Rosacea

Rosacea is a chronic skin disease that affects more than 16 million Americans. The cause of rosacea is still unknown, and there is no cure. However, research has allowed doctors to find ways to treat the condition by minimizing its symptoms.

There are four subtypes of rosacea. Each subtype has its own set of symptoms. It is possible to have more than one subtype of rosacea at a time.

Rosacea’s trademark symptom is small, red, pus-filled bumps on the skin that are present during flare-ups. Typically, rosacea affects only skin on your nose, cheeks, and forehead.

Flare-ups often occur in cycles. This means that you will experience symptoms for weeks or months at a time, the symptoms will go away, and then return.

Types of rosacea

The four types of rosacea are:

  • Subtype one, known as erythematotelangiectatic rosacea (ETR), is associated with facial redness, flushing, and visible blood vessels.
  • Subtype two, papulopustular (or acne) rosacea, is associated with acne-like breakouts, and often affects middle-aged women.
  • Subtype three, known as rhinophyma, is a rare form associated with thickening of the skin on your nose. It usually affects men and is often accompanied by another subtype of rosacea.
  • Subtype four is known as ocular rosacea, and its symptoms are centered on the eye area.

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The cause of rosacea is unknown, but it could be due to a combination of hereditary and environmental factors. Rosacea is not caused by poor hygiene.

A number of factors can trigger or aggravate rosacea by increasing blood flow to the surface of your skin. Some of these factors include:

  • Hot drinks and spicy foods
  • Alcohol
  • Temperature extremes
  • Sunlight or wind
  • Emotions
  • Exercise
  • Cosmetics
  • Drugs that dilate blood vessels, including some blood pressure medications

Anyone can develop rosacea. But you may be more likely to develop it if you:

  • Are a woman
  • Have fair skin, particularly if it has been damaged by the sun
  • Are over age 30
  • Smoke
  • Have a family history of rosacea

Signs and symptoms of rosacea may include:

  • Facial redness. Rosacea usually causes a persistent redness in the central part of your face. Small blood vessels on your nose and cheeks often swell and become visible.
  • Swollen red bumps. Many people who have rosacea also develop pimples on their face that resemble acne. These bumps sometimes contain pus. Your skin may feel hot and tender.
  • Eye problems. About half of the people who have rosacea also experience eye dryness, irritation and swollen, reddened eyelids. In some people, rosacea's eye symptoms precede the skin symptoms.
  • Enlarged nose. Rarely, rosacea can thicken the skin on the nose, causing the nose to appear bulbous (rhinophyma). This occurs more often in men than in women.

There's no specific test for rosacea. Instead, doctors rely on the history of your symptoms and a physical examination of your skin. In some cases, your doctor may have you undergo tests to rule out other conditions, such as other forms of acne, psoriasis, eczema or lupus. These conditions can sometimes cause signs and symptoms similar to those of rosacea.

If your eyes are involved, your doctor may refer you to an eye specialist (ophthalmologist).

Treatment for rosacea focuses on controlling signs and symptoms. Most often this requires a combination of skin care and prescription treatments.

The duration of your treatment depends on the type and severity of your symptoms. Recurrence is common.

Medications

The type of medication your doctor prescribes depends on what signs and symptoms you're experiencing. Prescription drugs for rosacea include:

  • Medications that reduce redness. Recent studies have shown the drug brimonidine (Mirvaso) to be effective in reducing redness. It is applied to the skin as a gel. It works by constricting blood vessels. You may see results within 12 hours after application. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to maintain any improvements seen.

Other topical products that have been shown to reduce redness and the pimples of mild rosacea are azelaic acid and metronidazole. With these drugs, improvements generally don't appear for three to six weeks.

  • Oral antibiotics. Antibiotics help reduce some types of bacteria but likely mainly fight inflammation when used for this disease. Doxycycline is an antibiotic taken as a pill for moderate to severe rosacea with bumps and pustules. Other similar oral antibiotics are also sometimes used (tetracycline, minocycline, others), but their effectiveness isn't as well-supported by studies.
  • Isotretinoin. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acne-like lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects.

Therapies

Laser therapy may help reduce the redness of enlarged blood vessels. Other options for treating visible blood vessels and changes due to rhinophyma are dermabrasion, intense pulsed light therapy and electrosurgery.

It is not possible to prevent rosacea, but it is possible to limit one’s exposure to triggering factors. Once a patient receives a diagnosis of rosacea, it is wise to avoid factors like spicy foods, hot liquids, smoking, and irritating cosmetics that are known to trigger rosacea.

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