Rosacea

What is Rosacea?

Rosacea is a common skin condition affecting an estimated 45 million adults around the world. Often mistaken for acne, it is characterized by redness along the center of the face, particularly on the cheeks, nose, chin, and forehead. At times, the redness can spread to the neck, ears, chest, scalp, and back.

Most people suffering from this illness are Caucasians with fair skin, particularly those with English, Irish, and Scottish heritage. It is more common among women than men, but men with this condition tend to have more severe symptoms.

Since it is a chronic condition, rosacea has periods of flares and remissions. Flare-ups can last for weeks or months at a time. However, rosacea is neither contagious nor infectious.

Rosacea Signs and Symptoms

The signs and symptoms of rosacea vary depending on the type, and these are as follows:

Subtype 1: Erythematotelangiectatic rosacea

• Redness and flushing at the center of the face
• Visible broken blood vessels or spider veins
• Swollen skin
• Dry skin with a bit of roughness and scaling
• Very sensitive skin
• Stinging and burning sensation

Subtype 2: Papulopustular rosacea

• Redness and flushing
• Acne-like breakouts
• Oily skin
• Very sensitive skin
• Burning and stinging sensation
• Visible spider veins
• Presence of plaques, which are raised patches of skin

Subtype 3: Phymatous rosacea

• Bumpy skin texture
• Thick skin, especially on the nose
• Visible spider veins
• Enlarged pores
• Oily skin

Subtype 4: Ocular rosacea

• Red and irritated eyes
• Itchy, stinging, or burning sensation in the eyes
• Sensitivity to light
• Blurry vision
• Spider veins on the eyelids
• Swollen eyelids
• Presence of eyelid cyst

Rosacea Causes and Risk Factors

Rosacea is common among fair-skinned women aged 30 to 50 years old. Those with rosacea or severe acne in the family are more likely to have the condition than those with normal skin.

What causes rosacea is still unknown. However, scientists have hypothesized on the following possible causes:

• Genetics. A lot of people diagnosed with rosacea have family members with the same disease. Still, it remains unclear how rosacea genes – if there are any – can be passed on.
• Microscopic mites. Some studies show that people with papulopustular rosacea react to a bacterium called Bacillus oleronius, which comes from Demodex folliculorum – a microscopic mite that lives harmlessly on the human skin. Some theories claim that the mites block oil glands and cause inflammation on the skin.
• Intestinal bacteria. It has been suggested that Helicobacter pylori, which are bacteria commonly found in the digestive system, can cause rosacea. The bacteria can stimulate the production of proteins known as bradykinins, which cause the blood vessels to expand.
• Blood vessel abnormalities. Though the exact abnormality is not known, some scientists believe that sun damage could be responsible for the degeneration of elastic tissue on the skin, hence causing dilation of blood vessels.
• Skin peptides. Certain triggers like ultraviolet light, alcohol, spicy food, stress, exercise, heat, and cold can activate peptides in the skin. This may affect the nerves and blood vessels of the skin, causing blood vessel dilation, redness, and swelling.

Weather changes and emotional factors like embarrassment, fear, and anxiety may trigger rosacea flare-ups. Exercising, drinking alcohol, and eating spicy food may also aggravate the skin condition.

Diagnosing Rosacea

Dermatologists diagnose rosacea by inspecting the skin and eyes for the known signs of rosacea. Though there are no specific tests required for diagnosing rosacea, there are occasional instances when skin scraping is performed by the doctor to check for mite infestation. Skin cultures and blood tests can rule out other causes of facial flushing, like lupus and herpes infections.

In extremely rare cases, a skin biopsy may be done to confirm the diagnosis.

Treatment Options for Rosacea

Since there is no cure for rosacea, treatment is focused on controlling signs and symptoms instead. It is important for the dermatologist to identify all the signs and symptoms present so that they can be managed accordingly.

Surgical

• Laser therapy. This procedure involves the use of a pulsed dye laser or intense pulsed light to treat the visible red blood vessels on the face without damaging nearby tissue. Laser therapy can also be used to trim back thickened skin in phymatous rosacea.

• Dermabrasion. This cosmetic procedure makes use of manual skin abrasion to remove the top layer of the skin, stimulating the healing process and encouraging skin rejuvenation. However, those with extremely sensitive skin will not be able to tolerate dermabrasion.
• Photodynamic Therapy. This involves the application of a topical photosensitizer liquid on the skin, which is activated by light. It treats inflammation and acne-like breakouts.
• Glycolic Peels. Some people get better with chemical peels, which are done every two to four weeks. However, people with extremely sensitive skin cannot tolerate the mild stinging, itching, and burning sensation brought about by glycolic peels.

Prescription vs Over the Counter

Medications that are used to treat rosacea all need to be prescribed by the dermatologist, as there are no over-the-counter treatments for this condition. The following are the most common oral and topical prescription treatments for rosacea.

• Oral

• Antibiotics. Some of the most common antibiotics prescribed for rosacea patients include tetracycline, doxycycline, minocycline, and amoxicillin. All these help reduce inflammation and pimples.
• Isotretinoin. For severe rosacea that does not respond to antibiotics, isotretinoin is prescribed. It should be taken once a day for four to six months.

• Topical

• Metronidazole. Applied on the affected areas twice a day after cleansing, metronidazole works to control the redness and bumps associated with rosacea.
• Azelaic Acid. This is effective for calming inflammation and minimizing the appearance of bumps on the skin.
• Brimonidine gel. Applying this gel once a day can peel off the previously red skin of rosacea patients, thereby lightening the complexion.
• Tretinoin cream. This is usually prescribed for patients with mild rosacea.

Home Remedies

• Camouflage make-up. This can cover up unsightly redness and bumps, although it does not provide a long-term solution for rosacea.

• White vinegar. As a natural disinfectant, white vinegar can help decrease the number of yeasts and bacteria on the skin on the skin. White vinegar facial soaks should be applied on a daily or weekly basis by mixing one part vinegar to six parts water.
• Green tea. This is another home remedy that has anti-inflammatory properties, thus decreasing the redness and swelling commonly experienced in rosacea.

Rosacea Prevention

Flare-ups can be prevented through the following:

• Avoid symptom triggers. Rosacea triggers differ from person to person, but some of the most common include smoking, hot drinks, spicy foods, and alcohol. It is best to have a food diary to keep track of these rosacea triggers.

• Take care of the skin. A gentle skin care routine suited for sensitive skin can help control rosacea. Patients are advised to clean their face using a mild cleanser, rinse it with lukewarm water, and blot it dry using a thick, cotton towel. Sunscreen is also important to protect the skin from sun exposure.
• Take care of the eyes. Patients suffering from ocular rosacea should apply a warm, wet cloth on the eyelids several times a day. Artificial tears can also be used if the eyes feel dry.

References

1. Del Rosso, James Q. “Advances in Understanding and Managing Rosacea: Part 1 & 2: Connecting the Dots Between Pathophysiological Mechanisms and Common Clinical Features of Rosacea with Emphasis on Vascular Changes and Facial Erythema.” J Clin Aesthet Dermatol. 5.3 Mar. 2012.
2. Abramowicz M (2013). Drugs for acne, rosacea, and psoriasis. Treatment Guidelines from The Medical Letter, 11(125): 1–8.
3. Van Zuuren EJ, et al. (2011). Interventions for rosacea. Cochrane Database of Systematic Reviews (3).
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5. Weinkle AP, Doktor V, Emer J; Update on the management of rosacea. Clin Cosmet Investig Dermatol. 2015 Apr 7;8:159-77. doi: 10.2147/CCID.S58940. eCollection 2015.
6. Odom, R, et al. (2009). Standard Management Options for Rosacea, Part 2: Options According to Subtype. National Rosacea Society Expert Committee on the Classification and Staging of Rosacea.
7. Wilkin, JK (1994). Rosacea: Pathophysiology and Treatment. Arch Dermatol. 1994;130(3):359-362. doi:10.1001/archderm.1994.01690030091015