Rosacea in Men vs Women: How It Presents Differently
Rosacea is a chronic inflammatory skin condition that affects millions of people worldwide. Characterised by facial redness, visible blood vessels, bumps, and sometimes eye involvement, rosacea is often misunderstood as “adult acne” or simply a cosmetic issue. But its impact goes beyond skin—it can affect self-esteem, confidence, and quality of life.
Interestingly, while rosacea affects both men and women, research shows that it often presents differently between the sexes. Hormonal influences, skin structure, lifestyle factors, and even genetics play a role in shaping how rosacea appears and progresses. Let’s dive deep into these differences and what they mean for diagnosis and management.
Understanding Rosacea
Before comparing men and women, it’s important to understand the main features of rosacea. There are four subtypes:
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Erythematotelangiectatic Rosacea (ETR): Persistent redness, flushing, and visible blood vessels.
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Papulopustular Rosacea: Red bumps and pus-filled lesions, often mistaken for acne.
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Phymatous Rosacea: Thickened, bumpy skin, commonly around the nose (rhinophyma).
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Ocular Rosacea: Eye redness, irritation, burning, and in severe cases, vision issues.
Triggers include sun exposure, hot beverages, alcohol, spicy foods, stress, and extreme temperatures. While anyone can develop rosacea, men and women often experience it differently.
Prevalence and Onset
Women:
-Rosacea is more commonly diagnosed in women, particularly those aged 30–50.
-Erythematotelangiectatic and papulopustular forms are most prevalent in women.
-Hormonal fluctuations, such as during menopause, can worsen redness and flushing.
Men:
-Men are less frequently diagnosed, but when they are, the condition often presents more severely.
-Phymatous rosacea (thickened skin and rhinophyma) is much more common in men.
-Men are more likely to seek treatment later, often after more noticeable skin changes have developed.
Differences in Symptoms
1. Facial Redness and Flushing
-Women: Often experience frequent, transient flushing that can be triggered by heat, exercise, or hormonal changes. Persistent redness tends to appear on the cheeks, nose, and chin.
-Men: Tend to have more persistent redness, often covering the entire central face. Flushing can be less noticeable than thickened skin changes, but overall inflammation may be greater.
2. Acne-Like Bumps (Papulopustular Lesions)
-Women: More likely to develop small, red bumps and pustules resembling acne, especially on the cheeks and chin. These lesions often respond well to topical treatments.
-Men: While men can develop bumps, they are less common than thickened skin changes. However, when papulopustular rosacea appears, it may be more resistant to treatment.
3. Thickened Skin (Phymatous Changes)
-Women: Rarely experience skin thickening. When it occurs, it’s usually mild.
-Men: Much more likely to develop phymatous rosacea, especially rhinophyma, which thickens and enlarges the nose. The exact cause is unknown, but genetics and androgen hormones likely play a role.
4. Eye Involvement (Ocular Rosacea)
-Women: Ocular symptoms like dryness, irritation, and redness are relatively common and often occur alongside facial rosacea.
-Men: More likely to have severe ocular involvement that can precede visible facial symptoms. Men are also at higher risk for complications if left untreated.
Hormonal and Skin Differences
Hormones play a significant role in how rosacea manifests:
-Women: Estrogen fluctuations can increase skin sensitivity, making redness and flushing more pronounced. Hormonal changes during menopause can worsen symptoms.
-Men: Higher androgen levels may contribute to thicker skin and phymatous changes, particularly around the nose. Testosterone may also influence sebaceous gland activity, worsening inflammation.
Skin structure also differs: men generally have thicker, oilier skin, which may affect how rosacea lesions form and heal. This can make treatment responses different between men and women.
Lifestyle Factors
Lifestyle factors also impact rosacea differently:
-Alcohol: Men may consume more alcohol, which can exacerbate flushing and trigger phymatous changes.
-Skincare Habits: Women are often more proactive about skincare, using gentle cleansers and sunscreen, which may mitigate flare-ups.
-Sun Exposure: Men who work outdoors or neglect sunscreen may experience more severe chronic redness and skin thickening.
Diagnosis and Treatment Considerations
Women
-Often diagnosed earlier due to noticeable redness and bumps.
-Respond well to topical treatments like metronidazole, azelaic acid, or ivermectin.
-Lifestyle adjustments (avoiding triggers, using sunscreen, gentle skincare) are highly effective.
Men
-Often present with more advanced disease, such as phymatous changes.
-May require oral medications, laser therapy, or surgical interventions for thickened skin.
-Early intervention is critical to prevent permanent tissue changes, especially rhinophyma.
Key Takeaways
-Rosacea is gender-influenced: Men and women experience different patterns, severity, and triggers.
-Men often face more severe or advanced disease: Especially phymatous rosacea and ocular involvement.
-Women experience more transient redness and bumps: Hormonal changes often play a role.
-Early diagnosis is crucial: Timely management improves outcomes, reduces complications, and enhances quality of life.
-Lifestyle and skincare matter: Sun protection, gentle skincare, avoiding triggers, and medical therapy tailored to the patient’s sex can make a significant difference.
Conclusion
Rosacea is far from a “one-size-fits-all” condition. While women are more commonly affected and often seek treatment early, men tend to develop more severe or permanent skin changes. Understanding these differences is key for both patients and dermatologists to implement effective, personalised treatment strategies.
Recognising the gender-specific nuances of rosacea not only improves management but also empowers individuals to make lifestyle choices that protect their skin and confidence.
