Rosacea

What is Rosacea?

Rosacea is an inflammatory skin condition resulting in the redness of the face. One may mistake its characteristics - red nose, flushed cheeks and small, red, pus-filled bumps or pustules for acne. Rosacea is also known as adult acne or acne rosacea, but it has little to do with pimples and blackheads that commonly afflict teenagers. The cause of rosecea is unknown.

Rosacea mostly affects adults, usually people with fair skin, between the ages of 30 and 60. It is more common in women. Rosacea is often more severe in men. It is not life threatening. Rosacea is a cyclic condition in most people. It may be active for a time, lessen in intensity and then flare-up again. Once diagnosed, it is highly treatable.

What is the cause?

The cause of rosacea is unknown, but researchers believe it is likely due to a combination of genetic and environmental factors.

Several theories exist as to what causes rosacea. One theory is that primarily a blood vessel disorder causes vessels to swell. Another is that a chronic bacterial infection in the gastrointestinal system (Helicobacter pylori infection) may cause it. Some researchers have suggested that tiny mites (Demodex folliculorum) living in human hair follicles may play a role by clogging up sebaceous gland openings. Yet another theory is that the immune system is somehow involved. None of these theories are proved, however.

Alcohol does not cause rosacea. But consumption of alcohol does lead to flushing of the skin and may worsen rosacea. People who do not consume alcohol may still experience severe signs and symptoms.

What are the symptoms?

Signs and symptoms of rosacea include:

• Red areas on the face
  
• Tendency to flush or blush easily
  
• Visible small blood vessels on the nose and cheeks
  
• Small, red bumps or pustules on the nose, cheeks, forehead and chin (not the same as whiteheads and blackheads)
  
• Inflammation of cheeks, nose, forehead and chin
  
• Burning sensation in the eyes (ocular rosacea)
  
• Red, bulbous nose (rhinophyma)

Rosacea appears in phases. It begins as a simple tendency to flush or blush easily, then progresses to a persistent redness in the central portion of the face, particularly the nose. The redness results from the dilation of blood vessels close to the skin's surface. This phase is called prerosacea.

As signs and symptoms worsen, vascular rosacea develops — small blood vessels on the nose and cheeks swell and become visible (telangiectasia). The skin may become dry and sensitive. Rosacea may also be accompanied by oily skin and dandruff. Small, red bumps or pustules may appear and persist, spreading across the nose, cheeks, forehead and chin. This is known as inflammatory rosacea.

In severe and rare cases, the oil glands (sebaceous glands) in the nose and cheeks become enlarged, resulting in a buildup of tissue on and around the nose (rhinophyma), which is more common in men.

More than half the people with rosacea experience ocular rosacea — a burning and gritty sensation in the eyes. Rosacea may cause the inner lining of the eyelids to become inflamed or appear scaly, a condition known as conjunctivitis.

What increases the risk of rosacea?

A number of factors can make it worse by increasing blood flow to the surface of the skin. Some of these include:

• Hot foods or beverages
  
• Spicy foods
  
• Alcohol
  
• Caffeine withdrawal, although caffeine itself isn’t a factor
  
• Temperature extremes
  
• Sunlight
  
• Stress, anger or embarrassment
  
• Strenuous exercise
  
• Hot baths, saunas
  
• Corticosteroids
  
• Drugs that dilate blood vessels

How is rosacea treated?

Although there is no way to eliminate rosacea, effective treatment can relieve its signs and symptoms. Most often this requires a combination of prescription treatments and certain self-care measures.

Prescription treatment involves antibiotics, which can be applied directly to the skin (topical) or are taken orally. In many cases, dermatologists first prescribe both oral and topical antibiotics to lessen symptoms, followed by a long-term use of a topical antibiotic alone to maintain remission. The doctor may treat ocular rosacea with oral antibiotics. Laser surgery can be used to reduce visible blood vessels and treat rhinophyma.

In addition, the doctor may recommend certain moisturizers, soaps, sunscreens and other products to improve the health of the skin. If hot flashes appear to trigger rosacea, one may ask the doctor about treatment options for menopause.

What is the home treatment?

One can minimize exposure to anything that causes a flare-up. It is important to find out what factors affect the person so that they can be avoided. Keeping a running list of flare-up triggers might help.

Here are other suggestions for preventing flare-ups:

• Wear sunscreen with a sun protection factor (SPF) of 15 or higher to protect the face from the sun.
  
• Protect the face in winters with a scarf.
  
• Avoid irritating the facial skin by rubbing or touching too much.
  
• Avoid facial products that contain alcohol or other skin irritants.
  
• When using moisturizer with a topical medication, apply the moisturizer after the medication has dried.
  
• Use products that are labeled noncomedogenic. These won't clog the pores (oil and sweat gland openings) as much.
  
• Stay cool on hot days.
  
• If using makeup, consider using green-tinted pre-foundation creams, which are designed to counter skin redness.