Rosacea

Previously known as "acne rosacea," this chronic inflammatory disorder usually attacks facial skin, where it triggers frequent flushing or blushing that comes and goes, or a persistent redness (erythema) and visibly dilated blood vessels (telangiectasia). More extreme cases result in bumps (papules) and pimples (pustules), eye and lid involvement and enlargement of the nose (rhinophyma). The changes of rosacea are typically limited to the cheeks, chin, nose, eyes, forehead and, in bald people, the scalp. 

Rosacea (pronounced roh-ZAY-shee-uh) affects millions of Americans, most of them between ages 30 and 50. The disorder usually begins with a tendency to blush easily, then progresses over several years to include persistent facial redness (inflammation) and tiny pimples on the forehead, cheeks and chin. Some people have facial burning, stinging or itching. Rosacea victims do not develop the "blackhead" and "whitehead" pimples so often produced by adolescent acne.

Although it is not life threatening, untreated rosacea can cause significant psychological injury to its victims by altering their appearance. Along with producing unsightly pimples and enlarged blood vessels, the condition sometimes leads to rhinophyma (rye-no-FEE-muh), which is characterized by a bright red, bulbous nose covered with hardened, knobby tissue.

In at least 50 percent of cases, rosacea also provokes eye involvement that can result in redness, burning, excessive tear production and the gritty sensation usually associated with a foreign body in the eye. The eyelids also may be involved; they can become inflamed and swollen. Although ocular rosacea can lead to blurred vision in some people, the condition does not cause significant sight impairment except in the most severe cases.

Some researchers believe rosacea is primarily a disease of the blood vessels (vascular system) in which swelling of vascular tissues culminates in facial flushing and redness. Most recent research suggests that the disorder has both genetic and environmental components. But some investigators suspect that rosacea could be caused by a tiny mite (Demodex folliculorum) that lives among facial hair follicles. According to this theory, the mites set off the disorder by blocking oil glands in the skin.

A chronic condition, rosacea cannot be cured at present but early diagnosis and treatment can help control the symptoms and may slow progression. Its symptoms tend to worsen and improve in regular cycles, however, and the effects of the disorder can be greatly eased with treatment. Treatment depends on the symptoms and the stage of the disease and includes oral medications, creams and lotions applied to the skin and laser surgery. Research shows that the periodic flare-ups of the disease are often caused by such factors as eating spicy foods, drinking hot beverages or alcohol, and spending time outdoors in bright summer sunshine or during the cold, windy days of winter.

Vascular rosacea is another common version of this disorder. It occurs mostly in women, after facial blood vessels begin to dilate. This condition does not produce pimples, but the unsightly redness caused by inflammation often becomes permanent.

Laser surgery is often helpful in reducing dilated blood vessels and the hardened nasal tissue of rhinophyma.

What to Do

Talk to your doctor if you find that your face is chronically red; if you often discover pus-containing pimples or solid red bumps along your cheeks, nose, forehead, neck or upper torso; or if the blood vessels in your face appear to be dilated for extended periods of time.

Use Medicine Effectively

Rosacea is often treated with oral and topical antibiotics, which reduce papules, pimples and eye symptoms. A typical antibiotic regimen might include 400 mg of tetracycline daily for four to eight weeks. Two other oral antibiotics that have proved effective are cotrimoxasole and metronidazole. Another powerful drug, isotretinoin, has been shown to be effective, but it can cause birth defects in pregnant women. Topical antibiotics, especially metronidazole, whether as a cream or gel, can help reduce symptoms in milder cases of rosacea. For more severe cases, topical and oral antibiotics should be combined. Never apply topical steroids to areas affected by rosacea, because these powerful substances can cause injury to sensitive skin tissues.

Other treatments include lasers, intense pulsed light sources or other medical and surgical procedures to remove visible blood vessels, decrease redness, or correct a disfigured nose. Ocular rosacea may be treated with oral antibiotics.

Self-Care Steps for Rosacea

To keep flare-ups to a minimum, avoid spicy foods, alcohol, hot showers, sunburn and emotional stress, when possible.