Are you just red-faced or is it rosacea? Here’s how to tell

If your cheeks are constantly rosy, chances are it’s not a permanent state of embarrassment. It may be a chronic skin condition known as rosacea.

Sporting rosy red cheeks that resemble blushing might be a popular beauty look at the minute, but permanent facial redness could be a sign of rosacea.

From symptoms to treatments and ways to manage a flare-up, here’s everything you need to know about this chronic skin condition.

On this page:

• What is rosacea?
• What are the symptoms of rosacea?
• What causes rosacea?
• Is there a link between helicobacter pylori and rosacea?
• Why do rosacea symptoms vary?
• Different types of rosacea
• How do you get a rosacea diagnosis?
• Can you get rid of rosacea permanently?
• What treatments are available for rosacea?
• How to calm a rosacea flare-up
• More tips for managing rosacea

What is rosacea?

A  non-contagious skin inflammation, rosacea is fairly common, affecting around 45 million people worldwide, including more than a million Australians.

“It is a chronic skin condition which primarily affects the face (and is) characterised by the appearance of red flushing, inflammation and a sunburn-like appearance which doesn’t go away when left untreated,” general practitioner and skincare specialist Dr Tanya Unni says.

What are the symptoms of rosacea?

Common rosacea symptoms can include facial redness, swelling, flushing, visible blood vessels and sometimes acne-like, pustular bumps, Dr Unni says.

“During a rosacea flare-up, rosacea typically presents on the central part of the face, spanning from one cheek to the other,” she notes.

“Symptoms can also appear around the nose, forehead, chin and eyelids, with the skin around the nose also becoming thicker in some cases.

“Some individuals also report they have experienced eye irritation and light sensitivity during a rosacea flare-up.”

What causes rosacea?

The cause of rosacea is unknown, dermatologist Dr Samantha Eisman says.

“It’s likely that rather than a singular cause, a combination of factors are involved,” Dr Eisman  explains.

Factors that may trigger or worsen rosacea include:

• Environment: Rosacea can be triggered by different indoor and outdoor environments, including chronic sun exposure, as well as exposure to cold weather, strong winds and hot indoor spaces.
• Genetics: Rosacea tends to run in families and affects those of northern European or Celtic ancestry at a higher rate; and while the condition is more common in women, it is typically more severe in men.
• Mites and bacteria: Studies have found people suffering from rosacea tend to have a higher incidence of Demodex mites, while others may have small intestinal bacterial overgrowth, or SIBO.
• Medication: Both oral and topical steroids are known to aggravate or induce rosacea.
• Immune dysregulation: Some people have an impaired immunity response in their skin, causing a higher concentration of a protein called cathelicidin — this leads to skin being overprotected, which then contributes to rosacea symptoms such as redness and swelling.

Is there a link between helicobacter pylori and rosacea?

“Evidence suggests a potential link between helicobacter pylori and rosacea, although this is not completely conclusive,” Dr Unni says.

“Some studies have found a higher prevalence of helicobacter pylori in individuals with rosacea compared to those without the condition.”

One recent study suggests there is a link between eradicating helicobacter pylori and improving rosacea symptoms but notes further research is needed.

Why do rosacea symptoms vary?

“Rosacea can present itself in different ways depending on the type,” Dr Eisman says.

Some people experience redness, flushing and visible blood vessels on the face, while others develop red lumps, acne-like spots and sensitive skin.

“You could also experience swelling and thickening of the skin,” Dr Eisman notes.

Different types of rosacea

Erythematotelangiectatic rosacea (ERT)

Dr Unni says this is probably one of the most identifiable rosacea subtypes.

“It presents as red flushing across the cheeks and nose; however, it can also present on other areas,” she says.

“Those suffering the symptoms of ERT may also report experiencing warm flushes, tingling or swelling in the affected areas.”

Papulopustular rosacea

Also known as acne rosacea, Dr Unni says this type tends to be more common in adult or middle-aged individuals.

“It is characterised by facial redness and inflammation but notably the presence of acne-like bumps, papules and pustules,” she says.

“These pustules can develop to be quite large and painful and in severe, untreated cases can appear on other parts of the body such as the chest, shoulders and neck.”

Phymatous rosacea

This is commonly identified as the subtype of rosacea that affects the nose’s appearance, Dr Unni explains, with a notably red and bulbous nose being key indicators.

“This is due to the skin around the nose becoming thicker and often resembling a likeness to the texture of scar tissue,” she says.

“Persistent redness, acne-like bumps and visible blood vessels are also symptoms.”

Ocular rosacea

This type of rosacea affects the eyes or eyelids and can occur independently or alongside other symptoms affecting the skin, Dr Unni says.

“(It is) characterised by symptoms such as watery eyes, redness, dryness, itching, burning, sensitivity to light and even bloodshot eyes,” she explains.

“Some individuals who experience ocular rosacea also report feeling a gritty or sandy feeling in their eyes, which can lead to blurred vision.”

How do you get a rosacea diagnosis?

To get a rosacea diagnosis, Dr Unni recommends making an appointment with your GP who may be able to diagnose you in the clinic.

“Otherwise, they can refer you to a dermatologist,” she says.

“Keep in mind that left untreated, rosacea does not go away and will only get worse, so your first step should be booking in with your trusted GP.”

Can you get rid of rosacea permanently?

Dr Unni says there is currently no known cure for rosacea and it is not possible to get rid of it permanently.

“However, there are various treatments available which can help manage your symptoms and improve the appearance of the skin,” she notes.

“Educating yourself and monitoring what may trigger a rosacea flare-up for you is also a powerful way to manage your rosacea moving forward.”

What treatments are available for rosacea?

Topical treatments

These are applied directly to the skin and can help reduce redness, inflammation and acne-like bumps, Dr Unni explains.

Oral medications

“For moderate to severe rosacea, oral antibiotics may be prescribed to reduce inflammation and control symptoms,” Dr Unni says.

Laser or light therapy

Pulsed dye laser (PDL) or intense pulsed light (IPL) therapy is sometimes recommended to help treat rosacea.

“These lasers work by targeting and heating the blood vessels, causing them to collapse and fade over time, leading to a reduction in redness,” Dr Unni explains.

How to calm a rosacea flare-up

Dr Unni says in addition to the previously suggested topical and professional treatments, implementing the necessary lifestyle changes according to your triggers can be crucial to help calm a rosacea flare-up.

“For more instant relief during a flare-up, applying a cool compress to the affected area can help reduce redness and inflammation,” she suggests.

“Use a soft cloth soaked in cool water or chilled green tea and apply it to your face for several minutes.”

More tips for managing rosacea

Avoid triggers

Monitor what triggers your rosacea to flare up and worsen so you can do your best to eliminate it from your lifestyle, Dr Eisman says.

“Common triggers are sun exposure, hot food and alcohol, so it’s a process of elimination,” she says.

Simplify skincare

Less is best for rosacea sufferers, as irritants can trigger flare-ups.

Dr Eisman suggests you avoid anything abrasive or astringent such as certain toners, scrubs and peels.

She also recommends using oil-free products and sunscreen rather than fragranced products and waterproof cosmetics.

Consider surgery

For sufferers with firm swelling and enlargement of facial features, surgical options including ablative laser or electrosurgery may be necessary, Dr Eisman says.

See an eye specialist

“If you are experiencing symptoms which affect your eyes, you may need to see an ophthalmologist,” Dr Unni says.

More on skin conditions:

• Bumpy skin on your arms? Here’s how to banish keratosis
• Itchy skin driving you nuts? You may have one of these conditions
• What to know about unsightly warts and verrucas
• The other skin cancer: What is basal cell carcinoma?

 Originally written by Charlotte Brundrett, September 2018. Updated by Melissa Hong, May 2024.