Rosacea is a skin condition that is often chronic and mainly causes redness and flushing of the face. In addition to redness there may be burning or stinging over the affected area, reddish spots that persist and visible tiny blood vessels under the skin. Over time the skin may become thick and enlarge usually over the nose causing significant deformity.
Rosacea commonly affects around 10% of all individuals and is particularly severe among fair skinned Caucasians. It can also, however, be seen in people of Asian and African origin. It affects persons of both genders and usually affects middle aged persons.
Diagnosis of Rosacea depends on clinical examination and some rarely used laboratory confirmatory tests.
Diagnosis more often than not is made based on clinical symptoms and appearance of the lesions.
A detailed history of trigger factors and clinical symptoms of the condition are obtained. Some of the common triggers for Rosacea flare ups include exposure to sunlight, stress, cold weather exposure, heat, vigorous exercise, alcoholic and caffeine containing beverages, spicy foods, certain medicines and after menopause. These may be present in many individuals. There are usually periods when the symptoms disappear or are less severe than others. History of similar lesions in the family are also enquired.
The skin lesions are examined in detail. Typically the lesions appear red and over time there may be enlargement of the skin over the nose leading to nose deformity. The blood vessels underlying the skin may be visible under the skin surface.
Other conditions that also manifest with similar facial lesions include systemic lupus erythematosus (SLE) which is an autoimmune condition where the immune system attacks healthy tissues of the body. Menopause may also give rise to similar symptoms.
These conditions need to be differentiated from Rosacea via blood tests that include immunological tests for ruling out SLE.
In rare cases a small scraping of the affected area of skin is taken and examined under the microscope. This is called a skin biopsy. This may reveal microscopic skin mites like Demodex folliculorum or skin infections.
Rosacea is a skin condition affecting the face and leads to redness and flushing of the face. Rosacea commonly affects around 10% of all individuals and is particularly severe among fair skinned Caucasians. It can however also be seen in people of Asian and African origin. It affects persons of both genders and usually affects the middle aged.
The common symptoms of the condition include:-
Episodes of flushing can last up to five minutes. Flushing may spread to the neck and chest and is usually a result of vigorous exercise, heat or cold exposure or taking hot beverages.
The cause of rosacea is unknown. Rosacea is typically characterized by redness and discoloration over the face with persistent red spots and prominence of blood vessels visible under the skin. Over time the skin enlarges and may become deformed.
The cause of rosacea is not clear but there are several hypothesis regarding the cause of this condition:-
Rosacea is typically characterized by abnormal flushing, redness and prominence of blood vessels over the face. There may be damage to the matrix or collagen over the skin due to exposure to excessive sunlight. Sun exposure leads to dilation of skin vessels and release of inflammation mediators that may be the cause of redness.
Although the exact gene that is connected to Rosacea has not been found, it has been seen that Rosacea runs in some families. This suggests a genetic mode of inheritance.
Demodex folliculorum is a type of a tiny mite that has been hypothesized to cause Rosacea. These mites usually reside on human skin harmlessly. They have been seen to exist in higher number on the affected skin of Rosacea patients.
This bacterium has been implicated in peptic ulcer and other diseases of the digestive system. However, some research suggests that this bacteria produces a protein called bradykinin that can cause blood vessels to dilate and this may be the cause of Rosacea.
Several caffeine containing medications, alcohol, spicy foods and some medications like amiodarone (used in abnormal heart rhythms), locally applied steroid creams, pills containing high doses of vitamins B-6 and B-12 have been implicated in causation of Rosacea.
There are several triggers that may lead to worsening of the symptoms. These include:-
Rosacea can't be cure, but can be controlled. Using your medications faithfully can give you much clearer skin and actually help keep the symptoms from coming back. Your provider will recommend treatment designed for you. In most cases this will include an oral antibiotic and/or a topical antibiotic (applied directly to your skin). Most people begin to notice some improvement in 3 to 4 weeks and significant improvement in 2 to 3 months. Once your symptoms have cleared up you will need to continue using your pill or topical therapy every day to keep your skin looking it's best. Without this regular therapy your symptoms will return.
For the eyes:
You play a key role in taking care of your rosacea. Here are a few steps to take:
Rosacea is a chronic skin condition characterized by reddish discoloration and flushing over the face. There may be prominence of the blood vessels underneath the skin along with deformities of the skin leading to rhinophyma.
The course of the disease includes a waxing and waning pattern. Patients with the condition experience periods of remission with little or no symptoms followed by periods of flare ups with exacerbated symptoms. The disease in many individuals progresses in stages. In yet others there is no set pattern for progression of the disease.
The early stage or prodromal stage of the disease is usually episodic erythema or redness over the face. These patients are usually more prone to blushing and flushing due to no specific triggers like sun exposure, ultraviolet radiation, heat, cold, stress, alcohol, hot drinks, spices, chemicals or cosmetics etc. This stage is followed by a stage of a permanent erythema on the central part of the face, cheeks, nose, chin, and forehead and even neck and chest. This stage is mediated by chemical mediators of inflammation present in the body that includes substance P, histamine, serotonin and prostaglandins.
The stages of progression of the disease include:
Rosacea is typically characterized by a flushing and reddish discoloration of facial skin, followed by increased prominence of blood vessels, swelling and scaling of skin, and the formation of subcutaneous bumps and pustules. Some patients also develop deformities of the nose, a condition called rhinophyma.
Rosacea is more prevalent among Caucasians compared with other ethnic groups and has a slightly higher incidence among females than males. Rhinophyma, however, is more common among males. The condition typically affects people aged 30 to 60 years.
The causes of rosacea are currently unclear but are thought to include:
Studies have shown that among patients with rosacea who develop reddish discoloration of the face with no presence of inflammatory papules, bumps or pustules, there is overactivation of genes that regulate the inflammatory process as well as blood vessel dilation and constriction in response to inflammation.
Research also supports an increased inflammatory response following an enhanced innate immune response to various “triggers” including exposure to ultraviolet rays, certain foods and medications. Although many studies favour a genetic element to the pathology of rosacea, no predisposing gene has yet been identified in humans.
There is a large body of research that is ongoing in understanding the pathology and possible genetic connection to the immune responses associated with the development of rosacea.
There are several skin conditions that affect women throughout their lifetime. These include acne during adolescence, striae or stretch marks due to drastic weight gain or loss, sun damage, skin cancer and rosacea.
The increasing life expectancy of the general population is accompanied by a greater risk of people being affected by sun damage, skin cancer and rosacea, especially among those who are middle aged or elderly. Of these conditions, rosacea is significantly more common among women than men, especially in the menopausal age group.
Rosacea commonly leads to complications including:
Pathophysiological and aetiologic studies into rosacea have not yet identified a specific cause of the condition, although spicy food, hot beverages, heat exposure and emotional stress include some of the factors that have been indicated.
However, most patients with rosacea report flushing episodes and this has led to the hypothesis that hyper-reactivity or overactivity of the skin blood vessels could play a role in causing rosacea. Studies also show that rosacea lesions express an excess of vascular endothelial growth factor, CD31, and the lymphatic endothelium marker D2-40.
Flushing and the sensation of warmth in the face are also common features of menopausal hot flashes and the menopause has been found to trigger or worsen rosacea in some sufferers.
Although there is no known cure for rosacea, the condition can be managed and controlled with medication. The use of skin creams and lotions containing antibiotics such as metronidazole has been reported to be beneficial and oral pills containing antibiotics such as tetracycline, clarithromycin, and doxycycline, have also proven effective.