Rosacea: What is it and how does it develop?

Red blood vessels in the face, also known as couperose, is a common skin condition. Although harmless, many people find couperose bothersome. But how does it actually develop? In this blog, as a skin therapist, I explain what science says about the causes and risk factors of couperose.

What is couperose?

Couperose is a condition in which the small blood vessels in the face are permanently dilated, causing red or purple lines to become visible on the skin. This occurs primarily on the cheeks, nose, and chin. Although couperose is not a medical condition in itself, it can be accompanied by sensitive skin and sometimes a burning or tingling sensation.

How does couperose develop?

The exact cause of couperose is complex and is influenced by various factors:

• Blood vessel changes: The small blood vessels in the skin temporarily dilate during temperature fluctuations or blushing. With couperose, they no longer contract, causing them to remain permanently visible.
• Genetic predisposition: People with fair skin (skin types I and II) and a family history of couperose or rosacea have a higher risk of developing visible blood vessels.
• Sun exposure (UV radiation): Sun damage weakens the blood vessel walls and can lead to an accelerated breakdown of collagen and elastin in the skin. As a result, the capillaries lose their firmness, making them more prone to dilation.
• Temperature fluctuations: Cold and heat (for example, from saunas, hot drinks, or spicy food) can cause an overactive response of the blood vessels, which can contribute to couperose in the long term.
• Hormonal influences: Pregnancy, menopause, and hormonal fluctuations can play a role in the development of couperose.
• Age: As the skin ages, the elasticity of the blood vessels and the firmness of the skin decrease, which increases the likelihood of visible veins.

Is couperose the same as rosacea?

Couperose is often associated with rosacea, but it is not exactly the same. Couperose refers purely to the visible blood vessels, whereas rosacea is a chronic skin condition in which inflammation, redness, and pimples can also occur. Nevertheless, many people with rosacea also suffer from couperose.

Histopathology: What happens in the skin with couperose?

Under the microscope, couperose reveals that primarily the small veins (venules) in the superficial skin remain dilated. The blood vessels are located close to the surface of the skin and are therefore clearly visible. With prolonged exposure to UV radiation and other triggering factors, these vessels can lose their firmness, partly due to the breakdown of collagen and elastin in the surrounding tissue.

What can you do about couperose?

Although couperose does not disappear on its own, there are ways to reduce the visible blood vessels or protect the skin from worsening:

• IPL and Laser Therapy – An effective method to treat small veins in a targeted manner and make them fade.
• Good sun protection – Using an SPF 30 or higher daily helps prevent further vascular changes and sun damage.
• Avoiding triggers – Hot drinks, alcohol, extreme temperatures, and spicy foods can worsen couperose.
• Soothing skincare – Use mild, non-irritating products to keep redness under control.

Conclusion

Rosacea is a common skin condition caused by a combination of genetic predisposition, external factors such as sun damage and temperature fluctuations, and a decrease in vascular wall elasticity. Although harmless, it can be cosmetically bothersome. Fortunately, effective treatments are available to reduce rosacea and prevent further worsening.

Sources

• Abram, K., Silm, H., Maaroos, HI, & Oona, M. (2010). Risk factors associated with rosacea. Journal of the European Academy of Dermatology and Venereology, 24(5), 565–571.
• Helfrich, Y.R., Maier, L.E., Cui, Y., Fisher, G.J., Chubb, H., Fligiel, S., … & Voorhees, J. J. (2015). Clinical, histologic, and molecular analysis of differences between erythematotelangiectatic rosacea and telangiectatic photoaging. JAMA Dermatology, 151(8), 825–836.
• Kim, M., Lee, HJ, & Hwang, Y. J. (2021). Angiogenesis in chronic inflammatory skin disorders. International Journal of Molecular Sciences, 22(21), 12035.
• Lee, WJ, Jung, JM, Lee, YJ, Won, CH, Chang, SE, Choi, JH, … & Lee, M. W. (2016). Histopathological analysis of 226 patients with rosacea according to rosacea subtype and severity. The American Journal of Dermatopathology, 38(5), 347–352.
• Rainer, BM, Kang, S., & Chien, A. L. (2017). Rosacea: Epidemiology, pathogenesis, and treatment. Dermato-Endocrinology, 9(1), e1361574.
• Walker, JG, Stirling, J., Beroukas, D., Dharmapatni, K., Haynes, DR, Smith, MD, … & Roberts-Thomson, P. J. (2005). Histopathological and ultrastructural features of dermal telangiectasias in systemic sclerosis. Pathology, 37(3), 220–225.