Rosacea

What Is Rosacea?

Rosacea -(pronounced rose-ay-shah) is a disease affecting the skin of the face -- mostly where people flush. Rosacea usually starts with redness on the cheeks and can slowly worsen.

Because changes are gradual, it may be hard to recognize rosacea in its early stages. Unfortunately, many people mistake rosacea for a sunburn, a complexion change, or acne and do not see a doctor. Rosacea can't be cured, but it can be controlled.

Fig 1. Rosacea (Stage I, III)- Flushing of the nose and cheeks with early rhinophyma.

What Should I Look For?
Many rosacea patients have only one or two symptoms; here is a complete list of the most common ones:

Redness
This looks like a blush or sunburn and it is caused by flushing (when a larger amount of blood flows through vessels quickly and the vessels expand under the skin to handle the flow). The redness gradually becomes more noticeable and will not go away. Facial skin may get very dry.

Fig 2. Rosacea (Stage II)- Pimples and redness are seen

Pimples (Papules)
Later, pimples may appear on the face. These pimples may be inflamed -- small, red and solid (papules) or pus-filled (pustules) like teenage acne. Because they look alike, rosacea has been called "adult acne" or "acne rosacea." But, people with rosacea do not normally have the blackhead or whitehead type of pimples (called comedones) that are usually seen in teenage acne.

Red lines
When people with rosacea flush, the small blood vessels of the face get larger -- eventually showing through the skin. These enlarged blood vessels look like thin red lines on the face, usually on the cheeks. These lines may be hidden at first by flushing, blushing or redness, but they usually reappear when the redness is cleared up. Doctors call these lines telangiectasia (tell-an-jek-taze-yah)

How Does Rosacea Progress?
In most people, the first sign of rosacea is rosy cheeks; the face gets red in patches and stays red--eventually redness doesn't go away at all as Rosacea is a chronic condition. In most people symptoms come and go in cycles.  Although the condition may improve (go into remission) for a while without treatment, it is often followed by a worsening of symptoms (redness, pimples, red lines or nasal bumps) that progresses over time.
 

What Causes Rosacea?
There are many theories but none have been proven. Researchers now believe that there is some link  between rosacea and how often (and how strongly) people flush or blush.

Nasal bumps
When rosacea is not treated, some people -- especially men -- may eventually get small knobby bumps on the nose. As more bumps appear, the nose looks swollen and disfigured. This condition is referred to as rhinophyma (rye-no-feye-muh).

(Stage III) can be treated with laser resurfacing as seen in this photograph.
(case performed by Dr. Harvey and Dr. Hardy).

Fig 3. Rosacea   

Who Gets Rosacea?
Rosacea is usually seen in adults. It seems to affect fair-skinned people more often, though it can affect any skin type. Most people who get rosacea have a history of flushing or blushing more easily and more often than the average person (they are sometimes described as having "peaches and cream" skin). Women get rosacea a little more often than men, but men are more likely to develop rhinophyma. The image of one famous sufferer, W. C. Fields, helped to mistakenly link rosacea with alcoholism. Although drinking alcohol can make rosacea worse, even people who never drink alcohol can also develop rosacea.
 

Fig 4. Ocular Stage-Redness  and Dryness of the Eyes.

                                                            
What Should I Do About Rosacea?
See your dermatologist. It is easy to mistake skin disorders and doctors know best how to identify and treat rosacea. Non-prescription acne medications may irritate dry, sensitive skin. These products may have ingredients that are not appropriate for treating rosacea.

Can Rosacea Be Treated?
Definitely yes. Treatment can lessen or get rid of symptoms. Most dermatologists think that treatment can prevent blood vessels from enlarging or rhinophyma from developing.

What Treatments Are Used for Rosacea?
Several medications are available by doctor's prescription. They control redness and reduce the number of papules and pustules. Some are applied to the skin (topically) and others are taken by mouth (orally) -- different types can be used in combination. In most cases, it may take several weeks to see results -- don't worry. Once symptoms have cleared, patients may need to continue taking medication to keep rosacea under control.

Controlling the causes of flushing and blushing can help prevent rosacea from getting worse and blood vessels from getting larger. But once red lines appear, they can only be covered up by makeup or removed by a surgical method. Surgery can also be used to correct a nose enlarged by rhinophyma.

Why Do I Have to Keep Taking Medication After My Rosacea Has Cleared?
Without regular treatment, redness and pimples can return. Studies of patients who stopped treatment after their symptoms were successfully cleared show that rosacea came back in many of the patients within a week to 6 months.

Can Rosacea Be Cured?
Not yet. But simple treatments can control rosacea, improve the skin's look, and maybe even stop or reverse progress of the disease. Getting medical help early and following the treatment program carefully are the keys.

Can Anything Make Rosacea Worse?
Facial flushing can make symptoms worse. It can even cause flare-ups in patients whose rosacea was under control with medications. Flushing can be triggered by many things ... hard exercise -- even menopause or some medicines. The most common triggers are: hot drinks, alcohol, spicy foods, stress, sunlight, extreme heat or cold.

Experts say you should avoid anything that causes flushing. But what bothers one person may not cause a problem in another. You will need to find out what things affect you and decide if you want to change your habits to avoid them. Just remember -- flushing may affect your success in controlling rosacea. Talk to your doctor about how you can learn to identify -- and deal with -- your own flushing triggers.

What About Washing or Moisturizing My Face?
How and what you use to cleanse your face -- and keep it moist -- are important when you have rosacea. Following a regular cleansing and medication routine will make treatment easier and more successful. You should be careful about what products you use with rosacea medications.
 

• Soaps/cleansers -- Only very mild products should be used on the face. Avoid products that contain alcohol or irritants.
   

• Moisturizers -- Apply a quality moisturizer as needed. When using with a topical medication, you can usually apply the moisturizer after the medication has dried.
   

• Sunscreens -- Use an SPF 15 or higher whenever you think you will be in the sun for a while. For more sun protection information, click here.

In general, it helps to choose facial products that will not clog pores; they will have the word "noncomedogenic" (non-coh-mee-dough-jen-ic) on the package. Avoid products that contain alcohol (check hair spray and astringent labels), acetone or oil.

For more information, please contact:

National Rosacea Society
E-mail address: rosaceas@aol.com
800 South Northwest Highway, Suite 200, Barrington, Illinois 60010

If you have any questions, or wish to schedule a consultation,  please call Ponte Vedra Dermatology & Aesthetic Surgery at (904) 285-7546 or email consultation@pvderm.com.