case of rosacea, heat, sensitization, and inflammation caused by sunlight all play a role.
- Vasodilation: The dilating of blood vessels to increase blood flow (and the transfer of essential oxygen, nutrients, and white blood cells) to an affected area. Part of a healthy inflammatory response, however, chronic or overactive vasodilation will result in damage to these blood vessels (i.e. rosacea).
- Demodicosis: An inflammation-causing infestation of demodex mites (yes, mites!) found on human skin. While these mites are typically present on all human skin and generally harmless, when our immune system or skin barrier falls short, an overproliferation of these mites can lead to dermatitis or signs of rosacea.
While we don’t exactly know what causes someone to develop rosacea, we do have a general understanding of the factors that can trigger rosacea flare ups. In other words, what might cause someone’s signs and symptoms to worsen. You’ll notice that many of the triggers listed below are similar to those that trigger skin sensitization or barrier disruption, as these skin conditions are closely related.
Below are some of the most common extrinsic(external) and intrinsic (internal) factors that can trigger rosacea:
- UV exposure
- Centralized heating and air conditioning (drying environments)
- Dry, cold, or windy weather exposure
- Hot water use (hot showers, steaming)
- Chemicals such as chlorine in swimming pools or over-exposure to pollutants
- External allergens
- Moisture-stripping skincare formulas, detergents and surfactants (such as over-drying cleansers)
- Over-exfoliation (using scrubs, BHA’s, AHA’s and enzymes too often)
- Vasodilation medication
- Exercise (increases heat and blood flow)
- Vitamin & mineral deficiency (especially omegas)
- Overconsumption of vasodilating foods and beverages (such as caffeine, alcohol, and spicy foods)
- Internal dehydration
- Internal inflammation
- Internal allergens
- Hormonal fluctuation
- Topical steroids
- Calcium-channel blockers
- Seborrheic dermatitis
- Demodex mite infestation (Demodex folliculorum overproliferation in the hair follicles)
As always, everyone’s skin won’t behave or respond exactly the same. What triggers rosacea in one person may not be a factor at all for another. However, for people with rosacea, preventing flare ups is going to be key in managing their condition.
Rosacea in Skin of Color (Fitzpatrick Types IV, V, VI)
Rosacea is often diagnosed earlier in Fitzpatrick Types I, II and III, since signs of flushing and broken capillaries are more visible in lighter skin tones. However, this doesn’t mean that rosacea is not present in those with skin tones that are higher on the Fitzpatrick Scale— and it’s our job to become experts at identifying it.
Signs & Symptoms in Skintones IV-VI
- Frequent warmth in the skin
- Dry, swollen skin
- Patches of darker skin or discolouration
- Yellowish or brownish hardened bumps around the eyes and/or mouth
- Acne that will not clear with traditional acne treatment
- Stinging or burning (for example, when applying skincare products)
- Swelling or thickened skin on the nose, cheeks, chin or forehead
- Enlarged pores
- Symptoms of ocular rosacea (as listed above)
While there unfortunately isn’t a cure for rosacea, you can help prevent and protect against flare ups, which will ionize symptoms and discomfort, and ensure it doesn’t progress to a more advanced stage of rosacea.
Because rosacea is caused by sensitivity to certain triggers, it is imperative to take a two-pronged approach to treatment.
Having a skincare plan focused on soothing and strengthening the skin barrier gives your more protection against environmental aggressors and won’t as easily trigger an immune response that’s causing redness and inflammation.
It is also important to simultaneously work towards identifying what triggers your flare-ups so that you can avoid exposure to them as much as possible.
As always, its is imperative to work with a skincare professional when dealing with any chronic skin condition. We are here to come up with an effective plan so you can get back to feeling your best.