Rosacea

Rosacea, previously called acne rosacea, is a chronic skin disease that affects both the skin and the eyes. The disorder is characterized by redness, bumps, pimples, and, in advanced stages, thickened skin on the nose. Rosacea usually occurs on the face, although the neck and upper chest are also sometimes involved. A mild degree of eye (ocular) involvement occurs in more than 50 percent of people with rosacea.

Approximately 13 million people in the United States have rosacea. It usually occurs in adults between the ages of 30 and 60. Women are more often affected by mild to moderate rosacea than men, but the disorder is often more severe when it strikes men. Although rosacea can develop in people of any skin color, it tends to occur most frequently in people with fair skin. A tendency to develop rosacea may be inherited; often, several people in a family have it.

What Does Rosacea Look Like?

Rosacea has a variety of clinical features, or signs and symptoms. Doctors generally classify rosacea into four types based on symptoms. The earliest recognizable stage is called prerosacea. Signs and symptoms at this stage include frequent episodes of flushing and redness of the face and neck that come and go. Many things can trigger a flareup, including exposure to the sun, emotional stress, alcohol, spicy foods, exercise, cold wind, hot foods and beverages, and hot baths. What causes a flareup in one person may not cause a problem in another.

Another type of rosacea, called vascular rosacea, is commonly seen in women. Blood vessels under the skin of the face swell (telangiectasia). As a result, flushing and redness become persistent and, eventually, permanent. The affected skin may be slightly swollen and warm.

Some people, often people with a history of vascular rosacea, also develop inflammatory rosacea. With this form of the disease, people develop pink bumps (papules) and pimples. Thin red lines that look like a road map may also appear as the small blood vessels of the face get larger and show through the skin.

In a few men with rosacea, a condition called rhinophyma develops. This type of rosacea is characterized by an enlarged, bulbous red nose. Both the oil-producing (sebaceous) glands and the surrounding connective tissues of the nose enlarge, and thick, knobby bumps may develop.

Some people may have more than one type of rosacea at a time. Other people can have any one type, including rhinophyma, without ever having had any of the others.

How Is the Eye Affected?

In addition to skin problems, rosacea may lead to conditions involving the eyes in about 50 percent of those affected. Typical symptoms include redness, burning, tearing, and the sensation of a foreign body or sand in the eye. Infection of the eyelids may cause the lids to become inflamed and swollen. Some patients complain of blurry vision. Only in severe cases can a person’s vision become impaired, however.

What Causes Rosacea?

Doctors do not know the exact cause of rosacea but believe that a combination of genetic predisposition and several types of environmental factors are related to its development. Some researchers believe that rosacea is primarily a disorder of the blood vessels, or vascular system, in which something causes blood vessels to swell, resulting in flushing and redness.

A tiny organism called Demodex folliculorum, a mite that lives in facial hair follicles, may be involved. Some researchers believe that these mites clog the sebaceous gland openings, leading to inflammation. Other investigators have shown a possible link between rosacea and Helicobacter pylori, a bacterium that causes infection in the gastrointestinal system. Also, some research has suggested that the immune system may play a role in the development of rosacea in some people.

There are several factors that can make rosacea worse but do not cause it. For example, drinking alcohol can increase flushing and redness. Other factors known to aggravate rosacea include heat, strenuous exercise, sunlight, wind, cold, hot drinks, spicy foods, emotional stress, and coughing.

Can Rosacea Be Cured?

While rosacea cannot be cured, it can be treated and controlled. A dermatologist, a medical doctor who specializes in diseases of the skin, often treats rosacea. Treatment goals are to control the condition and improve appearance. Doctors usually prescribe a topical antibiotic, such as metronidazole, that is applied directly to the affected skin.

For people with more severe cases, doctors often prescribe an oral (taken by mouth) antibiotic. Tetracycline, minocycline, erythromycin, and doxycycline are the most common antibiotics used to treat rosacea. Some people respond quickly, while others require long-term therapy.

Isotretinoin may be considered as a treatment option for all forms of severe or therapy-resistant rosacea. However, isotretinoin is linked to a number of adverse effects, some of which can be severe. The most serious potential adverse effect is that it is teratogenic; that is, it can cause birth defects in pregnant women who take it. Therefore, it is crucial that women of childbearing age are not pregnant and do not get pregnant while taking isotretinoin. Women must use an appropriate birth control method 1 month before the initiation of therapy, during the entire course of therapy, and until 2 months after cessation of the drug. The doctor will order a blood pregnancy test before therapy is started and every month during therapy.

Doctors usually treat the eye problems of rosacea with oral antibiotics, particularly tetracycline or doxycycline. People who develop infections of the eyelids must practice frequent lid hygiene. Doctors recommend scrubbing the eyelids gently with diluted baby shampoo or an over-the-counter eyelid cleaning product and applying warm (not hot) compresses several times a day.

Electrosurgery and laser surgery may be options to treat redness, enlarged blood vessels, and rhinophyma. In some patients, laser surgery may result in improved skin appearance with little scarring or damage. For patients with rhinophyma, several surgical methods may help reduce the size of the nose and improve appearance.

Finally, sunscreens, particularly those that protect against ultraviolet A and B light waves and have a sun-protecting factor (SPF) of 13 or higher, are recommended for all people with rosacea.

Working With Your Doctor To Help Manage Rosacea

The role you play in managing your rosacea is just as important as your doctor’s. You can take several steps to keep rosacea under control.

• Keep a written record of factors that seem to trigger flareups.
• Develop a plan to avoid or minimize your exposure to these triggers. By doing this, you may actually reduce or eliminate the need for medication to control your rosacea.
• Use a sunscreen with a sun-protecting factor (SPF) of 13 or higher every day.
• Avoid using facial cleaning products, moisturizers, and cosmetics with alcohol or other ingredients that irritate your skin.
• If your eyes are affected, faithfully follow your doctor’s treatment plan and clean your eyelids as instructed.
• Try to minimize your stress level.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.