Rosacea

Rosacea has been classified into below four standard subtypes, reflecting common patterns of signs and symptoms. Many patients may experience characteristics of more than one subtype at the same time.

Facial Redness

Bumps and Pimples

Skin Thickness

Eye irritation

Rosacea is a common but poorly understood disorder of the facial skin that affects an estimated 14 million Americans.

It is a chronic but treatable condition that primarily affects the central face, and is often characterized by flare-ups and remissions. Although rosacea may develop in many ways and at any age, patient surveys indicate that it typically begins any time after age 30 as a flushing or redness on the cheeks, nose, chin or forehead that may come and go.

Over time, the redness tends to become ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases - particularly in men - the nose may grow swollen and bumpy from excess tissue. In many people the eyes are also affected, feeling irritated and appearing watery or bloodshot.

Although rosacea can affect all segments of the population, individuals with fair skin who tend to flush or blush easily are believed to be at greatest risk. The disorder is more frequently diagnosed in women, but tends to be more severe in men. There is also evidence that rosacea may tend to run in families, and may be especially prevalent in people of Northern or Eastern European descent.

In recent surveys by the National Rosacea Society, nearly 70 percent of rosacea patients said this condition had lowered their self-confidence and self-esteem, and 41 percent reported it had caused them to avoid public contact or cancel social engagements. Among those with severe rosacea, nearly 70 percent said the disorder had adversely affected their professional interactions, and nearly 30 percent said they had even missed work because of their condition. The good news is that well over 70 percent reported medical treatment had improved their emotional and social well-being.

While the cause of rosacea is unknown and there is no cure, its signs and symptoms can be controlled or mitigated with medical therapy, lifestyle changes and effective adjuvant moisturizer. Individuals who suspect they may have rosacea are urged to see a dermatologist or other qualified physician for diagnosis and appropriate treatment before the disorder becomes increasingly severe and intrusive on daily life.

What Should I Look For?

Rosacea can vary substantially from one individual to another, and in most cases some rather than all of the potential signs and symptoms appear. According to a consensus committee and review panel of 17 medical experts worldwide, rosacea always includes at least one of the following primary signs ??and various secondary signs and symptoms may also develop.¹

Primary Signs of Rosacea

           Flushing

Many people with rosacea have a history of frequent blushing or flushing. This facial redness may come and go, and is often the earliest sign of the disorder.

       Persistent Redness

Persistent facial redness is the most common individual sign of rosacea, and may resemble a blush or sunburn that does not go away.

       Bumps and Pimples

Small red solid bumps or pus-filled pimples often develop. While these may resemble acne, blackheads are absent and burning or stinging may occur.

       Visible Blood Vessels

In many people with rosacea, small blood vessels become visible on the skin.

Other Potential Signs and Symptoms

       Eye Irritation

In many rosacea patients, the eyes may be irritated and appear watery or bloodshot, a condition known as ocular rosacea. The eyelids also may become red and swollen, and styes are common. Severe cases can result in corneal damage and vision loss without medical help.

       Burning or Stinging

Burning or stinging sensations may often occur on the face. Itching or a feeling of tightness may also develop.

       Dry Appearance

The central facial skin may be rough, and thus appear to be very dry.

       Plaques

Raised red patches, known as plaques, may develop without changes in the surrounding skin.

Skin Thickening

The skin may thicken and enlarge from excess tissue, most commonly on the nose. This condition, known as rhinophyma, affects more men than women.

           Swelling

Facial swelling, known as edema, may accompany other signs of rosacea or occur independently.

          Signs Beyond the Face

Rosacea signs and symptoms may also develop beyond the face, most commonly on the neck, chest, scalp or ears.

Subtypes of Rosacea

Medical experts have also identified four common patterns of rosacea signs and symptoms, known as subtypes. These are shown and described at the beginning of this booklet.

Although these patterns are common, many patients have characteristics of more than one subtype at the same time, and these often may develop in succession. While rosacea may or may not evolve from one subtype to another, each individual sign or symptom may progress from mild to moderate to severe. Early diagnosis and treatment are therefore recommended

What Causes Rosacea?

While there are many theories, the underlying cause or causes of rosacea have not been scientifically proven. It is hoped that ongoing research in these areas will lead to improvements in its management and potential prevention or cure.

Many believe that rosacea may be a vascular disorder because of its association with flushing, redness and visible blood vessels. Some physicians have also speculated that flushing may involve the nervous system, since rosacea is often triggered or aggravated when patients are under emotional stress.

One theory about swelling is that increased blood flow during flushing leads to an increase in tissue fluid, which accumulates faster than the lymphatic system can remove it. The swelling in turn may contribute to skin thickening as tissue accumulates.

Beyond vascular factors, the presence of a microscopic mite called Demodex folliculorum has been considered as a potential contributor. This mite is a normal inhabitant of human skin, where it consumes cast-off cells, but has been found to be substantially more numerous in rosacea patients. It is unclear, however, whether this is a cause or a result of rosacea.

The bacterium Helicobacter pylori, which plays a role in duodenal ulcers, has also been implicated in rosacea, perhaps by raising gastrin levels that may stimulate flushing. However, recent studies have shown that H. pylori was no more common in patients with rosacea than in those without.

How Is Rosacea Treated?

Because rosacea may vary substantially from one patient to another, treatment must be tailored by a physician for each individual case.

Various oral and topical medications may be used to treat the bumps, pimples and redness often associated with the disorder. Dermatologists usually prescribe initial treatment with oral antibiotics and topical therapy to bring the condition under immediate control, followed by long-term use of topical therapy alone to maintain remission. The effectiveness of antibiotics in rosacea is believed to be due to their anti-inflammatory rather than anti-bacterial properties.

When appropriate, lasers, intense pulsed light sources or other medical and surgical devices may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Ocular rosacea may be treated with oral antibiotics and other therapy, and recommendations from an eye doctor may be needed.

Skin Care

But because the long-term use of topical steroids is known to make rosacea-like symptoms which is called steroid induced rosacea and can weaken skins more, a gentle skin-care are usually recommended to help control rosacea together with medication. Patients are advised to clean their face with a mild and non-abrasive cleanser, then rinse with lukewarm water and blot the face dry with a thick cotton towel. Never pull, tug or use a rough washcloth.

Patients may apply non-irritating skin-care products as needed, and are advised to protect the

skin from sun exposure using a sunscreen with an SPF of 15 or higher. Mild or pediatric sunscreen formulations are available for sensitive skin, and rosacea patients should avoid any skin-care products that sting, burn or cause additional redness.