Rosacea is a chronic and potentially life-disruptive disorder primarily of the facial skin, often characterized by flare-ups and remissions. It generally begins any time after age 30 as a redness that may come and go on the cheeks, nose, chin or forehead. In some cases, rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness tends to become ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue. In many rosacea patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.
Rosacea is not considered an infectious disease, and there is no evidence that it can be spread by contact with the skin or through inhaling airborne bacteria. The effectiveness of antibiotics against rosacea symptoms is widely believed to be due to their anti-inflammatory effect, rather than their ability to destroy bacteria.
Although rosacea can affect all segments of the population, individuals with fair skin who tend to flush or blush easily are believed to be at greatest risk. Although no scientific research has been performed on rosacea and heredity, there is evidence that suggests rosacea may be inherited. Nearly 40 percent of rosacea patients surveyed by the National Rosacea Society said they could name a relative who had similar symptoms. In addition, there are strong signs that ethnicity is a factor in one's potential to develop rosacea. In a separate survey by the Society, 33 percent of respondents reported having at least one parent of Irish heritage, and 26 percent had a parent of English descent. Other ethnic groups with elevated rates of rosacea, within the U.S. population included individuals of Scandinavian, Scottish, Welsh or eastern European descent.
Rosacea can vary substantially from one individual to another, and in most cases some rather than all of the potential signs and symptoms appear. According to a consensus committee and review panel of 17 medical experts worldwide, rosacea always includes at least one of the following primary signs, and various secondary signs and symptoms may also develop.
Primary Signs of Rosacea
Other Symptoms
Treatment Options
While there is no cure for rosacea and the cause is unknown, medical therapy is available to control or reverse its signs and symptoms. Individuals who suspect they may have rosacea are urged to see a dermatologist or other knowledgeable physician for diagnosis and appropriate treatment.
Because the signs and symptoms of rosacea vary from one patient to another, treatment must be tailored by a physician for each individual case. Various oral and topical medications may be prescribed to treat the bumps and pimples often associated with the disorder, and a topical therapy to reduce facial redness is now available. Dermatologists often prescribe initial treatment with oral and topical therapy to bring the condition under immediate control, followed by long-term use of topical therapy to maintain remission. A version of an oral therapy with less risk of microbial resistance has also been developed specifically for rosacea and has been shown to be safe for long-term use.
When appropriate, treatments with lasers, intense pulsed light sources or other medical and surgical devices may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Ocular rosacea may be treated with oral antibiotics and other therapy.
A gentle skin care routine can also help control rosacea. Patients are advised to clean their face with a mild and non-abrasive cleanser, then rinse with lukewarm water and blot the face dry with a thick cotton towel. Never pull, tug or use a rough washcloth.
Sunscreens or sunblocks effective against the full spectrum of ultraviolet A and B radiation can be especially important for rosacea patients, whose facial skin may be particularly susceptible to sun damage and consequent rosacea flare-ups. An SPF of 15 or higher is recommended, and physical blocks utilizing zinc or titanium dioxide may be effective if chemical sunscreens cause irritation.
Lifestyle Management
In addition to medical treatment, rosacea sufferers can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors that trigger rosacea flare-ups or aggravate their individual conditions.
In a survey of 1,221 rosacea sufferers by the National Rosacea Society, 96 percent of those who believed they had identified personal trigger factors said avoiding those factors had reduced their flare-ups.
Some of the most common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, heavy exercise, hot baths, heated beverages and certain skin care products.
Patients should avoid using any products that burn, sting or irritate their skin. In a National Rosacea Society survey, many individuals with rosacea identified alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus oil, clove oil and salicylic acid as ingredients that irritated their individual cases, and many also avoided astringents and exfoliating agents. A useful rule of thumb may be to select products that contain no irritating or unnecessary ingredients.
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