What is Rosacea?
Rosacea is a common skin condition characterized by persistent facial redness, facial flushing, dryness, and sensitivity. Individuals may also develop small dilated blood vessels (telangiectasias) on the face. The disease is most often seen in adults and rarely affects children – it is often referred to as “adult acne.” Most affected individuals are fair-skinned such as those of Celtic and Northern European origin. There are four main subtypes of rosacea depending on the appearance and distribution of the rash.
The precise cause of the disease is uncertain but likely related to immune system abnormalities, reactions to skin bacteria, and exposure to UV (ultraviolet) radiation. Various factors can make the condition worse, including extreme temperature, sun exposure, hot beverages, spicy foods, and alcohol.
What Causes Rosacea?
The precise cause of rosacea is not known, however, the condition appears to be related to abnormalities in the innate immune system and inflammatory reactions against bacterial skin flora. UV (ultraviolet) radiation damage from the sun is also implicated in the pathogenesis of the disorder. Lastly, there is evidence to suggest that vascular reactivity likely contributes to facial flushing in rosacea. Dilation of the blood vessels of the face typically leads to flushing and erythema (redness).
How Common is Rosacea?
Rosacea has a prevalence of about 1%-10% in fair-skinned individuals. People of Celtic and Northern European origin are at increased risk for the disease. The condition can occur in people with dark skin complexion, but this is very infrequent – increased melanin or genetic factors may have a protective effect against rosacea in these individuals.
Most people are diagnosed with rosacea after age 30. Consequently, the disease is often referred to as “adult acne.” Women are affected more often than men. The condition is often evaluated in the primary care clinic, but advanced cases may require referral to a dermatology specialist, particularly if first-line measures are unsuccessful.
Signs and Symptoms
Rosacea is divided into four subtypes depending on the appearance and distribution of the rash. The cardinal features of the condition include persistent facial redness, facial flushing, dryness, and skin sensitivity. Individuals may also develop small dilated blood vessels (telangiectasias) involving the skin of the face. In some cases, lesions can have a very similar appearance to inflammatory acne. These lesions are normally papular (bumpy), nodular, or pus containing (pustular). Individuals with ocular rosacea often have eye redness (conjunctival hyperemia), inflammation of the eyelid (blepharitis), and eye irritation. These patients generally require referral to an eye specialist (ophthalmologist).
Various factors may lead to exacerbations of rosacea symptoms including:
- Extreme temperature (hot or cold)
- Ultraviolet (UV) exposure
- Hot beverages or spicy foods
- Use of topical creams or ointments
- Mood changes such as anger and embarrassment
The majority of patients with rosacea are diagnosed clinically based on the patient’s symptoms and the physical appearance of the facial rash on skin examination. An erythematous (red), dry, papular (bumpy) rash located in in the midface in an adult age >30 is highly suggestive of the condition. Telangiectasias are also characteristic. There are no specific blood tests to diagnosis the disorder. Biopsies of the skin lesions are not necessary in most cases but may be indicated if the diagnosis is uncertain and another disorder needs to be ruled out.
The treatment of rosacea begins with general measures such as avoiding triggers, protection against UV rays of the sun, and proper skin care. Patients often benefit from the use of facial sun block with a sun protection factor (SPF) of 30 or greater. Alcohol-based preparations should be avoided as they may result in skin irritation. Your doctor will often encourage you to avoid mid-day sun exposure and to wear sun-protective clothes. Some women use cosmetics such as flesh-colored facial foundation to help conceal the rash.
Self-administered topical therapy for facial redness includes Mirvaso (Topical Brimonidine). Your dermatologist may recommend laser or intense pulsed light treatment as an alternative. This treatment is also effective against telangiectasias. Individuals often require periodic retreatment.
Occasionally, you doctor may recommend one of the following topical agents:
- MetroGel (Metronidazole)
- Azelex (Azelaic acid)
- Subantimicrobial doxycycline
- Soolantra (Ivermectin)
- Klaron (Sodium Sulfacetamide)
Patients that fail to improve with topical treatment frequently require oral antibiotics such as Adoxa (Tetracycline), Vibramycin (Doxycycline), or Minocin (Minocycline) for 1-3 months. Patients with refractory rosacea may benefit from Accutane (oral isotretinoin).
- Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol 2004; 51:327. - https://www.jaad.org/article/S0190-9622(04)00844-8/fulltext
- Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol 2002; 46:584. - https://www.ncbi.nlm.nih.gov/pubmed/15153893
- Odom R, Dahl M, Dover J, et al. Standard management options for rosacea, part 2: options according to subtype. Cutis 2009; 84:97. - https://www.ncbi.nlm.nih.gov/pubmed/19746768
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.