Rosacea

What is Rosacea?

For most people, a flushed face is a standard reaction to emotions ranging from excitement to embarrassment to anger. Yet for many, facial redness is a manifestation of rosacea: an often unrecognized and misunderstood skin disorder.

Rosacea (pronounced "roh-ZAY-sha") is a chronic and often progressive skin disease that causes redness and swelling of the face. It may begin as a rise in skin sensitivity and a tendency to flush or blush easily, then progress to persistent redness in the centre of the face that may gradually involve the cheeks, forehead, chin and nose. While it may be isolated to one patch, in rare cases it may spread to the ears, scalp, neck, chest, back and upper limbs.

Rosacea incorporates a wide range of skin symptoms; it is not merely limited to blemishes. While not all patients encounter all potential concerns, several features usually surface at once. There are many ways to classify the signs of rosacea but as these symptoms usually combine in particular ways. The following four different types of rosacea[1] have been identified:

Type 1: Flushing and persistent redness; may also include visible blood vessels

This rosacea-type is usually the least severe. Like the other types, it may be accompanied by enlarged sweat glands, oiliness and/or dry and flaky skin. The skin may become sensitive with a burning and stinging effect when it comes into contact with make-up, sunscreens and other facial creams or by exposure to sun and/or hot and spicy food or drink (anything that reddens the face).

Type 2: Persistent redness with transient bumps and pimples

This rosacea-type often includes raised red patches without changes in the surrounding skin. Pimples without blackheads or whiteheads appear on and around the reddened area, some of which may contain pus.

Even though rosacea used to be called 'acne rosacea' and shares certain similarities with acne, it is actually quite different. There are red spots and sometimes pus-filled pimples in both conditions, but in rosacea, they are dome-shaped rather than pointed and there are no blackheads, whiteheads, deep cysts, or lumps.

Type 3: Skin thickening, often resulting in an enlargement of the nose

This type is a more advanced case of rosacea, also called rhinophyma. In this rosacea-type, all parts, including the eyelids, may become subject to swelling. Surface irregularities of the nose with prominent pores and fibrous thickening can occur. More common in men, rhinophyma is characterized by a bulbous, enlarged red nose and puffy cheeks. Thick bumps can also develop on the lower half of the nose and cheeks. This type of rosacea is relatively uncommon.

Type 4: Eye irritation

This rosacea-type may involve a reddening of the eyes, a feeling of 'grit' in the eyes, crusting on the lashes and sometimes a clear discharge. The eyes may also become dry or teary with a burning sensation. Other possible symptoms include swollen eyelids, recurrent styes and potential vision impairment from corneal damage if no treatment is undergone. Many with this condition mistakenly think they have allergies.

Contrary to the apparent rigidity and isolation of the rosacea-types above, it should be noted that many patients experience characteristics of more than one rosacea-type at the same time. While rosacea may or may not evolve from one type to another, each individual sign or symptom may progress from mild to moderate to severe. When it first develops, rosacea may come and go on its own. When the skin doesn't return to its normal colour and when further symptoms, such as pimples and enlarged blood vessels, become visible, dermatologic treatment should be sought. The condition rarely reverses itself and may last for years. Rosacea can become worse without treatment so early diagnosis and treatment is recommended.

Whom does rosacea affect?

Most people affected by the condition are fair-skinned between the ages of 30 and 60; however, anyone of any race can develop rosacea. Rosacea often runs in families and the women are more often affected. However, men are more likely to fall victim to severe forms of rosacea. Those with a personal or family history of significant acne also have a higher incidence of rosacea.

What are the available treatments?

The range of available treatments is as diverse as the rosacea symptoms themselves; the type of treatment depends upon the type of rosacea.

Lifestyle modification

Dietary triggers of rosacea vary from one individual to another and one's own triggers should be identified as a primary course of action. Several foods have been recognised as usual culprits; their avoidance has often been found to reduce the severity and incidence of symptoms. Spicy foods, bananas, cheeses, yoghurts, figs, nuts, hot drinks, alcohols (especially champagne, red wines, beer and most spirits) feature on this list.

Less open to conjecture is the fact that rosacea is provoked by excessive exposure to the sun. This must be avoided either by the use of a broad-spectrum sunscreen, by wearing a wide-brimmed hat or by generally remaining sheltered and by avoiding temperature extremes.

Topical treatments

One of the earliest changes that occurs in people afflicted by rosacea is an increased sensitivity to the elements and topical products both in daily routine and in skin care. Topical skin care treatments such as soap-free cleansers, gentle emollients and light foundations (those containing a broad-spectrum sunscreen are recommended). Such treatments may be necessary if lifestyle modifications are not proving to be sufficient. Use water-based make-up and ensure that your cosmetics and sunscreens contain silicones.

Certain recent products that incorporate polymer technology help to absorb excess surface skin oils without causing skin dryness. Anti-oxidants and vitamin E fight free radical damage, promoting skin rejuvenation.

Metronidazole cream and azelaic acid are two other topical treatments that have been used to effectively treat mild to moderate cases.

Another method is to treat the appearance of symptoms by using green-tinted make up and sunscreen. Even though this approach won't solve the problem at its source, it can help to conceal red areas by neutralising their appearance.

Rosacea patients often have very sensitive skin and need to be especially careful with their skin care. Skin care products to avoid include astringents, toners, menthols, camphor and sodium lauryl sulfate products. Heavy foundations and cosmetics that are hard to remove such as oil-based facial creams must also be spurned. Topical steroids must not be used to treat rosacea.

Other treatments

Oral antibiotics and topical retinoids such as retinoic acid (tretinoin, Retina® or Adapalene) are used for several types of rosacea, including the early stages of type 3.

Other medications that reduce flushing have been found to be occasionally effective including beta-blockers, clonidine, naloxone and selective serotonin reuptake inhibitors.

Some women find that their rosacea becomes aggravated at peaks in their hormonal cycle. Among them, many have benefited from oral contraceptive therapy.

For treatment of advanced type 3 rosacea such as nasal tissue overgrowth (Rhinophyma) surgical alternatives are available such as reshaping, dermabrasion and laser treatment. Following surgical treatment, long-term maintenance is required with a topical retinoid.

Laser therapy or light treatment can also be suitable modes of treatment for the appearance of broken veins, redness and flushing; symptoms that are common to all types of rosacea. Where these are unavailable, cautery, diathermy or sclerotherapy (strong saline injections) may be helpful.

Consult with your dermatologist if you wish to discuss your suitability for surgical treatment.

Links

• National Rosacea Society, www.rosacea.org
• Rosacea Research Foundation, www.rosacea-research.org
• RosaceaNet (AmericanAcademy of Dermatology), USA, www.skincarephysicians.com/rosaceanet/index.html