Rosacea
What is Rosacea?
Rosacea (rose-AY-sha) is a common, incurable and chronic inflammatory skin condition that usually affects the central area of the face with persistent redness. It often begins with a tendency to blush or flush more easily mainly on the nose and cheeks. The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest and back can be red all the time for some people. Rosacea is not contagious or infectious.
Rosacea is estimated to affect around 3%-4% of adults worldwide. Rosacea most often develops between the age of 30 to 60 years. However, it can occur at any age and occasionally presents in children too. Rosacea is often thought to be more common in females than males. Rosacea is more common in Celtic or North European descent people with fair skin and blue eyes.
Rosacea may be mistaken for acne, eczema, an allergic skin reaction or sunburn. Rosacea symptoms are easily controllable by medicines, medical treatments, general skin care and other few home remedies. The main symptoms of rosacea are redness of the face (easy facial blushing or flushing), red pimples on facial skin, fine red vascular lines (telangiectasias) on facial skin, irritated skin and eye problems such as swollen and red eyelids.
There is currently no cure for rosacea, but people can manage the symptoms using creams and medications. Untreated rosacea tends to worsen over time. Rosacea can be a very stressful and embarrassing condition. Sun exposure as well as some foods and beverages such as alcohol, caffeine, dairy products and spicy foods may worsen the symptoms.
Causes of Rosacea
The cause of the disease is largely unknown and unproven. However, the most common proposed causes and factors regarding this condition are listed below.
Genetic factors: Rosacea often runs in families. Person is more likely to develop this disease if a person is having other close relatives with rosacea. This means it is possible that people inherit genes for rosacea.
Abnormalities in the blood vessels: According to dermatologists, facial flushing and spider veins are developed due to abnormalities in the blood vessels of the face. However, it is unclear what causes inflammation in the blood vessels. Sun exposure could cause them to get wider and more visible on facial skin.
A skin mite (Demodex folliculorum): This mite lives on the skin and mostly on the nose and cheeks. This mite isn't harmful. Many studies found that people with rosacea have large numbers of this mite on their skin and too many mites could irritate skin. However, it is unclear whether the mites cause the rosacea or the rosacea causes the increased mites.
Helicobacter pylori Bacteria: These bugs are common and live in the gut. Some studies suggest that these bugs can infect the small intestines or can raise the amount of a digestive hormone gastrin. This situation may develop the rosacea which might cause skin to look flushed.
Environmental and Lifestyle Factors:
Rosacea most often develops between the age of 30 to 60 years.
Rosacea is often thought to be more common in females than males.
Rosacea is more common in Celtic or North European descent people with fair skin, blonde hair and blue eyes.
Excess Sun exposure and UV light can damage the dermis and increase skin inflammation.
Exercise, alcohol consumption, smoking, caffeine, dairy products and spicy foods may worsen the symptoms.
Emotional factors such as stress, fear etc may trigger symptoms of rosacea.
Changes in the weather (mostly strong winds) or a change in the humidity may trigger rosacea.
Types of Rosacea
There are mainly four types based on the area they affect and symptoms they show. These types are as below:
Erythematotelangiectatic Rosacea: This is the most common type and mostly affects facial skin. A person with this type can have symptoms such as blush in the center of the face, flushing, tiny visible blood vessels in spider veins pattern, skin discoloration, burning or stinging sensation, dry, rough and scaly facial skin etc.
Papulopustular (Inflammatory) Rosacea: This type resembles acne due to the similar look of symptoms. This type is distinguished by papules (red bumps) and pustules (pus-filled spots). Papules are red bumps on the facial skin without any fluid. Pustules are bumps filled with pus. A person with this type can have symptoms such as acne-like breakouts, oily skin, skin burning and stinging, sensitive skin, flushing, swelling and Visible broken blood vessels (spider veins).
Phymatous rosacea: This type is rare. A person usually gets affected by another type of rosacea first. Skin gets oily, bumpy and starts to thicken around the forehead, cheeks, chin, ears and especially nose. Gnathophyma describes thickening of the chin. Metophyma describes the thickening of the forehead. Rhinophyma describes thickening of the nose and this subtype is the most common among all 3 subtypes.
Ocular Rosacea: In this type, rosacea affects the eye. A person with this type can have symptoms such as eye redness and irritation and swollen eyelids, eye dryness, constantly watering eyes, burning or stinging eyes, blurry vision, visible broken blood vessels on an eyelid etc.
Symptoms of Rosacea
The symptoms may vary from person to person. Initially, rosacea symptoms can come and go. They might flare up for a few weeks or months, then fade and then come back. Rosacea is developed in stages and typically causes inflammation of the facial skin, particularly the forehead, cheeks, nose and chin. If rosacea is untreated, symptoms become worse with time. Some of common symptoms tend to be present in most cases of rosacea are listed below:
Facial skin redness
Blushing in the center of the face
Flushing on facial skin
Tiny visible blood vessels in spider veins pattern
Skin discoloration
Skin burning and stinging sensation
Dry, rough and scaly facial skin
Red bumps on the facial skin without any fluid (Papules)
Bumps filled with pus (Pustules)
Acne-like breakouts
A swollen and bulb-shaped nose
Oily skin
Sensitive skin
Bumpy and thicken skin around the forehead, cheeks, chin, ears and especially nose
Eye redness and irritation
Eye dryness
Constantly watering eyes
Burning or stinging eyes
Blurry vision
Problems with seeing
Swollen eyelids
Visible broken blood vessels on an eyelid
How is Rosacea diagnosed?
Family doctors or dermatologists may diagnose by gathering more information about a person's medical condition by examining and knowing the following things:
By knowing about the person's symptoms & possible triggers.
By knowing about the medical history of the person.
By knowing about the family history of the person.
There is no clinical test to diagnose rosacea. Dermatologists can make a diagnosis after examining the person’s skin as well as eyes and knowing about symptoms and triggers. Dermatologists usually diagnose rosacea based on the typical redness or blushed or tiny visible blood vessels in spider veins pattern on the facial skin. Dermatologists may want to make sure a person doesn’t have another medical condition because another medical condition can look a lot like rosacea. Dermatologists can conduct medical tests to rule out similar skin conditions such as lupus and an allergic skin reaction.
Treatment of Rosacea
Unfortunately, there is no universal cure for rosacea. However, there are a number of options available for treating and managing the disease after diagnosis. Medications and medical treatments as well as diet and lifestyle management help to manage symptoms. Usually, it can take a few weeks or months for skin to improve after taking medicines.
Medications:
Topical Gels / Creams: This topical gel is helpful to tight blood vessels in the skin and relieve facial redness. This gel can be applied once or twice a day on the affected skin area as per doctor’s advice.
Topical Gels / Creams (For inflammation): This topical lotion is helpful to reduce inflammation.
Sulfacetamide Sodium, (Klaron)
Topical Gels / Creams (Antibiotics): This topical antibiotics gel is helpful to kill bacteria on the skin and clear up bumps, swelling and redness. Azelaic acid and metronidazole can be used as alternate combinations where one in the morning and one at night.
Metronidazole, (Metrogel, Flagyl)
Clindamycin hcl, (Cleocin hcl)
Oral Medicines: This oral acne medication is helpful to clear up severe skin bumps. This medication should only be used if other treatments have not worked. This medication has severe side effects so it should not be used by females when they are pregnant.
Isotretinoin, Accutane, Amnesteem, Claravis
Eye Medicines: These medications are useful to treat ocular rosacea. This medication relieves eye symptoms.
Blephamide (eye drops)
Doxycycline (improves dryness, itching, blurred vision and light sensitivity)
Medical Treatments:
Laser: Applying laser intense light on the affected facial skin area may get rid of bigger blood vessels to make them tighter and smaller.
Dermabrasion: This medical treatment sands off the top affected layer of the skin.
Electrocautery: Applying an electric current on the affected facial skin area may zap damaged blood vessels.
Diet: Diet also plays a crucial role in hair growth. Person should take the following protein, vitamin and mineral rich foods:
Avoid Alcohol
Avoid or reduce Caffeine
Avoid or reduce spicy and oily foods
Avoid or reduce dairy products
Lifestyle management: Person should take the following steps to reduce symptoms:
Take prescribed medications regularly.
Find and avoid your triggers among many things that can cause rosacea to flare. Common triggers for rosacea include sunlight, hot or cold temperatures, hot baths, cold wind blowing on the face, spicy foods, alcohol etc. Different persons can have different triggers.
Avoid excess sunlight.
Put on sunscreen lotion to block UVA and UVB rays wherever you go outside.
Wear a wide-brimmed hat that covers your face.
Apply only gentle skin care products on the face and avoid products that have harsh ingredients such as alcohol, fragrance, witch hazel etc.
Always use soft cloth to dry your skin after washing.
Use a moisturizer during cold weather and chilled wind to prevent your skin from getting dried.
If your eyes are affected with rosacea, use a watered-down baby shampoo or eyelid cleaner to gently clean your eyelids every day.
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