Rosacea
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Rosacea is a chronic (long-term) disease that affects the
skin and sometimes the eyes. The disorder is characterized by redness,
pimples, and, in advanced stages, thickened skin. Rosacea usually
affects the face; other parts of the upper body are only rarely
involved.
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Approximately 14 million people in the United States have
rosacea. It most often affects adults between the ages of 30 and 60.
Rosacea 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.
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There are several symptoms and conditions associated with
rosacea. These include frequent flushing, vascular rosacea, inflammatory
rosacea, and several other conditions involving the skin, eyes, and
nose.
Frequent flushing of the center of the face--which may
include the forehead, nose, cheeks, and chin--occurs in the earliest
stage of rosacea. The flushing often is accompanied by a burning
sensation, particularly when creams or cosmetics are applied to the
face. Sometimes the face is swollen slightly.
A condition called vascular rosacea causes persistent
flushing and redness. Blood vessels under the skin of the face may
dilate (enlarge), showing through the skin as small red lines. This is
called telangiectasia (tel-AN-je-ek-tay-ze-ah). The affected skin may be
swollen slightly and feel warm.
A condition called inflammatory rosacea causes persistent
redness and papules (pink bumps) and pustules (bumps containing pus) on
the skin. Eye inflammation and sensitivity as well as telangiectasia
also may occur.
In the most advanced stage of rosacea, the skin becomes a
deep shade of red and inflammation of the eye is more apparent. Numerous
telangiectases are often present, and nodules in the skin may become
painful. A condition called rhinophyma also may develop in some men; it
is rare in women. Rhinophyma is characterized by an enlarged, bulbous,
and red nose resulting from enlargement of the sebaceous (oil-producing)
glands beneath the surface of the skin on the nose. People who have
rosacea also may develop a thickening of the skin on the forehead, chin,
cheeks, or other areas.
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In addition to skin problems, up to 50 percent of people
who have rosacea have eye problems caused by the condition. Typical
symptoms include redness, dryness, itching, burning, tearing, and the
sensation of having sand in the eye. The eyelids may become inflamed and
swollen. Some people say their eyes are sensitive to light and their
vision is blurred or otherwise impaired.
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Doctors do not know the exact cause of rosacea but believe
that some people may inherit a tendency to develop the disorder. People
who blush frequently may be more likely to develop rosacea. Some
researchers believe that rosacea is a disorder where blood vessels
dilate too easily, resulting in flushing and redness.
Factors that cause rosacea to flare up in one person may
have no effect on another person. Although the following factors have
not been well-researched, some people claim that one or more of them
have aggravated their rosacea: heat (including hot baths), strenuous
exercise, sunlight, wind, very cold temperatures, hot or spicy foods and
drinks, alcohol consumption, menopause, emotional stress, and long-term
use of topical steroids on the face. Patients affected by pustules may
assume they are caused by bacteria, but researchers have not established
a link between rosacea and bacteria or other organisms on the skin, in
the hair follicles, or elsewhere in the body.
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Although there is no cure for rosacea, it can be treated
and controlled. A dermatologist (a medical doctor who specializes in
diseases of the skin) usually treats rosacea. The goals of treatment are
to control the condition and improve the appearance of the patient's
skin. It may take several weeks or months of treatment before a person
notices an improvement of the skin.
Some doctors will prescribe a topical antibiotic, such as
metronidazole, which is applied directly to the affected skin. For
people with more severe cases, doctors often prescribe an oral (taken by
mouth) antibiotic. Tetracycline, minocycline, erythromycin, and
doxycycline are the most common antibiotics used to treat rosacea. The
papules and pustules symptomatic of rosacea may respond quickly to
treatment, but the redness and flushing are less likely to improve.
Some people who have rosacea become depressed by the changes in
the appearance of their skin. Information provided by the National Rosacea
Society indicates that people who have rosacea often experience low self-esteem,
feel embarrassed by their appearance, and claim their social and professional
interactions with others are adversely affected. A doctor should be consulted
if a person feels unusually sad or has other symptoms of depression, such
as loss of appetite or trouble concentrating.
Doctors usually treat the eye problems of rosacea with
oral antibiotics, particularly tetracycline or doxycycline. People who
develop infections of the eyelids must practice frequent eyelid hygiene.
The doctor may recommend scrubbing the eyelids gently with diluted baby
shampoo or an over-the-counter eyelid cleaner and applying warm (but not
hot) compresses several times a day. When eyes are severely affected,
doctors may prescribe steroid eye drops.
Electrosurgery and laser surgery are treatment options if
red lines caused by dilated blood vessels appear in the skin or if
rhinophyma develops. For some patients, laser surgery may improve the
skin's appearance with little scarring or damage. For patients with
rhinophyma, surgical removal of the excess tissue to reduce the size of
the nose usually will improve the patient's appearance.
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The role you play in managing your rosacea is
important. You can take several steps to keep rosacea under
control:
- Keeping a written record of when flareups occur may provide
clues regarding what is irritating the skin.
- Most people should use a sunscreen every day that protects
against UVA and UVB rays (ultraviolet rays) and has a
sun-protecting factor (SPF) of 15 or higher, but sunscreen is
particularly important for people whose skin is irritated by
exposure to the sun.
- Using a mild moisturizer may be helpful, but avoid applying
any irritating products to the face. Some people find that a
green-tinted makeup effectively conceals skin redness.
- If your eyes are affected, faithfully follow your doctor's
treatment plan and clean your eyelids as instructed.
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Researchers are studying the eyes of people who have
rosacea to find ways to prevent dry eyes and other eye problems related
to rosacea. Scientists also are evaluating the most effective ways to
use medications to treat rosacea and the best methods to minimize
scarring of the sebaceous glands when removing excess nasal tissue in
rhinophyma.
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National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
American Academy
of Dermatology
National Rosacea
Society
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