Acne Rosacea is a common but often misunderstood condition that is estimated to affect over 45 million people worldwide. It affects fair-skinned people of both sexes, but is almost three times more common in women, and has a peak age of onset between 30 and 60. Rosacea has a hereditary component and those that are fair-skinned of European or Celtic ancestry have a higher genetic predisposition to developing it.
It begins as erythema (flushing and redness) on the central face and across the cheeks, nose, or forehead but can also less commonly affect the neck and chest. As rosacea progresses, other symptoms can develop such as semi-permanent erythema, telangiectasia (dilation of superficial blood vessels on the face), red domed papules (small bumps) and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red lobulated nose (rhinophyma). The disorder can be confused and co-exist with acne vulgaris and/or seborrheic dermatitis. The presence of rash on the scalp or ears suggests a different or co-exisitng diagnosis, as rosacea is primarily a facial diagnosis.
Famous people with cases of rosacea inlcude: Bill Clinton, Lady Diana, Rosie O’Donnell and W.C. Fields.
The precise pathogenesis of rosacea remains unknown, but most experts believe that rosacea is a disorder where the blood vessels become damaged when repeatedly dilated by stimuli. The damage causes the vessels to dilate too easily and stay dilated for longer periods of time or remain permanently dilated, resulting in flushing and redness. Triggers that cause episodes of flushing and blushing play a part in the development of rosacea. Exposure to temperature extremes can cause the face to become flushed as well as strenuous exercise, heat from sunlight, severe sunburn, stress, cold wind, moving to a warm or hot environment from a cold one such as heated shops and offices during the winter.
There are also some foods and drinks that can trigger flushing, including alcohol, foods high in histamine and spicy food. Certain medications and topical irritants can also quickly progress rosacea. If redness persists after using a treatment, then it should be stopped immediately. Some acne and wrinkle treatments that have been reported to cause rosacea include microdermabrasion, chemical peels, high dosages of isotretinoin, benzoyl peroxide and tretinoin.
Treating rosacea varies from patient to patient depending on the severity and subtypes. Dermatologists are recommended to take a subtype-directed approach to treating rosacea patients. Trigger avoidance can help reduce the onset of rosacea but alone will not normally cause remission for all but mild cases. The National Rosacea Society recommends that a diary be kept to help identify and reduce triggers.
It is important to have a gentle skin cleansing regimen using non-irritating cleansers. Protection from the sun is important and daily use of a sunscreen of at least SPF 15 containing a physical blocker such as zinc oxide or titanium dioxide is advised.
Oral tetracycline antibiotics (e.g. tetracycline, doxycycline, minocycline) and topical antibiotics such as metronidazole are usually the first line of defence prescribed by doctors to relieve papules, pustules, inflammation and some of the redness caused by rosacea. Oral antibiotics may also help to relieve symptoms of ocular rosacea (infections of the eyelids). If papules and pustules persist, then sometimes isotretinoin can be prescribed.
more informationNational Rosacea Society
Rosacea Awareness Program