Definition and Overview

Rosacea is a skin condition that typically affects the central part of the face. The disorder is characterized by erythema and the presence of superficial pus-filled lesions. It is a chronic condition, with episodes of flares and resolutions. Since the condition affects the individual's physical appearance, patients who have this condition may experience psychological and emotional problems.

Four Types of Rosacea

  • Erythematotelangiectatic rosacea is the type characterized by permanent redness of the face. Patients may also have visible blood vessels on the skin's surface. Their skin is flaky, dry and easily gets flushed.

  • Papulopustular rosacea. Patients with this type have persistent redness of the face, with occasional pustules developing.

  • Phymatous rosacea. This type is associated with thickening of the facial skin.

  • Ocular rosacea. In this type of rosacea, the eyes are also affected.

Patients can have a combination of more than one type of rosacea at any given time. One type may also evolve to another type.

Rosacea occurs in adult patients, rarely occurring in people younger than 30 years of age. Heredity appears to play a role in the development of rosacea. Although no specific study has been conducted showing that rosacea is inherited, surveys have shown that approximately a third of patients can name a relative with the same symptoms. Rosacea is more commonly seen in women. Men who have this condition, however, tend to have more severe symptoms. An estimated 16 million people in the United States alone are affected by this condition.

Causes of Condition

At present, there is still no known cause of rosacea. Fair-skinned people who have a tendency to blush easily are believed to be the population most at risk for the development of this condition. Certain triggers may also play a role. These include climate changes, exposure to extremes of temperature, and getting sunburnt. Specific components in food, namely caffeine, alcohol and spices, may also produce this condition. Other triggers include stressful exercise and anxiety. Some medications, such as topical steroids, may cause skin irritation leading to rosacea. Chemical peels, microdermabrasion treatments, tretinoin and benzoyl peroxide, which are all used to manage acne, may also cause rosacea. If you are using any of these medications, it may be better to decrease the dosage gradually instead of stopping them completely all at once, in order to prevent an acute episode or flare.

Key Symptoms

Common symptoms of rosacea include redness or erythema over the cheeks, forehead, chin and nose. This redness comes and goes. Patients commonly experience flushing and blushing. Through time, the erythema becomes persistent, and can result in permanent skin changes. Depending on the type of rosacea, some patients may develop visible blood vessels, and small pimples or pus-filled lesions on the face. Plaques or raised patches may also develop. Swelling and edema of the face may also occur. The physical symptoms may be accompanied by burning, itching or stinging sensation.

In patients with the ocular type of rosacea, the eyes become irritated. The eyes become bloodshot, and the eyelids swell and become red. Patients may experience a foreign body or gritty sensation in the eyes, and light sensitivity. The eyes may also be prone to developing infections, such as styes. In severe cases, the cornea of the eye can get damaged, leading to loss of vision.

Long-standing rosacea results in overgrowth of the skin and connective tissues, particularly of the nose. Rhinophyma results from thickening of the skin over the nose, producing nose enlargement. The nasal skin develops irregularities and nodularities.

Who to See and Types of Treatments Available

If you experience recurrent or persistent redness of the face or any other symptoms of rosacea, it is best to consult a dermatologist or skin specialist. This condition can be confused with other common skin conditions such as seborrheic dermatitis or acne. Your dermatologist will be able to diagnose this condition and can give you the proper treatment.

Treatment depends on the type of rosacea that the patient has and the severity of the condition. The goal of the treatment is symptomatic: to decrease the redness and the facial lesions, and minimize the occurrence and the severity of the flares. A combination of topical and oral medications is usually initiated in order to control the symptoms. Once the flare has been controlled, topical treatments are used to ensure remission of the condition. Improvements are usually noted after one to two months of treatment.

Lifestyle modification and good skin care are important aspects in the management of rosacea. Trigger avoidance is advocated. Patients may need to start a journal and take note of what food or drugs lead to exacerbations. Minimizing sun exposure is also recommended, along with regular use of sunscreen, hats with wide brims, and umbrellas. Skin care for patients with rosacea includes the use of gentle cleansers, sunblock, and non-irritating moisturizers and products. Patients with mild rosacea, on the other hand, may use cosmetics and make-up to cover up the redness.

Certain medications can be used to treat the lesions caused by rosacea. Topical treatments, such as the antibiotic metronidazole, can reduce the lesions and the inflammation. Occasionally, topical treatment may be combined with the use of oral antibiotics, such as doxycycline, to treat the pustules. Certain topical medications, such as the alpha-agonist brimonidine and the beta-blocker propranolol, can help minimize flushing.

In some cases of rosacea, laser therapy is recommended. Intense pulsed light or better known as IPL treatments can reduce the erythema of the skin. Treatment with IPL uses light and heat to damage the small blood vessels located in the dermis, and allows the skin to heal itself.

For patients with rhinophyma, several options are available to take out the excess tissue over the nose and subsequently re-contour it. These options include the use of carbon dioxide lasers, radiofrequency ablation or RFA, and even surgery.

In cases of ocular rosacea, further consult with an ophthalmologist may be needed in order to relieve the eye symptoms and prevent permanent damage and vision loss.

References:

  • Home of the National Rosacea Society. https://www.rosacea.org/
  • American Acne and Rosacea Society. https://acneandrosacea.org/
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