Rosacea , also referred to as Acne Rosacea, is a chronic and potentially life-disruptive disorder primarily of the facial skin. Rosacea is often characterized by flare-ups and remissions. Many have observed that it typically begins any time after age 30, as a redness on the cheeks, nose, chin or forehead that may come and go. In some cases, Rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness becomes ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue. This condition, called Rhinophyma (pronounced “rhi-no-FY-muh”), gave the late comedian W.C. Fields his trademark bulbous nose. In many Rosacea patients, the eyes are also affected by feelings of irritation and appearing watery or bloodshot.
There are four subtypes of Rosacea. These includes the following:
Facial Redness (Erythematotelangiectatic Rosacea)- Rosacea sufferers often experience flushing and persistent facial redness. Small blood vessels may also become visible in some patients, and stinging, burning, swelling and roughness or scaling may occur.
Bumps and Pimples(Papulopustular Rosacea)– In addition to persistent redness, bumps (papules) and/or pimples (pustules) are common in many rosacea sufferers. Some patients may also experience raised red patches known as plaques.
- This is the classic presentation of rosacea; features include the following:
- Patients are typically women of middle age
- Patients usually present with a red central portion of the face containing small erythematous papules surmounted by pinpoint pustules
- Patient may describe a history of flushing
- Telangiectasias are likely present but may be difficult to distinguish from the erythematous background in which they exist
Enlargement of the Nose (Phymatous Rosacea)– Rosacea may be associated with enlargement of the nose from excess tissue, a condition known as rhinophyma. This may include thickening of the skin and irregular surface nodules, which in rare cases may also develop in areas other than the nose.
Eye Irritation (Ocular Rosacea)- Rosacea affects the eyes in many patients, and may result in a watery or bloodshot appearance, irritation and burning or stinging. The eyelids may also become swollen, and styes are common.
Who gets it?
Rosacea most often affects middle-age and older adults. It is more common in women (particularly during menopause) than men. Although rosacea can develop in people of any skin color, it tends to occur most frequently and is most apparent in people with fair skin.
Is it contagious?
Rosacea is not considered contagious or infectious. There is no evidence that rosacea can be spread by contact with the skin, sharing towels, or through inhalation.
Signs and Symptoms :
Primary Signs of Rosacea
- Many people with rosacea have a history of frequent blushing or flushing. This facial redness may come and go, and is often the earliest sign of the disorder.
- Persistent Redness
- Persistent facial redness is the most common individual sign of rosacea, and may resemble a blush or sunburn that does not go away.
- Bumps and Pimples
- Small red solid bumps or pus-filled pimples often develop. While these may resemble acne, blackheads are absent and burning or stinging may occur.
- Visible Blood Vessels
- In many people with rosacea, small blood vessels become visible on the skin.
- Eye Irritation
- In many people with rosacea, the eyes may be irritated and appear watery or bloodshot, a condition known as ocular rosacea. The eyelids also may become red and swollen, and styes are common. Severe cases can result in corneal damage and vision loss without medical help.
- Burning or Stinging
- Burning or stinging sensations may often occur on the face. Itching or a feeling of tightness may also develop.
- Dry Appearance
- The central facial skin may be rough, and thus appear to be very dry.
- Raised red patches, known as plaques, may develop without changes in the surrounding skin.
- Skin Thickening
- The skin may thicken and enlarge from excess tissue, most commonly on the nose. This condition, known as rhinophyma, affects more men than women.
- Facial swelling, known as edema, may accompany other signs of rosacea or occur independently.
- Signs Beyond the Face
- Rosacea signs and symptoms may also develop beyond the face, most commonly on the neck, chest, scalp or ears.
Other Potential Signs and Symptoms
Minimise factors that may aggravate symptoms:
- Tea and coffee, especially taken hot or strong
- Mustard, pepper, vinegar, pickles or spicy foods
- Excessive heat
- Direct sunshine
- Topical steroid
Rosacea can cause complications that affect you physically and psychologically.
Rosacea that affects your eyes (ocular rosacea) can lead to a number of eye conditions.
Blepharitis (inflammation of the eyelids) is the most commonly reported eye condition resulting from rosacea. It can usually be successfully treated by adopting a daily eye-cleaning regime and by using antibiotic tablets and creams.
Up to one in 20 people with rosacea may experience symptoms that affect their cornea (the clear outer layer at the front of the eyeball). This can:
- make your eyes bloodshot and watery
- cause scarring of your cornea
In severe cases, if not treated, ocular rosacea can lead to vision loss. Your GP may refer you for treatment with an ophthalmologist (a doctor who specialises in eye conditions and their treatment or surgery).
Psychological and social effects
Any chronic (long-term) condition can have an adverse psychological effect, but rosacea can be particularly troublesome because it affects your appearance. This can change how you feel about yourself and how you interact with others.
Many people with rosacea have reported feelings of:
- low self-esteem
Over the counter treatment
- Creams and Gels
Your doctor might start treatment with a prescription cream or gel you apply to your face once or twice a day.
Topical metronidazole (MetroCream or MetroGel) is an antibiotic cream and a very common rosacea treatment. Other antibiotic creams include clindamycin (Cleocin and Clinda-Derm) and erythromycin (Emgel and Erygel).
Brimonidine (Mirvaso) is another option and may work by constricting the dilated facial blood vessels to reduce the redness of rosacea.
Your doctor may also recommend azelaic acid (Azelex and Finacea) and sodium sulfacetamide and sulfur (Clenia and Plexion).
Tretinoin (Avita, Retin-A), a retinoid, is used in some hard to treat cases.
These topical treatments have side effects, like skin irritation. A few are not safe for women who are pregnant or planning to become pregnant. Talk to your doctor about the risks.
- Oral Antibiotics
If your rosacea is more severe — or doesn’t respond to ointments — your doctor might suggest antibiotic pills, though you might keep using skin treatments as well. Antibiotic pills may also be used if you have ocular rosacea.
Some oral antibiotics your doctor might try are minocycline(Dynacin), erythromycin (ERYC), metronidazole (Flagyl), and doxycycline (Vibramycin.)
Like any medicine, oral antibiotics can cause side effects. Treatment is typically long-term, often lasting at least six months.
- Other Drugs
If these rosacea treatments don’t work, your doctor may try other medicines, such as isotretinoin (Amnesteem, Claravis, and Sotret). However, because of its side effects — like the risk of birth defects — its use is not routine.