Updated: Aug 2, 2020
WHAT IS IT?
Rosacea is a common progressive, chronic vascular, inflammatory skin disease, usually affecting the face. It affects approximately 5% of the population, usually with fair skin, mostly Northern and Western European descent in their 30’s and 40’s, is more common in women but usually more severe in men.
The first symptoms are dilated capillaries across the nose and cheeks (erythematic), occurring in facial flushing which becomes more persistent and eventually constant with fluctuations in its’ intensity. Inflammation can progress to multiple raised and/or broken capillaries (telangiectasia). In later stages, acne type papules, pustules and even large nodules (skin lesions) develop. It is not related to acne as comedones are not symptoms and lesions are due to inflammation not bacteria.
A burning sensation can be felt, the skin appears red, oily or dry and in some severe cases texture thickens. Facial swelling caused by water leakage in the skins’ structures is mainly due to facial flushing. Red lumpy swellings may form over the lower part of the nose, sometimes progressing to a larger deformed nose known as Rhinophyma, due to growth of sebaceous glands. This is more common in men.
Rosacea can cause damage to the dermal matrix. Occasionally long periods of remission occur. In severe cases blepharitis (styes) and conjunctivitis are common complications. For a minority it slowly worsens to disfigurement and sometimes serious eye disease, threatening eyesight.
Rosacea can cause severe emotional and psychological problems due to visible facial deterioration.
The exact causes are unknown, although there are contributing factors and theories as listed.
Demodex mites inhabit the skins’ pores. Rosacea is not contagious but these mites can be passed on. When mites are removed there is a huge reduction in symptoms
Lesions on the hypothalamus gland
Yeast or fungus in the skin
Vascular growth factor (VGF) (biochemical in the skin)
"Acne rosacea appears to be caused by an overly zealous innate immune response and not by bacteria, investigators here said. Patients with rosacea have significantly higher levels of cathelicidin in facial skin compared with patients who don’t have the condition. Higher levels combined with an increase in serine protease activity results in the generation of pro inflammatory forms of the antimicrobial peptide, which in turn cause an inflammatory skin response, they said." 
CONTRIBUTING FACTORS / TRIGGERS
Sun damage contributes to features and possibly occurrence
Hot drinks, alcohol, acidic or spicy foods, extreme heat or cold temperatures, wind, some medications and stress may aggravate rosacea
Alcohol based lotions, makeup, sunscreens and other skin care products may cause skin sensitivity
Rosacea can be controlled but not cured. Early treatment is best to avoid permanent tissue inflammation. It would be advisable to seek a dermatologists’ opinion for diagnosis and treatment.
“Topical rosacea medicines are used in conjunction with oral medicines until the disease is controlled. Then the oral medications are stopped, and the topical therapies are used for maintenance.” 
Depending on the severity of rosacea would depend on the treatments to be used, which are listed below.
Use tepid water only
Treat for sensitive skin
Topical anti-inflammatory & anti-yeast medications
Topical Vitamin C therapy (reduces inflammation)
Oral & topical antibiotics
Vascular lasers for broken capillaries
Rhinophyma - medication, surgical or laser resurfacing
Demodex mites - permethrin
Psychological treatment if necessary
Massage & meditation for stress reduction
DRY & OILY ROSACEA
Avoid sun, heat, spicy foods, alcohol, stress and all other known triggers.
Treat for sensitive skin, use tepid water only, gentle, fragrance free, non-comedogenic products and lightweight broad-spectrum sunscreens. Non stimulating alcohol free spray toners.
Alpha Hydroxy Acid (AHA) products can be used but not during a flare or when the skin is red or irritated. Do not use any with very low PH levels.
DRY ROSACEA (flaky, dehydrated, parchment like red skin)
Very mild non foaming, non detergent cleansers
Antioxidant serums using soothing ingredients e.g. grape seed extract & green tea
Fragrance free, non-comedogenic moisturiser
OILY ROSACEA (bouts of pimples, oiliness, seborrhoeic dermatitis)
Gentle fragrance free rinseable foaming cleansers
Lightweight, fragrance free moisturiser
For pictures of subtype 1-4 rosacea go to: www.rosacea.org\patients\allaboutrosacea.php
 Richard L. Gallo, MD PhD of the University of California at San Diego and colleagues reported online in Nature Medicine,
 Michael H Gold, MD, Rosacea Overview, www.skinandageing.com/article/2334