Rosacea appears to be more common among fair-skinned people and affects an estimated 5% of Americans. Although the causes are not fully understood and there is no cure, there are a number of ways to relieve symptoms.
In this article we will discuss the symptoms, diagnosis and treatments for rosacea.
Contents of this article:
Fast facts on rosacea
Here are some key points about rosacea. More detail and supporting information is in the main article.
- The major symptom of rosacea is the development of facial pustules
- Around 14 million Americans are thought to be affected
- Other symptoms of rosacea include blushing easily and inflamed blood vessels
- The exact causes are not known but a number of factors are thought to be at play
- Some foods can worsen the symptoms of rosacea, such as dairy products and spicy foods
- Currently, there are no clinical tests to diagnose rosacea
- There are no cures for rosacea, but medications can minimize symptoms
- Sometimes oral antibiotics are prescribed
- There are a number of lifestyle and home remedies that can help reduce symptoms.
What is rosacea?
An estimated 1 in 20 Americans have rosacea - around 14 million people.
As it is frequently misdiagnosed the incidence may be a lot higher. A Gallup survey revealed that 78% of Americans do not know anything about rosacea, its symptoms or what to do about it.
Rosacea is more common among fair-skinned people of northern European ancestry. However, studies have revealed that its incidence in many parts of Asia, including the Middle-East, South Asia, and China is growing, especially in regions that have undergone socioeconomic development in recent years.
This has triggered speculation that lifestyle may be a risk factor, and not just skin color. Others say incidence has grown in those areas because health care and diagnosis techniques have improved.
Symptoms of rosaceaMany signs and symptoms are associated with rosacea, however they may vary considerably from person-to-person. The following signs and symptoms tend to be present in most cases:
- Flushing (easily blushing)
This is usually the first sign of what many call pre-rosacea. Flushing episodes can last as long as five minutes. The blush can spread from the face down to the neck and chest. Some people say the skin feels unpleasantly hot during flushing episodes.
- Facial skin hyper-reactivity
Sensitive blood vessels dilate very easily to topical triggers (touch), and some other physical stimuli, such as sunlight. Many mistakenly refer to this as "sensitive skin", but with rosacea it is sensitive blood vessels and not sensitive skin cells which cause this.
- Persistent redness
Sometimes the flushing episodes may eventually be followed by bouts of persistent facial redness. The redness, like a patch of sunburn, may not go away. This occurs because hundreds of tiny blood vessels near the surface of the facial skin dilate (expand).
- Spots, papules, and pustules (Inflammatory rosacea)
Small spots, papules and pustules sometimes appear on the face - this is also known as inflammatory rosacea. Misdiagnosis is common because of their teenage acne appearance. However, with rosacea the skin has no blackheads, unlike acne.
- Inflamed blood vessels (vascular rosacea)
As the signs and symptoms of rosacea progress and get worse, small blood vessels on the nose and cheeks swell and become visible (telangiectasia) - they sometimes look like tiny spiderwebs.
The skin on the face can become blotchy, similar to the skin of some alcoholics. However, it is caused by inflammation of tiny blood vessels in the surface of the skin, and not alcohol.
People with rosacea may become concerned and distressed at being labeled hardened drinkers because of this. Although alcohol may trigger rosacea flare-ups in patients who already have rosacea, alcohol consumption is never the source of the condition.
- Rhinophyma - Excess facial skin around the nose
Severe rosacea can result in the thickening of facial skin, especially around the nose. The nose can become bulbous and enlarged (rhinophyma). This is a very rare complication, and tends to affect males much more than females.
- Ocular rosacea
There is a burning, gritty sensation in the eyes, making them bloodshot. The inside of the eyelid may become inflamed (blepharitis) and appear scaly, causing conjunctivitis. Some people may not tolerate contact lenses and styes may develop. In very rare cases vision may become blurred. Approximately 50% of patients with rosacea experience some kind of eye irritation or symptoms.
- Facial swelling
Excess fluid and proteins leak out of the blood vessels and eventually overwhelm the lymphatic system that cannot drain the leakage away fast enough. This results in fluid buildup in the facial skin.
Causes of rosacea
One of the factors involved in rosacea appears to be abnormalities in blood vessels.
- Abnormalities in facial blood vessels
Skin specialists (dermatologists) suggest that a major factor is probably abnormalities in the blood vessels of the face, which cause the flushing, persistent redness and visible blood vessels. What causes the inflammation of the blood vessels is still a mystery.
- Light skin color
A much higher percentage of people with fair skin develop rosacea compared to other people.
- Demodex folliculorum (microscopic mite)
Demodex folliculorum lives on human skin and usually causes no problems. However, patients with rosacea have much higher numbers of these mites than others do. Experts do not know whether the mites cause the rosacea, or whether the rosacea causes the overpopulation of the mites - i.e. whether the high population of demodex folliculorum is the cause or the effect of rosacea.
- H. pylori bacteria
H. pylori, a bacteria found in the gut, stimulates the production of bradykinin, a protein known to cause blood vessels to dilate. Experts suggest that this bacterium may play a role in the development of rosacea.
- Family history (inheritance, genes)
30% to 40% of patients with rosacea have a close relative with the condition. Unfortunately, scientists do not yet know how which genes are involved and how they are passed on.
Some factors can aggravate rosacea or make it worse by increasing blood flow to the surface of the skin. Below are some of these factors:
Hot and caffeinated drinks can worsen the symptoms of rosacea.
- Hot foods
- Hot drinks
- Spicy foods
- Dairy products
- Extremes of temperature
- Stress, anxiety, anger, embarrassment
- Vigorous exercise
- Hot baths
- Some medications - such as those for treating high blood pressure
- Acute medical conditions - such as a cold, cough, or fever
- Some chronic medical conditions - such as hypertension (high blood pressure)
- Alcohol - alcohol does not cause rosacea, but it can be a trigger for people with the condition. Rosacea is not caused by alcohol abuse.
Tests and diagnosis of rosaceaThere is no clinical test for rosacea. The GP (general practitioner) reaches a diagnosis after examining the patient's skin, and asking about symptoms and triggers. The presence of enlarged blood vessels will help the physician distinguish it from other skin disorders.
The presence of a rash on the scalp or ears usually indicates a different or co-existing diagnosis. Rosacea signs and symptoms are mainly on the face.
Early diagnosis and subsequent prompt treatment significantly reduces the risk of rosacea's progression. If the doctor suspects there may be an underlying medical condition or illness, such as lupus, blood tests may be ordered. The GP may refer the patient to a dermatologist.
On the next page, we look at the treatments and possible complications of rosacea.