Rosacea: Signs and symptoms
Do you flush easily? In the center of your face, do you see redness (lighter skin tones) or a brown or violet color (darker skin tones)? Have you noticed acne-like breakouts on your cheeks that just won’t clear? Do you have visible blood vessels on your face? These are all signs of rosacea.
Where does rosacea develop?
Rosacea develops on the face, usually across your nose and cheeks. While less common, some people see rosacea spread to their forehead, chin, ears, scalp, neck, upper chest, or back.
Rosacea can also affect your eyes. It’s estimated that 50% of people who have rosacea will have a flare-up that affects their eyes.
What does rosacea look like and feel like?
The following can help you recognize the signs and symptoms.
Flushing
Rosacea often begins with a tendency to flush easily. You may notice redness or a darker color on your face, along with a warm feeling. With time, these may last longer. If you have a darker skin tone, the only sign of flushing may be a warm feeling on your cheeks.
Redness/violet color lasts longer
As rosacea progresses, you may notice that the redness or violet color remains for weeks, months, or longer. Depending on your skin tone, you may see red, violet, or brown across your nose and cheeks. Sometimes, the color appears on the chin, forehead, ears, neck, upper chest, or scalp.
Acne-like breakouts
Many people who develop rosacea have these breakouts. They are visible on all skin tones. Your dermatologist may refer to them as “papules” and “pustules.” If you have a darker skin tone, the papules (bumps) and pustules (bumps filled with pus) may be the first sign of rosacea that you see.
Visible blood vessels
If you have a lighter skin tone, you may see blood vessels on your cheeks or nose. These are difficult to see on darker skin tones.
Changes to your eyes
Your eyes may feel gritty, noticeably dry, or itchy. They may tear, burn, or feel sore. Other signs include light sensitivity, a feeling that you have something in your eyes, red eyes, or discoloration around your eyes. Some people develop honey-colored crusts on their eyelashes, painless cysts, or changes to their eyesight. When rosacea affects your eyes, it’s called “ocular rosacea.”
Thickening skin
Fewer people develop thickening skin, but it can occur when rosacea goes untreated for years. Men are more likely to develop this sign than women. Thickening skin usually develops on the nose, but you can see it on the chin, ears, foreheads, or eyelids. The medical name for thickened skin on the nose is “rhinophyma.” “Phyma” (fie-ma) means thickened skin.
Multiple signs of rosacea
It’s common to have more than one sign of rosacea. You may see a red color and acne-like breakouts (left). If you have a darker skin tone, you may see acne-like breakouts and an area of darker skin called hyperpigmentation (right).
Burning, stinging, or both
Some people experience a burning or stinging sensation when they apply anything to their face. Even water can cause this sensation. Burning and stinging are more common in people who have discoloration that lasts for weeks or months, acne-like breakouts, or dryness.
Dryness
Rosacea can cause rough, scaly skin that feels dry. Skin that’s dry often burns or stings. Your skin may also feel tight, itchy, or both.
Itch
This isn’t a common symptom of rosacea. Dermatologists say your skin may itch if it’s dry or irritated.
With so many possible signs and symptoms, you may wonder what can cause them. Find out at Rosacea: Causes.
Images
Images 1,2,3,7,8,16,18: Getty Images
Image 4,6,12: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2018;78:148-55.)
Images 5,14,15, 17: Produced with permission from ©DermNet www.dermnetnz.org 2024.
Images 9, 10, 11: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2004;50:907-12.)
Image 13: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2015;72:749-58.)
References
Alexis AF, Callender VD, et al. “Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience.” J Am Acad Dermatol. 2019 Jun;80(6):1722-9.e7.
Gallo RL, Granstein RD, et al. "Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee.” J Am Acad Dermatol. 2018 Jan;78(1):148-55.
Kang CN, Shah M, et al. “Rosacea: An update in diagnosis, classification and management.” Skin Therapy Lett. 2021 Jul;26(4):1-8.
Thiboutot D, Anderson R, et al. “Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee.” J Am Acad Dermatol. 2020 Jun;82(6):1501-10.
van Zuuren EJ, Arents BWM, et al. “Rosacea: New concepts in classification and treatment.” Am J Clin Dermatol. 2021 Jul;22(4):457-65.
Written by:
Paula Ludmann, MS
Reviewed by:
Elan M. Newman, MD, FAAD
Rajiv I. Nijhawan, MD, FAAD
Brittany Oliver, MD, FAAD
Last updated: 4/3/24