Rosacea is a chronic skin illness that mostly affects the face and is marked by flare-ups and remissions. Many people have noticed that it usually starts as a redness on the cheeks, nose, chin or forehead and can affect the neck, chest, scalp and ears in some cases. Over time, redness increases and visible blood vessels may emerge. Bumps and pimples commonly form if left untreated and in severe cases, the nose may become bloated and bumpy due to excess tissue (Rhinophyma). The eyes of many rosacea patients are affected as well, feeling irritating and appearing watery or bloodshot.
Although rosacea can affect people of all races and ethnicities, those with fair complexion who flush or blush easily are thought to be the most vulnerable. Women are more likely to be diagnosed with the disease, but men have more severe symptoms, possibly because they postpone seeking medical treatment until the disorder has progressed.
Nearly 90% of rosacea patients claimed their disease had decreased their self-confidence and self-esteem and 41% said it had caused them to avoid public contact or cancel social activities, according to the National Rosacea Society (NRS). Over 88 percent of those with severe rosacea stated the condition had harmed their professional interactions and nearly 51 percent indicated they had even skipped work because of it. The good news is that well over 70% said their emotional and social well-being had improved as a result of medical treatment.
While there is no cure for rosacea, awareness of its signs and symptoms has progressed to the point where it can be adequately managed with medical therapy and lifestyle adjustments. Individuals who feel they may have rosacea should get treatment from a dermatologist before the condition worsens and becomes more obtrusive in daily life.
Rosacea Symptoms and Diagnosis
The occurrence of either of these symptoms indicates the existence of rosacea:
- Redness that doesn't go away — The most prevalent individual symptom of rosacea is persistent redness or facial flushing, which might mimic a persistent blush or sunburn.
- Thickening of the skin — Excess tissue can cause the skin to thicken and expand, most commonly on the nose (known as rhinophyma). This is a less frequent ailment that, if left untreated, can result in facial deformity and a lack of nasal airflow.
Rosacea’s Most Noticeable Symptoms
Rosacea is diagnosed by the presence of at least two of these symptoms.
- Visible Blood Vessels — In many people with rosacea, prominent and visible small blood vessels called telangiectasia become on the cheeks, nasal bridge and other areas of the central face.
- Flushing — Many persons who suffer from rosacea have a history of blushing or flushing. This facial redness may be accompanied by a sense of heat, warmth or burning that comes and goes and is often an early feature of the disorder.
- Pimples and Bumps — Often, little red solid bumps or pus-filled pimples appear. While these may resemble acne, they lack blackheads and may cause burning or stinging.
- Irritation of the Eyes — In many rosacea patients, the eyes may be irritated and appear watery or bloodshot, a condition commonly known as ocular rosacea. The eyelids also may become red and swollen and styes are common. Crusts and scale may accumulate around the eyelids or eyelashes and patients may notice visible blood vessels around the lid margins. Severe cases can result in corneal damage and loss of visual acuity without medical help.
Secondary Signs and Symptoms
These may appear with one or more of the diagnostic or major signs.
- Burning or Stinging — Burning or stinging sensations may often occur on the face. Itching or a feeling of tightness may also develop.
- Swelling — Facial swelling, known as edema, may accompany other signs of rosacea or occur independently. Raised red patches, known as plaques, may develop without changes in the surrounding skin.
- Dryness — The central facial skin may be rough and appear scaly despite some patients complaining of oily skin.
In rare cases, rosacea signs and symptoms may also develop beyond the face, most commonly on the neck, chest, scalp or ears.
Causes of Rosacea
Although the cause of rosacea remains unknown, researchers have now identified major elements of the disease process that may lead to significant advances in its treatment. Recent studies have shown that facial redness is likely to be the start of an inflammatory continuum initiated by a combination of neurovascular dysregulation and the innate immune system. The role of the innate immune system in rosacea has been the focus of groundbreaking studies funded by the NRS, including the discovery of irregularities of key microbiological components known as cathelicidins. Further research has now demonstrated that a marked increase in mast cells, located at the interface between the nervous system and vascular system, is a common link in all major presentations of the disorder.
Beyond neurovascular and immune system factors, the presence of a microscopic mite called Demodex folliculorum has been considered as a potential contributor to rosacea. This mite is a normal inhabitant of human skin, but has been found to be substantially more abundant in the facial skin of rosacea patients. Researchers have also discovered that two genetic variants of the human genome may be associated with the disorder.
Other recent studies have found associations between rosacea and increased risk for a growing number of potentially serious systemic diseases, suggesting that rosacea may be an outcome of systemic inflammation. Although causal relationships have not been determined, these have included cardiovascular disease, gastrointestinal disease, neurological and autoimmune diseases and certain cancers.
Treatment for Rosacea
Because the signs and symptoms of rosacea vary from one patient to another, treatment must be customized by a physician for each individual case.
A range of oral and topical medications may be used to treat the various signs and symptoms associated with the disorder. Physicians may prescribe medical therapy specifically to control the redness. Bumps and pimples often receive initial treatment with oral and topical therapy to bring the condition under immediate control, followed by long-term use of an anti-inflammatory therapy alone to maintain remission. Therapies specific for rosacea are now available in various formulations that can be selected for each patient.
When appropriate, lasers, intense pulsed light sources or other medical and surgical devices may be used to remove visible blood vessels or correct disfigurement of the nose. Ocular rosacea may be treated with anti-inflammatory medications and other therapy and recommendations from an eye doctor may be needed.
Proper skin care for Rosacea
Patients should check with their physicians to ensure their skin-care routine is compatible with their rosacea. A gentle skin-care routine can also help control symptoms.
Patients may benefit by using non-irritating skin-care products as needed and are advised to protect the skin from sun exposure using a sunscreen that delivers UVA/UVB protection with an SPF of 30 or higher. Mild or pediatric formulations are available for sensitive skin and look for non-chemical (mineral) sunscreens that contain zinc or titanium dioxide. Rosacea patients should avoid any skin-care products that sting, burn or cause additional redness.
Cosmetics may be used to conceal the effects of rosacea. Green makeup or green-tinted foundations can be used to counter redness. This can be followed by a skin-tone foundation with natural yellow tones, avoiding those with pink or orange hues.
Lifestyle Management for People with Rosacea
In addition to long-term medical therapy, rosacea patients can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors — often related to flushing — that may trigger flare-ups or aggravate their individual conditions. Identifying these factors is an individual process, however, because what causes a flare-up in one person may have no effect on another.
Rosacea patients are advised to keep a diary of daily activities or events and relate them to any flare-ups they may experience to help identify personal trigger factors