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What is couperose and how can it be recognized?

Rosy apple cheeks are considered a sign of health and freshness. But what happens when cheeks are permanently red and there is also a burning sensation? This may be due to the skin disease couperosis. But how can you tell the difference? Tikbow asked dermatologists.

It all starts with harmless red bumps, which are quite unnoticeable at first, because they always appear when you expect them: for example, when you come back from the ski slope to the well-heated cottage, have drunk some red wine or have been in the sauna in the evening. For an estimated five to seven percent of Germans, however, it does not stop there. They suffer from couperose or rosacea.

"At first, her cheeks stay red a little longer than those of the person sitting next to her in the ski lift, then the redness slowly establishes itself as a permanent guest and causes a burning pain; Finally, pimples appear in the mid-face area", explains Marie-Luise Klietz, dermatologist from Munich and author of the book "Hautsache schön, Hautsache gesund". 1 Together with her colleague and co-author, plastic surgeon Dr. Matthias Aitzetmüller, she answers questions about skin problems.

What is the difference between couperose and rosacea?

Couperosis is often falsely used as a synonym for rosacea. However, it is only one form of rosacea. Strictly speaking, only the first stage of the disease is meant. Couperosis or rosacea erythematosa-teleangiectatica – also known as "copper rose" or "curse of the Celts" – is the term doctors use to describe a lesion of the midface with dilated blood vessels (telangiectasias) that show through the skin. "As soon as papules and pimples appear, other forms of rosacea are present", says Klietz.

If Rötungen appear together with papules, pimples or even pustules, a Rosacea papulopustulosa is present. In the worst case, it can lead to nodular growths of the connective tissue. The consequence: Thick knots develop under the skin or the nose becomes larger and larger. According to the dermatologist, this is called phymatous rosacea: "The altered, thickened and nodular nose – in technical language the rhinophyma – is still misinterpreted as a säufer nose.

Comedian W. C. Fields and ex-US President Bill Clinton are well-known examples of this condition." However, the fact that both are men is no coincidence. Women are more likely to go to the doctor for rosacea, and according to some statistics they are also more often affected than men, but the disease is often more severe in men,” says the doctor.

What Ärzte sometimes like to üoverlook is rosacea ocularis with gerötetened eyes, inflammation of the eyelid margin and severe dryness to corneal inflammation. It is estimated to be present in 58 percent of all rosacea cases.

What causes couperose?

Genetic factors can favor the disease, but do not cause it. According to Marie-Luise Klietz and Dr. Matthias Aitzetmüller, a malfunction of the immune system caused by the protein cathelicidin is considered the most likely cause. This protein is so altered in its structure and function that it throws the skin microbiome out of balance. Likewise, this protein can stimulate the formation of new blood vessels. The immune system does not miss its fire, it tries to fight off the disease at the first signs and sends immune cells to the affected area.

The result: local inflammation, increased blood flow and renewed stimulation of blood vessel formation. And that is not all. The demodex mite also gets in on the act. "Demodex mites can be detected in increased numbers in rosacea patients. In the past, it was considered to be the cause of the disease, but today it is seen more as a side effect,” explain the experts.

How can you prevent it?

According to the dermatologist, one should avoid everything that could trigger the disease. These include alcohol, coffee, heat, cold, sun or hot spices. They do not cause couperose, but they can cause damage. Of course, there are triggers that cannot always be avoided. These include sports, excitement and hormonal changes in the monthly cycle and pregnancy. In all cases, it helps to gently cool the face in the heat and protect it from the cold, in order to at least cushion the temperature stress,” says Klietz. In addition, unnecessary stress should be avoided. Circulation-boosting massages, mechanical peelings, harsh surfactants and additives such as perfume are also counterproductive.

How can couperosis be treated?

Basically, rosacea is well treatable – the earlier, the better. "Time and again, we see patients who have been prescribed high-potency steroids (strong cortisone). This is an absolute no-go in rosacea! Although it works excellently at first, the side effects are fatal: increase in telangiectasia, skin thinning and cortisone dependency," warns Klietz.

Medical therapy is often difficult because patients respond very individually to the various measures. A combination of creams, tablets and laser therapies works best.

Daily skin care

For basic facial care, a moisturizing cream with high UVA sun protection is recommended. Vitamin C serums also have a positive effect, best used daily, but in low doses, because their antioxidant effect counteracts the disease. When cleansing in the evening, one should resort to well-tolerated rosacea skin care products. Many cosmetics manufacturers offer their own rosacea care range, which is usually available in pharmacies. Make-up is also no problem if it is suitable for hypersensitive skin.

Medicinal creams

Medicinal creams beinhalten meistens Metronidazol, Azelainsäure oder Ivermectin. "Es gibt auch Produkte mit anderen Antibiotika sowie mit Retinol, jedoch attestiert ihnen die derzeitige Studienlage keine überzeugenden positiven Effekte", sagt Klietz. "Lediglich bei Metronidazol und Azelainsäure liegen hochwertige Studienergebnisse vor, und auch Ivermectin konnte in den letzten Jahren klinisch überzeugen."


To alleviate inflammation, antibiotics in tablet form are often used. Doxycycline and tetracycline, for example, have been able to reduce inflammation. The antihypertensives atenolol and clonidine also provide a small benefit. They have a vasoconstrictive effect and can thus reduce the risk of inflammation, according to the dermatologist.

Laser treatment

Lasers are the only way to permanently treat existing vascular dilatations. In the vast majority of cases, several sessions are needed to put the condition to rest. "The price for this, however, is high. The patient has to put up with a long downtime and the pain associated with such a profound procedure," explains Dr. Matthias Aitzetmüller.


As a last resort, those affected often have to undergo surgery, in which the rhinophyma is either removed by laser or reduced in size with a scalpel as a dermashave. Of course, it is much better to prevent rosacea from developing to the point where a rhinophyma develops,” warns the plastic surgeon.

Why should couperose be taken seriously?

"We recommend seeing the doctor as soon as Rötung and burning in the cheek area increase", says the doctor and scientist of aging research. Not only because rosacea is then much easier to treat, but also because it can be linked to numerous other diseases, including depression, high blood pressure, cardiovascular disease, anxiety, lipid metabolism disorders, diabetes and migraine.


1with expert advice from Marie-Luise Klietz, dermatologist and operator of Doctor Aesthetics, and Dr. Dr. med. univ. Matthias M. Aitzetmüller, plastic surgeon and scientist, from München, authors of the book "Hautsache schön, Hautsache gesund"