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What is Rosacea?
Rosacea is a common skin disorder that causes red patches, 'pimples', bumps and 'burst' capillaries on the face. In some cases it can also affect the eyes. Rosacea can occur at any age but is most likely to start in fair skinned people in their 30's and 40's. It very rarely affects children.
The first symptoms noticed by people with rosacea is a tendency to blush (facial flushing) which becomes more frequent and more noticeable. Some things such as alcohol, which causes facial redness in most people, are likely to cause a more rapid and prolonged flushing or redness in people with rosacea. Eventually the redness of the face becomes constant, only changing in intensity. The areas most likely to be affected are over the nose and cheeks, but it can affect the whole face, ears and neck.
On this background of more intense than usual skin redness there may also appear, small, dilated blood vessels known as telangiectases. Sometimes referred to as 'burst capillaries', these telangiectases are seen as a fine red pattern just below the surface of the skin.
People with rosacea can also develop inflamed red bumps on the face, often appearing with yellow heads, in a pattern similar to the redness. As individual bumps go away new ones appear and the overall appearance can be similar to that of teenage acne.
People with rosacea also tend to have more sensitive easily irritated skin. Alcohol based lotions, make-up, sunscreens and other skin-care products may cause stinging, redness and irritation.
Another symptom of rosacea is a shiny, slightly oily appearance of the skin. Some people who are more severely affected may also find that the texture of their skin changes and thickens in some areas, developing an 'orange peel' feel. More localised lumpy swellings may form, particularly over the nose causing a disfigurement known as 'potato' nose or rhynophyma.
Pustules and papules of rosacea
What Causes Rosacea?
Various theories have been suggested to explain the origin of rosacea but the precise cause remains obscure. Some things like hot drinks, alcohol and spicy foods, which can cause a flushed face in many people who don't have the disorder, may aggravate rosacea, making the condition more apparent. However, there is no evidence that these factors are the primary cause of the problem. In Australia, sun-damage contributes to the features, and possibly the occurrence of rosacea. Rosacea mainly affects those with fair skin, blue eyes and Celtic origins.
The Course of the Condition
People with rosacea occasionally experience long periods of remission (absence of any noticeable features of rosacea), even without treatment. More often though rosacea is constant, with fluctuations in its severity. For a minority of people rosacea slowly worsens and can lead to significant and distressing disfigurement which may be accompanied by serious eye disease.
Typical butterfly distribution of rosacea over the central face
Possible Complications
Conjunctivitis is a common complication of rosacea and causes a dry, gritty sensation in the eyes as well as inflammation of the veins in the whites of the eyes. The more severe cases of rosacea are almost always accompanied by some conjunctival irritation and serious complications involving the eyes can occur, sometimes posing a very real threat to eyesight.
Rhinophyma (potato nose) is an irregular thickening of the nose, usually more pronounced towards the lower part of the nose. It happens mainly in men and can progress from a mild 'cobblestone' pattern with dilated pores, to larger rounded protrusions on a deformed, bulbous nose. Although rhinophyma may partially improve with medication, surgical or laser remodelling is often recommended for a more cosmetically acceptable result.
Is Rossacea Related to Acne?
Although sometimes referred to as 'acne rosacea', and sometimes resembling acne, the condition is unrelated to acne. Unlike acne, blackheads and whiteheads do not appear as a symptom of rosacea.
How Can Rosacea be Treated?
Unfortunately, rosacea can't be cured, but it can be controlled.
Flushing 'triggers' that can make rosacea worse are:
- very spicy food
- hot drinks
- alcohol
- sitting close to an open fire
- wind and excessive exposure to sunlight
- hot baths, hot tubs and saunas
- some medications
In some people with only a mild degree of rosacea avoiding these triggers of facial flushing and rosacea may be enough to improve the condition.
Skin care products that cause stinging, burning or irritation can also worsen the redness and flushing caused by rosacea and should be avoided.
Oral tetracyclines (an antibiotic) are effective in suppressing the condition in most cases, however, for the majority the effect is temporary. Nevertheless, once remission has been achieved, surprisingly low doses of tetracycline, or even an antibiotic cream alone, may be sufficient to maintain control. Both eye and skin involvement usually respond to oral tetracyclines.
Topical metronidazole (an antibiotic) is effective in many people with rosacea but may take several weeks or months for its beneficial effects to become apparent. Its regular application may prolong periods of remission or reduce oral antibiotic requirements.
There are several second line drugs which may help people with rosacea who are unresponsive to the usual treatments or who are unable to tolerate treatment with tetracycline, doxycycline or minocycline. These include erythromycin, cotrimoxazole and isotretinoin. However, like tetracycline, they only suppress the condition rather than cure. Hydrocortisone cream may be prescribed to treat rosacea, but more potent corticosteroids are unsuitable.
Dermatologists also use Vascular Lasers to treat persistent redness, 'broken' capillaries, and difficult to control cases of rosacea. These are usually very effective, and a variety of different vascular lasers are available in Australia. Multiple treatments may be required. Rosacea can recur with time following laser treatment and future treatments may be necessary. Resurfacing Lasers are also often effective for treating rhinophyma ('potato' nose).
Papular variant of Rosacea
Acknowledgement
This information is based on a publication of the Australasian College of Dermatologists.
Last Modified 30 June, 2001 Dr J R Sullivan / © 2001 Australasian College of Dermatologists
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