Rosacea affects approximately 2-5% of adults, making it a more common skin condition than you might think. This condition mainly affects fair-skinned women between 30 and 60 years old, and it is often confused with rosacea. In this guide, we'll clarify the difference between rosacea or rosacea, examine rosacea symptoms, explore the causes of rosacea, and notably detail the rosacea treatment options available to help you better understand and manage your sensitive skin and rosacea on a daily basis.
Rosacea or rosacea: understanding the difference
What is rosacea?
The term rosacea comes from the Latin "cupri rosa", combining copper and rose, a direct reference to the characteristic reddish coloring of dilated blood vessels on the face. Rosacea specifically refers to the permanent dilation of small blood vessels, medically called telangiectasia. These fine red or bluish-red vessels show clearly through the skin, creating persistent redness mainly on the cheeks and nose.
This chronic dilation of the capillaries results from a loss of elasticity which makes the dilation lasting. People with fair and sensitive skin are particularly affected. Rosacea is essentially an aesthetic problem with no medical danger. The affected skin is often dry and reactive, sometimes with moderate burning or itching. Unlike more advanced forms, inflammatory manifestations such as pustules are absent from the clinical picture.
What is rosacea?
Rosacea is a chronic inflammatory disease that affects the small blood vessels of the face. This skin condition is manifested by persistent redness, very reactive and sensitive skin, sometimes accompanied by papules or pustules. Affected people often describe burning or tingling sensations.
Rosacea has several distinct forms. The vascular form, frequently called rosacea, combines persistent redness and telangiectasia. The papulo-pustular form develops additional inflammatory symptoms with pus-filled pimples on reddened areas. The hypertrophic form, a rare complication, causes thickening of the skin, particularly rhinophyma which more frequently affects men at advanced age. The ocular form can lead to conjunctivitis, blepharitis or, more rarely, keratitis.
This disease typically progresses in the form of flare-ups. Symptoms may disappear for several weeks before reappearing with greater intensity. Mixed forms exist, combining several manifestations simultaneously. This variability sometimes makes diagnosis difficult, particularly when symptoms are subtle or atypical.
Why is this confusion so common?
Terminological history largely explains this persistent confusion. In the 19th century, the disease was called "pink gout." The term "rosacea" was then used to designate the entire pathology before gradually being restricted to vascular anomalies of the cheeks. The disease then bore the names "acne rosea" then "acne rosacea" before the current term "rosacea" took hold.
Confusion persists because rosacea is actually a symptom of facial rosacea, not a separate disease. Rosacea represents the vascular form of rosacea, which is also the most widespread form. In other words, rosacea is the generic term that encompasses the entire disease and its different manifestations, while rosacea specifically refers to the permanent dilation of small blood vessels visible on the skin.
Some experts consider rosacea to be an early stage of rosacea, while others see it as a stand-alone manifestation that may progress to rosacea. One thing remains certain: early-stage rosacea shows the same vascular dilations as early rosacea. Although the treatments for rosacea and rosacea are often different, distinguishing between the two remains important to adapt the appropriate care to each situation.
Symptoms of rosacea and rosacea
Persistent redness and visible blood vessels on the face
The first signs often appear as diffuse redness which appears in the form of patches that are pinker than the rest of the face. These areas mainly affect the cheeks, nose, central forehead and chin, while sparing the eye and mouth contours. At first, this redness is temporary. The blood gradually stagnates under the skin, and the redness eventually becomes permanent over time.
Dermatologists speak of erythrosis when this diffuse redness settles lastingly in the center of the face. On these reddened areas, small dilated blood vessels become visible. These telangiectasias appear as fine red or purplish capillaries just below the surface of the skin. They sometimes create a characteristic spider web pattern on the cheeks and nose. The affected skin frequently has a rough appearance accompanied by small scales that slough off.
Feelings of heat and discomfort
Hot flashes, called flushes in medical terminology, represent a striking symptom. These episodes cause intense and sudden redness of the face, sometimes even the neck, accompanied by an unpleasant feeling of heat. Several factors trigger these flushes: sudden changes in temperature, consumption of alcohol or spicy foods, hot drinks. These bursts cause a dilation of the blood vessels which, with repetition, becomes permanent.
Furthermore, the skin becomes particularly sensitive and reactive. Burning and stinging sensations in the face occur frequently. Some people describe unpleasant tingling during these episodes. The skin then has difficulty tolerant certain cosmetic products, and can even react to simple contact with water or soap.
Pimples and inflammation: papulopustular rosacea
Against a background of persistent redness, papules and pustules appear. These small, red, firm growths generally measure between 1 and 4 millimeters. The papules are often surrounded by an inflammatory halo and form spontaneously in the center of the face. As inflammation progresses, pus-filled pustules develop.
These skin lesions appear in unpredictable outbreaks, without any particular triggering factor. Unlike juvenile acne, they have no blackheads or scars. The rashes may resolve spontaneously, but the number of papules and pustules tends to increase over time. The flare-ups gradually become closer together without proper treatment.
Eye symptoms and advanced forms
Ocular rosacea affects between 30 and 50% of people affected. This form can precede facial redness by several years. Symptoms include dry eye present in almost 100% of cases, inflammation of the eyelids (blepharitis), itching and redness of the eyes. Affected people complain of a sensation of foreign body or sand in the eyes, burning and hypersensitivity to light. In severe cases, visual disturbances may occur.
Rarely, the hypertrophic form develops in less than 5% of patients, with a male predominance. It causes thickening of the skin and tissues of the face, particularly at the tip of the nose. This area takes on a red, swollen appearance called rhinophyma, with visible dilation of pores and significant seborrhea.
Causes and triggering factors
Genetic predisposition and sensitive skin and rosacea
The causes of rosacea remain complex and result from a combination of several factors. The genetic component plays a determining role. Up to 50% of affected patients have a family history of rosacea. Other studies report that up to 30% of affected people have a family history of the condition. This hereditary predisposition suggests the existence of as yet unidentified genes responsible for the disease.
Rosacea mainly affects people with fair skin, light eyes and hair. In Europe, its prevalence varies from 2 to 10% depending on the country. Certain populations have particularly high rates. In Estonia, the rate reaches 22%, compared to only 2.2% in Germany. This geographical disparity reinforces the hypothesis of a genetic predisposition specific to certain populations in Northern Europe.
The role of Demodex and the immune system
Demodex folliculorum, a microscopic mite that lives naturally on human skin, proliferates excessively in affected people. A person suffering from rosacea wears 10 times more than a healthy subject. In one study, the presence of Demodex was found in 36.6% of patients examined. In patients with papulopustular rosacea, 100% had Demodex infestation, compared to 50% in those with the erythematotelangiectatic form.
The immune system of affected people malfunctions. Indeed, the skin's defense system becomes hyperactive and triggers an excessive inflammatory reaction. This hyperactivity causes the blood vessels to dilate and the characteristic redness to appear. Antimicrobial peptides, particularly cathelicidins, are present in abnormally high quantities and contribute to chronic inflammation.
Environmental factors: sun, temperature, stress
Exposure to the sun directly promotes inflammation and redness. UV radiation activates certain skin receptors which amplify the inflammatory response. Wind, especially cold wind, irritates sensitive skin. Sudden changes in temperature are major triggers. Rapid transitions from intense cold to heat partly explain why rosacea is more common in Nordic countries.
Strong emotions and repeated stress significantly worsen symptoms. Stress promotes inflammatory and vascular reactions responsible for burning sensations. Intense exercise that heats up the body can also trigger flare-ups.
Food, alcohol and lifestyle habits
Alcohol consumption, while not causing rosacea, makes it significantly worse. Alcohol causes blood vasodilation and increases skin circulation. Hot drinks of any type worsen symptoms in a third of patients. Contrary to popular belief, it is their high temperature that is the problem, not the caffeine.
Spicy foods containing capsaicin trigger flushing. Foods high in histamine like citrus fruits, tomatoes, and shellfish can exacerbate redness. Studies also link gut health to facial rosacea. The prevalence of digestive disorders such as celiac disease, Crohn's disease or Helicobacter pylori infection is higher in affected patients.
Rosacea care : medical and natural options
Medical treatments prescribed by the dermatologist
No cure exists for facial rosacea. The options available aim to reduce symptoms and control flare-ups. The treatment remains suspensive, which means that relapses occur when the treatment is stopped.
For erythematotelangiectatic rosacea, metronidazole gel 0.75% is applied twice a day for 3 months. Azelaic acid 15% gel is an effective alternative. These topical treatments reduce inflammation and redness. Brimonidine 0.3% gel acts as a vasoconstrictor and temporarily reduces facial erythema for 9 to 12 hours.
In papulo-pustular forms, ivermectin 1% cream is applied once a day for 3 months. This treatment targets Demodex folliculorum in particular. In case of resistance, doxycycline 100 mg during dinner constitutes the initial treatment for 3 months. This antibiotic from the cyclin family acts through its anti-inflammatory rather than antibacterial effect. Cyclins make the skin photosensitive, which limits their summer use.
Laser and pulsed light for vessels
The vascular laser targets dilated blood vessels and selectively eliminates them. Several types exist depending on the depth and size of the vessels. The 532 nm KTP laser effectively treats small and medium vessels[211]. The pulsed dye laser works by thermocoagulation for mild forms or by photothermolysis for severe cases[211]. This last method causes purpura which persists for 10 to 15 days.
The 1064 nm Nd:YAG laser penetrates deeper and is suitable for large, bluish-colored vessels. Intense pulsed light (IPL) represents a less aggressive alternative. It requires between 3 and 6 sessions spaced 3 to 4 weeks apart. These treatments are carried out on untanned skin, preferably in winter. Allow 1 to 5 sessions depending on the technique used.
Rosacea cream and topical care
Rosacea skin requires minimalist and gentle routines. Cleaning is done with a soap-free product in lukewarm water. Daily hydration with a non-irritating cream maintains pH balance of the skin and strengthens the skin barrier. SPF 50 sun protection remains essential.
Rosacea soothing active ingredients and natural approaches
Several natural active ingredients significantly reduce symptoms. Niacinamide reduces redness and strengthens the barrier function. Hemp oil, rich in omega-3 and omega-6, calms inflammation without a greasy film. Aloe vera soothes immediately the burning sensations. Calendula has recognized anti-inflammatory and healing properties. Chamomile extract and colloidal oatmeal have a powerful anti-irritation effect. Zinc PCA regulates inflammation in pustular forms.
Living daily with facial rosacea
Adapt your care routine
We must simplify our daily actions to protect our sensitive and rosacea skin. Cleaning is carried out morning and evening with a mild soap-free product, using lukewarm water only. We then dry with delicate pattings, never by rubbing. Hydration follows immediately with a light, non-comedogenic cream. Furthermore, maintain the pH balance of the skin strengthens the weakened skin barrier. We absolutely avoid waterproof products, which are difficult to remove and are irritating, as well as alcoholic lotions or lotions containing menthol, camphor or eucalyptus.
Sun protection and trigger management
We apply SPF 50+ protection daily, as UV rays worsen vascular dilation. We identify our personal triggers to avoid them. We give up spicy foods, hot drinks and alcohol. We cover our faces in cold weather and avoid strenuous exercise.
Makeup and camouflage of redness
We choose high tolerance products specially formulated for sensitive skin. A light green base neutralizes redness, followed by a localized green concealer. We favor a foundation with neutral undertones applied by tapping with a dense brush. We set lightly with a loose powder.
The psychological impact and acceptance of one's skin
Nearly 75% of us report low self-esteem. We are 5 times more likely to experience depression than the general population. However, effective treatment significantly improves our emotional quality of life. We can consult a psychodermatologist to rebuild our physical and psychological envelopes.
Rosacea and rosacea now have no secrets for you. We have demystified this chronic condition by exploring its different forms, its multifactorial causes and the symptoms that characterize it. Although there is no cure for this skin condition, there are many solutions to effectively control breakouts and improve your quality of life.
Whether you opt for medical treatments prescribed by your dermatologist or favor natural approaches with soothing active ingredients, the main thing remains to adapt your daily routine to your sensitive skin. We encourage you to identify your personal triggers and consult a professional to build a tailor-made care strategy.
Is your skin prone to redness, discomfort or rosacea? Discover our range of care specially formulated for sensitive and reactive skin in order to soothe, protect and sustainably strengthen the skin barrier.
