Rosacea

Overview

Rosacea is a common skin condition that primarily affects the face, causing symptoms such as facial blushing or flushing, visible blood vessels, and in some cases, small, pus-filled bumps. Rosacea can also cause swelling, burning sensations, and eye problems. The exact cause of rosacea is unknown, but it may be linked to an overactive immune system, heredity, or environmental factors. Triggers for rosacea flare-ups can include hot drinks, spicy foods, alcohol, temperature extremes, sun or wind exposure, emotions, exercise, certain medications, and some cosmetic products. It is important to consult a doctor or dermatologist for an accurate diagnosis and proper treatment if you experience persistent symptoms on your face or eyes.

Understanding the disease

Symptoms

The symptoms of rosacea include facial blushing or flushing, visible veins, small blood vessels of the nose and cheeks breaking and becoming visible (spider veins), and the development of pimples on the face that resemble acne, sometimes containing pus. Rosacea can also cause a burning sensation on the affected skin, and some people may experience dry, irritated, and swollen eyes and eyelids (ocular rosacea). In severe cases, rosacea can thicken the skin on the nose over time, causing it to appear bulbous (rhinophyma). If you experience persistent symptoms of rosacea, it is important to see your doctor or a skin specialist (dermatologist) for diagnosis and treatment.

Risk Factors

The risk factors for developing rosacea include: being female, having skin that burns easily in the sun, being over age 30, smoking, and having a family history of rosacea.

Development

Rosacea develops when the skin's blood vessels become inflamed and enlarged, causing visible redness and sometimes pus-filled bumps. The causes of rosacea are not fully understood, but it may be due to an overactive immune system, heredity, environmental factors, or a combination of these. Flare-ups can be triggered by various factors such as hot drinks, spicy foods, alcohol, sun or wind exposure, emotions, exercise, certain medications, and some cosmetic products. Rosacea is not caused by poor hygiene and is not contagious. There's no cure for rosacea, but treatment can control and reduce the signs and symptoms.

Assessment and Diagnosis

Triage

If you experience persistent symptoms of rosacea, such as facial blushing or flushing, visible veins, swollen bumps, burning sensations, eye problems, or an enlarged nose, you should see your doctor or a skin specialist (dermatologist) for a diagnosis and proper treatment.

Diagnosis

No specific test is used to diagnose rosacea. Your doctor relies on the history of your symptoms and an examination of your skin. They may perform tests to rule out other conditions such as psoriasis or lupus. Misdiagnosis or missed diagnosis can occur in people of color, where rosacea might be mistaken for an allergic reaction or seborrheic dermatitis. If your symptoms involve your eyes, your doctor may refer you to an eye specialist (ophthalmologist) for evaluation.

Management and Treatment

Complications

Potential complications of rosacea may include:

1. Rhinophyma: Over time, rosacea can thicken the skin on the nose, causing the nose to appear bulbous (rhinophyma) in some cases, particularly in men.
2. Eye problems: Ocular rosacea can occur, causing dry, irritated, swollen eyes and eyelids. Severe cases can lead to vision problems.
3. Social and emotional impact: The visible symptoms of rosacea, such as facial redness and bumps, can cause emotional distress, low self-esteem, and social embarrassment.
4. Increased risk of other skin conditions: People with rosacea may be more susceptible to developing other skin conditions, such as acne, seborrheic dermatitis, or Demodex mites. It is important to manage rosacea effectively to prevent or minimize these potential complications. Proper treatment and lifestyle modifications can help control the symptoms and prevent the progression of the condition. Consult a dermatologist for an accurate diagnosis and appropriate treatment plan.

Treatment

To treat rosacea, follow these steps:

1. Identify and avoid triggers: Pay attention to what causes flare-ups for you and avoid those triggers.
2. Protect your face: Apply sunscreen daily with an SPF of 30 or higher, wear a hat, and avoid midday sun. In cold, windy weather, wear a scarf or ski mask.
3. Treat your skin gently: Use a nonsoap cleanser, moisturize, and choose fragrance-free products without alcohol, camphor, urea, or menthol.
4. Use topical products: Azelaic acid (Azelex, Finacea), metronidazole (Metrogel, Noritate, others), and ivermectin (Soolantra) can help control mild rosacea pimples. Improvements may take two to six weeks or longer.
5. Consider oral antibiotics: If you have moderate to severe rosacea with bumps and pimples, your doctor may prescribe oral antibiotics like doxycycline (Oracea, others).
6. Explore oral acne drug: Isotretinoin (Amnesteem, Claravis, others) may be suggested if other therapies don't work. It's a powerful oral acne drug that helps clear up acnelike lesions of rosacea, but it's not recommended during pregnancy.
7. Reduce visible flushing with makeup: Certain makeup products and techniques can help reduce the appearance of skin flushing.
8. Try alternative therapies: Discuss the pros and cons of specific alternative therapies with your doctor. Remember that the duration of treatment depends on the type and severity of your symptoms, and recurrence is common. Consult with your doctor to find the best treatment plan for you.

Preparing for medical consultation

To prepare for an appointment for rosacea, you can create a list of questions to ask your doctor, such as:

• What might be causing the signs and symptoms of rosacea?
• Do I need tests to confirm the diagnosis?
• What is the best treatment for rosacea?
• Is this condition temporary or chronic?
• Is there a generic alternative to the medicine you're prescribing?
• How can I manage other medical problems alongside rosacea?
• Can I wait to see if the condition resolves on its own?
• What are the alternatives to the treatment approach that you're suggesting?
• What skin care routines do you recommend I use? You can also gather information about your symptoms, including when they started and if anything triggers them. Additionally, make a list of any medications you're currently taking, including oral medications, creams, or ointments. Sharing this information with your doctor will help you make the most of your appointment and ensure you receive the best possible care for your rosacea.