Rosacea is a common skin disease that causes redness, pustules, papules, and swelling on the face. Often referred to as “adult acne,” rosacea frequently begins as a tendency to flush or blush easily. It may progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin, and nose. The eyes, ears, chest, and back may also be involved. With time, small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads.
When rosacea first develops, the redness may come and go. Some people may flush or blush and never form pustules or papules. Small dilated vessels also may be present due to prolonged sun exposure. However, when the skin does not return to its normal color, and when other symptoms such as pimples and enlarged blood vessels become visible, it is best to seek advice from a dermatologist. The condition may last for years, rarely reverse itself, and can become worse without treatment.
About 50% of people with rosacea have eye involvement (ocular rosacea). Some rosacea patients experience burning and grittiness of the eyes, a common condition known as conjunctivitis. If this condition is not treated, it can lead to more serious eye complications.
How to Recognize Rosacea
Small red bumps, some of which may contain pus, appear on the face. These may be accompanied by persistent redness and the development of many tiny blood vessels on the surface of the skin.
In more advanced cases, a condition called rhinophyma may develop. The oil glands enlarge causing a bulbous, red nose, and puffy cheeks. Thick bumps may develop on the lower half of the nose and nearby cheeks. Rhinophyma occurs more commonly in men.
Who is at Risk for Rosacea?
Fair skinned adults between the ages of 30 and 50 may develop rosacea. It affects men and women of any age, and even children. Since it may be associated with menopause, women are affected more often than men and may notice an extreme sensitivity to cosmetics. An occasional embarrassment or a tense moment also may trigger flushing.
Tips for Rosacea Patients
• Avoid triggers, including hot drinks, spicy foods, caffeine, and alcoholic beverages that make the face red or flushed. It is important to note that although alcohol may worsen rosacea, the condition may be just as severe in someone who does not drink at all; thus rosacea has been unfairly linked to alcoholism.
• Practice good sun protection. Seek shade when possible and limit exposure to sunlight, wear hats and use broad-spectrum sunscreens with SPF of 15 or higher; reapply every 2 hours.
• Avoid extreme hot and cold temperatures which may exacerbate the symptoms of rosacea. Exercise in a cool environment. Do not overheat.
• Avoid rubbing, scrubbing or massaging the face.
• Avoid cosmetics and facial products that contain alcohol. Use hair sprays properly, avoiding contact with facial skin.
• Keep a diary of flushing episodes and note associated foods, products, activities, medications or other triggering factors.
Many people with rosacea do not recognize it in its early stages. Identifying the disease is the first step to controlling it. Self diagnosis and treatment are not recommended since some over-the-counter skin products may make the problem worse.
Dermatologists often recommend a combination of treatments tailored to the individual patient. These treatments can stop the progress of rosacea and sometimes reverse it.
Creams, lotions, foams, washes, gels, and pads that contain various topical antibiotics, metronidazole, sulfacetimide, benzoyl peroxide, and retinoids may be prescribed. A slight improvement can be seen in the first three to four weeks of use. Greater improvement is usually noticed in two months.
Oral antibiotics tend to produce faster results than topical medications. Cortisone creams may reduce the redness of rosacea; however, they should not be used for longer than two weeks since they can cause thinning of the skin and flare-ups upon discontinuation. It is best to use these creams only under the direction of a dermatologist.
The persistent redness may be treated with a small electric needle (clectrodessication) or by laser surgery to close off the dilated blood vessels. Cosmetics also may be helpful. Green-tinted makeup may mask the redness.
Rhinophyma is usually treated with surgery. The excess tissue can be carefully removed with a scalpel, laser, or through electrosurgery. Dermabrasion, a surgical method that smoothes the top layer of the skin, will help improve the look of the scar tissue.
The key to successful management of rosacea is early diagnosis and treatment. It is important to follow all of the dermatologist’s instructions. When left untreated, rosacea will get worse and may be more difficult to treat.