Rosacea

Rosacea is a difficult to manage chronic inflammatory skin condition that primarily affects the central face and is characterized by redness, visible blood vessels, and, in some cases, acne-like bumps. It is a lifelong condition that adversely affects the emotional health and quality of life of those affected. It is more common in adults over the age of 30 and typically affects people with fair skin, although it can occur in people of all skin tones.

Rosacea most commonly affects the cheeks, nose, chin, and forehead, but in some cases, it can involve the neck, chest, ears, and even the eyes. Rosacea progresses in cycles, with periods of flare-ups followed by periods of remission. If not treated or managed properly, the condition can worsen over time.

Rosacea tends to begin in middle age. Pimples or pustules can resemble acne, and it is often accompanied by redness and flushing. In more advanced cases, particularly in men, rosacea may cause a thickening of the skin on the nose, a condition called rhinophyma.

There are four types of rosacea, vascular, inflammatory and sometimes ocular components.

Rosacea presents differently in each individual, but the most common signs include:

1. Facial redness: Persistent redness (erythema) is the hallmark of rosacea. This redness is usually most noticeable in the central part of the face—particularly the cheeks and nose—and is caused by the dilation of blood vessels near the surface of the skin.
2. Flushing: People with rosacea often experience frequent and prolonged episodes of facial flushing, which may be triggered by heat, sun exposure, spicy foods, alcohol, or stress.
3. Visible blood vessels: Small blood vessels (telangiectasias) can become visible on the surface of the skin, particularly around the nose and cheeks.
4. Bumps and pimples: Inflammatory lesions resembling acne may appear on the face. These may include red, swollen bumps (papules) or pus-filled lesions (pustules).
5. Eye irritation: Ocular rosacea affects the eyes and eyelids, causing dryness, redness, burning, and a gritty sensation. In severe cases, it can lead to vision problems if left untreated.
6. Skin thickening: In some individuals, especially men, the skin of the nose may thicken and enlarge due to excess tissue growth (rhinophyma).
7. Burning or stinging: The skin may feel tender or sensitive, with burning or stinging sensations, especially when applying skincare products.
8. Dry, rough skin: Dryness and flaky skin.
9. Raised red patches: These are called plaques and may appear without the presence of pustules. They can resemble a rash and are typically localized to the cheeks, forehead, or chin.
10. Facial swelling: noticeable welling in the midface.

Rosacea flare-ups are linked to environmental, dietary or lifestyle factors.

What are some common triggers?

1. Sun exposure
2. Hot weather and temperature extremes
3. Wind and cold weather
4. Stress and emotional changes
5. Spicy foods and alcohol
6. Some medications
7. Hormonal changes

The exact cause of rosacea is not fully understood, but it is believed to result from a combination of genetic, environmental, and vascular factors. Researchers have proposed several contributing mechanisms:

• Immune system dysfunction: Some individuals with rosacea may have an overactive immune response to certain triggers, resulting in inflammation and skin damage.
• Abnormalities in facial blood vessels: Increased blood flow or blood vessel reactivity can contribute to persistent redness and flushing.
• Microorganisms on the skin: The presence of the skin mite Demodex folliculorum and certain strains of bacteria (Helicobacter pylori) have been associated with rosacea, although their roles remain unclear.
• Genetic predisposition: Rosacea tends to run in families, suggesting a hereditary component.

Rosacea is more commonly diagnosed in women, but men are more likely to develop severe symptoms, including rhinophyma. It is particularly prevalent in individuals with light skin, blue eyes, and northern European ancestry.

There is no single test to diagnose rosacea. Instead, diagnosis is based on a clinical examination of the skin and a detailed patient history. Dr. Newsome will evaluate your skin looking for cardinal signs like facial redness, flushing, bumps, and visible blood vessels.

She will ask about:

• The onset and duration of symptoms
• Any known triggers or flare-up patterns
• Family history of rosacea or related skin conditions
• Use of skincare products or medications

In cases where rosacea is accompanied by eye symptoms, an ophthalmologic evaluation may be necessary to assess ocular involvement.

Other skin conditions, such as acne, seborrheic dermatitis, lupus, or allergic contact dermatitis, may mimic rosacea, so ruling out these possibilities is part of the diagnostic process. In rare cases, a skin biopsy may be performed to eliminate other diagnoses, but this is not routinely required.

Because rosacea is a chronic and often progressive condition, early diagnosis and management are important for minimizing its impact. Treatment typically focuses on controlling symptoms and avoiding known triggers. Treatment options vary depending on the severity and subtype of rosacea.