Rosacea: Symptoms, Causes & Treatment - A Comprehensive Guide

What Is Rosacea?

What Is Rosacea?

Sometimes called the "great pretender," rosacea (rose-AY-sha) affects an estimated 14 million Americans and is a common, chronic skin disease. Also referred to as "adult acne," rosacea causes facial swelling and redness and, therefore, is easy to confuse with other skin conditions, such as acne or sunburn.

Famous rosacea sufferers include W.C. Fields and former President Bill Clinton, both often captured on film with the classic mid-face redness and bumpiness of rosacea.

People with rosacea might first notice a tendency to flush or blush easily. The condition can occur over a long period of time and often progresses to a persistent redness, with pimples and visible blood vessels in the center of the face that might eventually involve the cheeks, forehead, chin and nose. Other affected areas include the neck, ears, chest and back. Sometimes, rosacea affects the eyes.

The cause of this disease is unknown. Researchers think that heredity and the environment might play roles in the development of rosacea.

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Symptoms & Causes of Rosacea

The symptoms of rosacea

Rosacea can cause redness, similar to that of a blush or sunburn. The flushing occurs when an increased amount of blood flows through vessels at a fast rate, and the vessels expand to accommodate the flow. The redness might become more noticeable and persistent as the disease progresses. Some people notice that their facial skin becomes increasingly dry.

Rosacea-related pimples, which often occur as the disease has progressed, are different from those caused by acne, because blackheads and whiteheads (known as comedones) rarely appear. Rather, people who have rosacea have visible small blood vessels and their pimples — some containing pus — appear as small, red bumps.

Some with rosacea notice red lines, telangiectasia (tell-an-jek-taze-yah), which appear when they flush. This is because the small blood vessels of the face become enlarged and show through the skin. These red lines usually appear on the cheeks — especially when the overall redness diminishes.

Nasal bumps, a condition called rhinophyma (rye-no-feye-muh), are a common symptom, especially in untreated rosacea. Men are more likely to experience the small, knobby bumps on the nose, and as the number of bumps increases, the nose and cheeks might appear swollen.

About half the people who have rosacea get it around the eyes and on the eyelids. They might experience burning and grittiness of the eyes (known as conjunctivitis). Their eyes can also become red and bloodshot, and their vision can become blurry. In rare circumstances, if the condition goes untreated, it can lead to serious eye complications.

A 2002 survey conducted by the National Rosacea Society indicated that some people with rosacea suffer physical symptoms, such as facial burning, stinging or itching. Nineteen percent of the 1,628 patients surveyed said their symptoms occurred beyond the face, on the neck, chest, scalp or ears.

Theories about the causes of rosacea

While the precise cause of rosacea remains a mystery, researchers believe that heredity and environmental factors are to blame. One possible explanation given is that something causes the blood vessels to swell. The result, these scientists believe, is the flushing and redness characteristic of rosacea.

Another theory is that a mite that lives in hair follicles, called Demodex folliculorum, could be a cause of rosacea. The belief is that the mites, which clog oil glands, lead to the inflammation seen in rosacea. Others believe that a bacterium that causes intestinal infection, called Helicobacter pylori, might be a cause. The immune system also has been implicated as playing a role in rosacea's development.

Who gets rosacea?

Adults, especially those between 30 and 50 years of age, are the most likely to suffer from rosacea. It occurs most often in people with lighter skin, such as those with blonde hair and blue eyes, but can affect people of any skin type. And while women are afflicted more often than their male counterparts, men frequently get more severe forms of rosacea.

When people with rosacea think about their pasts, they often remember flushing or blushing more easily than most. In many cases, rosacea is passed on in families. Some equate rosacea with alcoholism, and while drinking alcohol can worsen its symptoms, even those who don't drink can develop rosacea.

Types of Rosacea

What are the types of rosacea?

Doctors usually classify rosacea into four categories, based on symptoms:

1. Prerosacea is the earliest identifiable stage, when symptoms include frequent and intermittent episodes of flushing and redness of the face and neck.
2. Vascular rosacea is another type of rosacea commonly seen in women. It appears as flushing and redness that come and go at first, then become permanent. Affected areas can become slightly swollen and warm. This type of rosacea occurs when blood vessels beneath the skin swell.
3. Inflammatory rosacea usually occurs in those with a history of vascular rosacea. The classic symptoms of this condition category include the appearance of pink bumps (called papules) and pimples. People with inflammatory rosacea often also notice thin red lines, caused by small facial blood vessels, that show through the skin.
4. Rhinophyma, which is characterized by facial bumps caused by enlarged oil-producing glands and surrounding connective tissue, occurs mostly in men. People who have this form notice thick, knobby bumps, especially around the cheeks and nose.

What triggers rosacea?

Sun exposure, emotional stress, alcohol, spicy foods, exercise, cold wind, hot foods and drinks, and hot baths have been known to trigger rosacea. Even coughing has been linked to triggering symptoms.

When to go see your dermatologist

Rosacea can be controlled with medications and lifestyle changes. Early intervention by a dermatologist is key to successful treatment. Delay in diagnosis and treatment because of non-physician treatments can result in scarring.

Since rosacea can mimic other common skin problems, the best thing a person can do is see his or her dermatologist at the first sign of symptoms. Dermatologists know best how to identify and treat rosacea, which rarely responds to over-the-counter remedies. Experts believe that early treatment of rosacea might keep the disease from progressing.

For more information see also: www.rosacea.org

Source: American Academy of Dermatology, 2002. All rights reserved