Dermatology Eye Health / Blindness

What is rosacea?

Rosacea (rose-ay-shah) is a common, long-lasting condition of the skin that causes facial swelling and redness. It typically begins with redness on the cheek and nose region, and can spread to the forehead and chin area.

Rosacea may be mistaken by people for acne, eczema, or an allergic skin reaction.

There is currently no cure for rosacea, but with creams and drugs, people can treat the symptoms. Rosacea appears to affect fair-skinned people between 30 and 50 years of age who have complexions of “peaches and cream” and a history of blushing easily. Women are more likely than men to develop rosacea, but men are more likely to develop lumpy, swollen noses, a disorder called rhinophyma.

rosacea on the face
Image credit: sruilk / Shutterstock.

Types

There are four main forms of rosacea according to the American Academy of Dermatology (AAD), but patients with rosacea may often develop symptoms of several types of rosacea, sometimes at the same time. The four types of rosacea are:

  • Erythematotelangiectatic Rosacea
  • Papulopustular (Acne) Rosacea
  • Phymatous Rosacea
  • Ocular Rosacea

Erythematotelangiectatic rosacea:

Erythematotelangiectatic rosacea, generally referred to simply as ETR, is the form which most people are familiar with. It causes facial redness and flushing that affects the cheeks, nose, and forehead most frequently. People can also find redness on their scalp, neck, and chin, however, especially if their rosacea is not handled properly. You may only note redness or clearly dilated blood vessels every now and then in the early stages. However, without adequate care, this condition will progress, leading to flare-ups that occur more often, last longer, cover larger quantities of skin or do not clear up at all. Although the most common symptoms of ETR are red colouring and clear blood vessels, people with this disorder can also feel warmth as well as tingling, stinging, or swelling in the affected areas. People also note, in some situations, that their skin begins to feel very dry or scaly.

Papulopustular rosacea:

Papulopustular rosacea, referred to as acne rosacea as you might have learned, causes facial redness and inflammation, as well as noticeable spider veins common to many people with rosacea. This form of rosacea, however, is followed by acne-like breakouts as well. While acne may cause several different forms of pimples (blackheads, whiteheads, cysts, pustules, papules, etc.), very large, painful blemishes called papules and pustules that grow deep into the skin are most frequently caused by papulopustular rosacea. There can be very painful pustules and papules. These blemishes grow more in the middle of the face, like other forms of rosacea, but on the scalp and neck, pimples can also develop. The chest and shoulders can also be affected in very serious, untreated instances. Papulopustular rosacea is more common in adults, particularly middle-aged women, unlike acne, which usually occurs first during the teen years. Patients with papulopustular rosacea will also find that their skin is very sensitive, and the affected area may burn or sting, in addition to the obvious pimples. Finally, people can encounter extremely oily and/or dry skin patches. The dry patches of skin might be thick and scaly, converting into hard, rough patches called plaques.

Phymatous rosacea: 

Individuals with phymatous rosacea, like the thickened plaques associated with papulopustular rosacea, will experience skin thickening that may start with plaques as small areas. The skin can grow bumpy and protrude over time. This texture is characterized by individuals as akin to scar tissue. In certain cases, a similar disease called rhinophyma is formed by individuals with phymatous rosacea. The term ‘rhino’ is used in medicine to name disorders that affect the nose, so it is no surprise that a bulbous nose is the most common side effect of rhinophyma. This condition occurs when the thickening of the skin caused by phymatous rosacea causes the skin to build up around the nose, causing a bulbous, swollen look. This disease is much more prevalent in men than in women and is almost always the product of rosacea that is poorly handled or untreated. This type of rosacea, in addition to skin accumulation, also causes redness and visible blood vessels familiar with other types of rosacea. In addition, phymatous rosacea may also cause the pores to expand visibly. Although this is one of the most extreme types of rosacea, the other forms of this skin condition are much less common.

Ocular rosacea: 

The eyes are affected by ocular rosacea. It causes redness and inflammation both within the eyes and on the eyelids and the skin around the eyes, like other types of rosacea. Individuals can see bloodshot eyes, style-like swelling around the eye, or bumps on the eyelids. Watery, burning, and irritated eyes are encountered by those with ocular rosacea. Individuals refer to the feeling as somewhat close to the eye getting dirt or dust. They also note general dryness and increased eye sensitivity, and blurred vision and photosensitivity are also encountered in some cases (discomfort or difficulty focusing eyes in bright light). As many medical practitioners struggle to make the correlation between a skin disorder such as rosacea affecting the eyes, this is one of the most commonly misdiagnosed types of rosacea. Instead of other common eye conditions, symptoms that suggest a person is dealing with ocular rosacea include:

  • Visible blood vessels on the eyelids and around the eyes
  • Cysts on the eyes
  • Redness, itching, or swelling of the skin around the eyes
  • Symptoms associated with other forms of rosacea

Treatments

Currently, there is no remedy for rosacea, but therapy can help with symptom management.

Long-term treatment is typically important, but periods of time can occur where your symptoms improve and you may temporarily avoid treatment.

Treatment requires a mixture of self-help interventions and medicine for most individuals, such as:

  • avoiding known triggers – for example, avoiding drinks containing alcohol or caffeine
  • creams and gels – medications applied directly to the skin to reduce spots and redness. Examples include topical antibiotics, tretinoin, benzoyl peroxide, and azelaic acid.
  • oral medications – tablets or capsules that can help clear up more severe spots, such as oral antibiotics. Examples include tetracycline, minocycline, and erythromycin. Tetracyclines are antibiotics that can be effective for symptoms of the eye. Doxycycline in people with ocular rosacea helps relieve dryness, scratching, blurred vision, and sensitivity to light.
  • Isotretinoin – Isotretinoin (Accutane) is an oral drug used by individuals in serious cases of rosacea (if other treatments have not worked). This is a strong medicine that protects the skin from releasing oil. The side effects can be severe. For individuals with erythematotelangiectatic rosacea, this drug is not beneficial.
  • Laser treatment – Laser treatment may be used by dermatologists to help decrease visible blood vessels, or telangiectasia. To shrink them, this procedure utilizes intense pulsed light. While some discomfort can be caused by the operation, most individuals will not require an anesthetic. Laser therapy can cause bruising, skin crusting, swelling, tenderness, and, very rarely, infection at times. They should talk to a cosmetic surgeon if a person wants to remove thickened skin that has formed due to rosacea. Laser therapy or scalpel surgery may remove excess skin. Thickened tissue can also be shrunk by a carbon dioxide laser.

Symptoms

The appearance of Rosacea can vary greatly from one person to another. Not all of the possible signs and symptoms occur most of the time. At least one of the primary signs mentioned below is often included in Rosacea. It can also develop multiple secondary signs and symptoms.

Primary signs of rosacea include:

  • Flushing: There is a history of recurrent blushing or flushing in many people who have rosacea. The redness of the face, which can come and go, is also the earliest symptom of disorder.
  • Persistent redness: A flush or sunburn that does not go away may mimic persistent facial redness.
  • Bumps and pimples: They also grow tiny red firm bumps or pus-filled pimples. The bumps can often mimic acne, but blackheads are absent. Burning or stinging may occur.
  • Visible blood vessels: In many people who have rosacea, tiny blood vessels become visible on their skin.

Other potential signs and symptoms of rosacea include:

  • Eye irritation: In certain people with rosacea, the eyes may be irritated and look watery or bloodshot. This disorder may also include styes, as well as redness and swelling of the eyelids, called ocular rosacea. Serious cases can result in corneal damage and loss of vision if left untreated.
  • Burning or stinging: There may be feelings of burning or stinging on the face, and itchiness or a feeling of tightness may also occur.
  • Dry appearance: It is likely that the central facial skin can be rough and therefore appear very dry.
  • Plaques: Without changes in the surrounding skin, raised red patches (plaques) could develop.
  • Skin thickening: In some cases of rosacea, excess tissue can thicken and expand the skin, contributing to a condition called rhinophyma. This disorder also happens in the nose, causing a bulbous appearance to occur.
  • Swelling: Facial swelling (edema) may occur separately or may be associated with other symptoms of rosacea.
  • Signs beyond the face: Beyond the face, signs and symptoms can develop, affecting areas such as the neck, chest, scalp or ears.

Rosacea causes

The cause is not known. Many think, however, that the following variables can worsen the condition:

  • Spicy foods
  • eating items that contain the compound cinnamaldehyde, such as cinnamon, chocolate, tomatoes, and citrus
  • drinking hot coffee or tea
  • having the intestinal bacteria Helicobacter pylori
  • a skin mite called demodex and the bacterium it carries, Bacillus oleronius
  • the presence of cathelicidin (a protein that protects the skin from infection)

Risk factors for rosacea

Some factors are likely to make someone more likely to have rosacea than other people. People aged 30 and 50 are more likely to development rosacea. People with fair-skinned and have blond hair and blue eyes are also at more risk.

Genetic links to rosacea exist, too. If you have a family history of the condition or have Celtic or Scandinavian ancestors, you are more likely to develop rosacea. Women are more likely than men to develop the disease, too. Men who develop the disease, however, also have more serious symptoms.

Natural remedies

Minimizing sensitivity to the causes of rosacea can help avoid its symptoms. Adopting good practices for skin care can also improve.

If a person uses them alongside medical treatments, the following lifestyle changes and home remedies may help control symptoms:

  • Avoid rubbing or touching the face.
  • Wash the face with a gentle cleanser, and avoid using products that contain irritants or alcohol.
  • Avoid comedogenic products. These block the oil and sweat gland openings.
  • Keep the skin hydrated with a gentle moisturizer. Wait for topical medications to dry before moisturizing.
  • Wear a broad-spectrum sunscreen when outdoors.
  • In cold weather, protect the face with a scarf or ski mask.
  • Avoid extreme temperatures.
  • Avoid foods and beverages that might trigger an outbreak.
  • Avoid using over-the-counter steroid creams unless a doctor has recommended them. These may worsen symptoms in the mid to long term.
  • Use an electric shaver when shaving, as this is less likely to trigger flare-ups than a normal razor.

Some individuals find that pre-foundation creams and powders use green or yellow to help mask the discoloration of the skin.

Stress reduction

A common cause for rosacea is stress. Taking any action to decrease levels of stress can help reduce flare-ups.

For certain people, rosacea can be a cause of stress. It can make you feel ashamed, irritated, nervous or untrustworthy.

Being well educated about rosacea will help people regulate their feelings so they feel more controlled and more equipped to cope with any potential recurrences or complications.

It may also be helpful to pursue appropriate therapies and talk to a psychiatrist or specialist in mental health, if necessary.

Diagnosis

No clinical rosacea test is available. After examination of your skin and asking about your symptoms and triggers, a physician can make a diagnosis. The presence of increased blood vessels helps to separate the doctor from other skin conditions.

The appearance of a scalp or ear rash typically suggests another diagnosis or the same. Signs and symptoms of rosacea often occur in the face.

The risk of progression can be greatly decreased by early diagnosis and timely treatment. The doctor may order a blood test or refer a person to a dermatologist if they think there may be an underlying medical condition, such as lupus.

Summary

Rosacea is a chronic skin disease that is inflammatory. Symptoms include facial flushing, skin thickening, and eye symptoms.

While no cure exists, people can treat symptoms with medicine. Home remedies may also be of assistance.

An individual may talk to a doctor about rosacea concerns.