Rosacea (pronounced: roh-ZAY-sha) is a common disorder of the facial skin that affects more than 14 million Americans and more than 45 million people worldwide. It affects mostly Caucasians, but it can also affect people of other ethnic descent. Many people do not realize they have rosacea, since rosacea symptoms develop so gradually. Rosacea initially develops as a facial flushing that comes and goes, but over time, develops into a more persistent facial redness. The redness and flushing of the face (erythema) appears first across the cheeks, forehead and nose, but can later also affect the neck, chest, scalp and ears. In later stages, symptoms can include red papules (bumps), pustules (pus filled bumps), red irritated eyes, dilated small blood vessels (telangiectasias), itchy and painful sensations of the face and in some cases, a enlarged red nose (rhinophyma).
Rosacea Symptoms
Rosacea affects three times more women than men with an average age of onset between 25 and 60. The following are the main rosacea symptoms:
- a persistent red face (erythema) with a tendency to blush or flush easily. The facial redness appears across the cheeks, nose and forehead
- permanent redness of the face with red bumps (papules) and/or bumps that are filled with pus (pustules). This stage resembles regular acne
- small blood vessels (capillaries) just underneath the skin are permanently dilated and become visible (telangiectasias)
- ocular rosacea: irritated, dry, red, scratchy and burning eyes and eye lids
- rhinophyma: an enlarged red, bulbous nose (more common in men)
Rosacea Causes
Since rosacea affects mainly fair-skinned people, it is thought that a certain genetic predisposition in combination with a number of trigger factors are important for its’ development. A skin mite (Demodex folliculorum) that infests hair follicles has long been suggested to be a contributing factor for rosacea and studies have found some rosacea patients with a high number of demodex mites. A bacterium (Helicobacter pylori) found in the digestive system of some people with acid reflux disease, has also been studied as a possible cause of rosacea. The skin mite and H. pylori connection with rosacea has never been fully proven. Recently, a study by Gallo and colleagues found that rosacea patients had higher levels of a natural antimicrobial peptide called cathelicidin and elevated levels of a cathelicidin processing protease in their skin versus control patients. It is now thought that certain antibiotics are effective against rosacea because they inhibit these cathelicidin processing proteases.
Rosacea Treatments
While there are many prescription and non-prescription rosacea treatments available, a successful rosacea treatment depends on the severity of the symptoms and the treatment preference of the patient. Rosacea is often not diagnosed until a more severe stage is reached, at which time the patient will go to a dermatologist for treatment. It will take approximately 1-2 years to get rosacea under control. Rosacea is a chronic skin condition, which needs to be treated for many years in order to slow down its progression. Listed below, is a summary of the most common prescription and over-the-counter treatment options:
Oral antibiotics (tetracycline, doxycycline) are prescribed to get relief from redness, inflammation, papules and pustules. Oral antibiotics cannot be taken for more than 4-6 weeks due to their damaging effect on teeth (yellowing) and kidneys. Oral antibiotics are sometimes prescribed to treat ocular rosacea. topical antibiotics (metronidizole, azelaic acid) in either a gel or lotion form can further reduce swelling and facial redness. Sunscreens are important as a defense against rosacea progression, since UV exposure is considered a rosacea trigger. It is recommended to use physical UV blockers such as zinc oxide or titanium dioxide instead of chemical sunscreens, since the latter can be irritating to rosacea skin. A low dose topical vitamin A (isotretinoin) can be effective against rosacea pustules. Avoiding rosacea trigger factors, such as very hot or cold weather, alcoholic beverages, caffeinated drinks, foods high in histamine, excessive sun exposure. Using a non-irritating gentle facial cleanser may also benefit the condition. Intense Pulsed Light treatment offers a great treatment option, especially for persistent redness and enlarged blood vessels.
References
Forton, F. and Seys, B. (1993) Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol. 128: 650-9.
Herr, H. and You, C.H. (2000) Relationship between Helicobacter pylori and rosacea: it may be a myth. J Korean Med Sci 15: 551-4.
Yamasaki, K. et al. (2007) Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med 13: 975-80.