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 women, more than men, in their 30′s and 40′s, particularly in those with Irish and Scottish heritage. It very rarely affects children. Many people are unaware they have rosacea or that it is a diagnosable and treatable condition. Some patients simply assume they blush easily or are red from the sun. Famous people with rosacea have included former President Bill Clinton and W.C. Fields.
What are the Symptoms of Rosacea?
The first symptom is usually a tendency to blush (facial flushing) which becomes more frequent and more noticeable. Chronic flushing may cause small blood vessels in the face to enlarge and to become more visible, as well as promoting inflammation, causing red bumps that resemble teenage acne. Because of this, Rosacea can frequently be mistaken for common acne and is sometimes referred to as Acne Rosacea. Blackheads, whiteheads or ‘squeezable” pimples are not usually associated with rosacea. The mid face is most likely to be affected, but rosacea can affect the whole face, eyes, ears and neck.
People with rosacea 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.
Rosacea may cause a shiny, slightly oily appearance of the skin. Those more severely affected may also find 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 rhinophyma.
What Causes Rosacea?
The cause of rosacea is unknown, though genetic, environmental, vascular and inflammatory factors may all play a part.
Hair follicle mites (Demodex folliculorum) may be involved in at least some cases, as these are found in greater numbers within rosacea papules.
An increased incidence of rosacea has been reported in those who carry the stomach bacterium, Helicobacter pylori, but most dermatologists do not believe it to be the cause of rosacea.
Rosacea may be aggravated by facial creams or oils, and especially by cortisone creams.
Hot drinks, alcohol and spicy foods, all of which can cause facial flushing even in those without the disorder, may aggravate rosacea. 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.
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 sufferers rosacea slowly worsens and can lead to significant and distressing disfigurement which may be accompanied by serious eye disease.
Though rosacea can’t be cured, it can usually be controlled.
Rosacea and facial redness and flushing may be accentuated by hot liquids, spicy foods, alcohol (hot or cold), caffeine, exposure to sunlight and heat (e.g. chefs working near a hot stove). Symptoms can be eased by avoidance of such triggering factors and lifestyle modification represents the first step towards managing rosacea.
Skin care products that cause stinging, burning or irritation can also worsen the redness and flushing caused by rosacea and should be avoided.
Antibiotic gels are effective for many but may take several weeks or months to work. Regular applications may prolong periods of remission or reduce oral antibiotic requirements.
Antibiotic tablets are effective in suppressing the condition in most cases. Once remission has been achieved, surprisingly low doses of antibiotic tablets, or even an antibiotic cream alone, may be sufficient to maintain control. Both eye and skin involvement usually respond to oral antibiotics.
The use of non-irritating sun screens is important. Most patients can tolerate physical sunscreens with titanium dioxide or zinc dioxide better than chemical screens. These physical barriers do not enter the body. Chemical barriers can be absorbed into the skin and so have a greater potential to cause irritation and to exacerbate pre-existing rosacea.
Mineral makeup such as those in the Ultraceuticals range are suitable for rosacea. Since they don’t absorb into the skin they are less likely to irritate than other formulations.