Rosacea is a red facial rash that affects an estimated 14 million Americans. Adults, especially those between 30 and 60 years of age who have lighter skin, blonde hair and blue eyes, are most likely to suffer from rosacea. However, rosacea can affect children and adults of any skin type. It may be transient, recurrent or persistent.
Some people who have rosacea become depressed by the changes in the appearance of their skin. People who have rosacea may experience low self-esteem, feel embarrassed by their appearance, and claim their social and professional interactions with others are adversely affected.
Rosacea begins with a tendency to flush or blush easily, then often progresses to a persistent redness, pimples, visible blood vessels, sometimes called broken capillaries or facial veins and, in advanced stages, thickened skin.
The redness and swelling occur primarily on the face. Other areas that can be affected are the scalp, neck, ears, chest and back. Sometimes, rosacea affects the eyes.
In more advanced cases, a condition called rhinophyma may develop, particularly in men. Caused by enlarged oil glands in the skin, rhinophyma makes the nose larger and the cheeks puffy. Thick bumps may develop on the lower half of the nose and nearby cheeks. Most people do not develop rhinophyma.
Rosacea also can affect the eyes. About 50 percent of people with rosacea have eye involvement, also called ocular rosacea. This often causes dryness, burning, and grittiness of the eyes. Left untreated, ocular rosacea can lead to serious eye complications.
Who Gets Rosacea?
Rosacea is often passed on in families, with women being affected more often than men. Men, however, often get more severe forms of rosacea. For women with rosacea, increased flushing and blushing may occur around and during menopause.
As women approach menopause, they may notice an extreme sensitivity to cosmetics and skin-care products. These can be symptoms of rosacea. Both men and women may notice that a particularly embarrassing or tense moment triggers flushing that lasts longer than in other people.
Famous rosacea sufferers include W.C. Fields and former President Bill Clinton.
What are the Characteristics of Rosacea?
Red papules and sometimes pustules on the nose, forehead, cheeks and chin. Rarely it involves the trunk and arms.
Frequent blushing or flushing
A red face due to persistent redness and/or prominent blood vessels – telangiectasia
Dry and flaky facial skin
Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)
Sensitive skin: burning and stinging, especially with make-up, sunscreens and other facial creams
Red, sore or gritty eyelid margins including papules and styes – ocular rosacea
Enlarged unshapely nose with prominent pores (sebaceous hyperplasia) and thickening – rhinophyma
Firm swelling of other facial areas including the eyelids
What Does Rosacea Look Like?
Early rosacea can be difficult to recognize. When rosacea first develops, the redness tends to come and go. Many people may consider this nothing more than flushing that lasts longer than normal. The visible blood vessels can be seen as an inevitable sign of aging. If papules and pustules appear, these can be mistaken for adult acne.
Left untreated, rosacea can worsen and become more difficult to treat.
Mild Rosacea: Flushing/blushing and eventually, persistent dilated blood vessels
Moderate Rosacea: Papules, pustules, dilated capillaries and persistent redness.
Severe Rosacea: Severe redness, skin swelling, thickening, papules, pustules and nodules
Rhynophyma. Without treatment, skin may continue to thicken.
What Causes Rosacea?
It is not known what causes rosacea. One explanation is that something causes the blood vessels to swell.
This tendency of the blood vessels to swell or dilate may be hereditary or environmental. Another theory is that a mite called Demodex, which lives in hair follicles, could be a cause of rosacea. The belief is that the mites clog oil glands, which leads to the inflammation seen in rosacea. The immune system also has been implicated as playing a role in rosacea’s development.
What Aggravates Rosacea?
Heat (including hot baths)
Strenuous exercise
Environmental factors, like sunlight, wind, very cold or very hot temperatures
Hot or spicy foods and drinks
Alcohol consumption
Menopause
Emotional stress
Long-term use of topical steroids on the face
How Is the Eye Affected?
In addition to skin problems, up to 50 percent of people who have rosacea have eye problems caused by the condition. Typical symptoms include redness, dryness, itching, burning, tearing, and the sensation of having sand in the eye. The eyelids may become inflamed and swollen. Some people say their eyes are sensitive to light and their vision is blurred or otherwise impaired.
Treatment for Rosacea
To effectively manage rosacea, treatments must be tailored to the individual patient. This approach can stop rosacea from progressing and sometimes reverses rosacea.
General measures
Where possible, reduce factors causing facial flushing
Avoid oil-based facial creams. Use water-based make-up.
Never apply a topical steroid (cortisone) to rosacea.
Protect yourself from the sun. Use light oil-free facial sunscreens.
Keep your face cool: minimize your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms.
Topical treatment
Topical treatments for rosacea can be used intermittently or long term on its own for mild cases and in combination with oral antibiotics for more severe cases.
Metronidazole creams or gels
Sulfur/sulfacetamide combinations
Topical dapsone gel (Aczone)
Azelaic acid creams
Topical calcineurin inhibitors, tacrolimus ointment and pimecrolimus cream
Oral antibiotics
Tetracycline antibiotics including doxycycline and minocycline reduce inflammation. They reduce the redness, papules, pustules and eye symptoms of rosacea.
Isotretinoin
When antibiotics are ineffective or poorly tolerated, oral isotretinoin (Accutane) may be very effective. Although isotretinoin is often curative for acne, it may be needed in low dose long term for rosacea, sometimes for years. It has important side effects and is not suitable for everyone.
Rhinophyma can be treated successfully by reshaping the nose surgically or laser treatments. Surgery is the most effective treatment for rhinophyma. The excess tissue can be carefully removed with a scalpel, laser, or electrosurgery.
Can Rosacea Be Cured?
Although there is no cure for rosacea, it can be treated and controlled. The goals of treatment are to control the condition and improve the appearance of the patient’s skin. It may take several weeks or months of treatment before a person notices an improvement of the skin.
TIPS FOR ROSACEA PATIENTS
Many everyday things can cause rosacea to flare. Anything that causes a flare-up is called a trigger. To help patients decrease flare-ups, we recommend the following:
Practice good sun protection. Sun exposure seems to be the most common trigger. Seek shade when possible, limit exposure to sunlight, wear protective clothing, and use nonirritating, oil-free, broad-spectrum sunscreen with SPF of 30 or higher.
Avoid certain foods and drinks. Spicy foods, hot drinks, and alcoholic beverages are common rosacea triggers.
Protect your skin from extreme hot and cold temperatures. Exercise in a cool environment. Do not overheat. Protect your face from cold and wind with a nonirritating scarf or ski mask.
Avoid rubbing, scrubbing, or massaging the face. Facials can often aggravate rosacea.
Avoid cosmetics and skin care products that contain alcohol or other irritating substances. Use hair sprays properly, avoiding contact with facial skin.
Keep your skin care routine simple. Fewer products are better.
Note flushing episodes. The above are common triggers, but what causes rosacea to flare in one person may not trigger it in another. By writing down what foods, products, activities, medications, and other things cause your rosacea to flare, you will learn your triggers.
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