Rosacea: Treatment, types, causes, and symptoms

Rosacea is a chronic, inflammatory skin condition that most often affects the face. Rosacea worsens with time if left untreated. It is often mistaken for acne, eczema, or a skin allergy.

Rosacea appears to be more common among fair-skinned people and affects an estimated 14 million Americans (1 in 20 people). Although the causes are not fully understood and there is no cure, there are a number of ways to relieve symptoms.

As it is frequently misdiagnosed, the incidence may be a lot higher. Rosacea is more common among fair-skinned people of northern European ancestry.

Fast facts on rosacea

The main symptom of rosacea is the development of facial pustules.

Around 14 million Americans are thought to have rosacea.

Other symptoms include blushing easily and inflamed blood vessels.

The exact causes are not known but a number of factors can trigger symptoms.

Some foods can worsen the symptoms, such as dairy products and spicy foods

Treatment

Close up of a red inflamed cheek.
Skin changes including redness, sensitivity, and pimples.

There is no cure for rosacea. However, there are various treatments which can relieve the signs and symptoms.

A combination of medications and lifestyle changes generally give the best results.

The doctor may prescribe camouflage creams that mask blemishes on the skin.

Medications

Treatment may involve a combination of prescribed topical medications (applied to the skin) and oral drugs (swallowing pills, tablets, or capsules). These include:

Topical medications: These help reduce inflammation and redness and are applied to the skin either once or twice a day. They are commonly used in combination with some oral medications. Antibiotics (metronidazole), tretinoin, benzoyl peroxide, and azelaic acid are examples of commonly prescribed topical medications.

Oral antibiotics: These may be prescribed for their anti-inflammatory properties. Oral antibiotics tend to give faster results than topical ones. Examples include tetracycline, minocycline, and erythromycin.

Isotretinoin (Accutane): This oral medication is sometimes used for severe cases of inflammatory rosacea if other treatments have not worked. Isotretinoin is a powerful drug that inhibits the production of oil by the sebaceous glands. As side effects may be severe, the patient needs to be monitored closely.

Blephamide: A specific type of steroid eye drop which is sometimes prescribed for patients with ocular rosacea (eye symptoms). Eye drops are applied daily for 3 days to 1 week, followed by a break or tapered use.

Tetracyclines: These are sometimes prescribed for patients with symptoms of ocular rosacea. Doxycycline helps improve dryness, itching, blurred vision and photosensitivity (sensitivity to light).

Laser treatment

For patients with visible blood vessels (telangiectasia) laser treatment, which uses intense pulsed light, can be used to shrink them. This will be done by a dermatologist. Although the procedure may cause some pain, most patients can tolerate it without the need for an anesthetic.

Laser treatment can sometimes cause bruising, crusting of the skin, swelling, tenderness, and, very rarely, infection. These complications will usually disappear within a few weeks, although if it becomes infected it may require antibiotics.

Plastic surgery for thickened skin (rhinophyma)

If the patient develops a bulbous enlarged red nose and puffy cheeks, and possibly thick bumps on the lower half of the nose and the nearby cheek areas, they might be referred to a plastic surgeon. Laser or scalpel surgery may be performed to remove excess tissue and remodel the nose. A carbon dioxide laser can also be utilized to shrink the tissue.

Types

There are many types of rosacea but four main types, according to the American Academy of Dermatology (AAD).

Steroid rosacea, <br>Image credit: Corinna Kennedy own work 2017 https://upload.wikimedia.org/wikipedia/commons/d/d9/Steroid_Rosacea.jpg
Steroid rosacea is a rosacea-like condition that can result from steroid use.
Image credit: Corinna Kennedy own work 2017 https://upload.wikimedia.org/wikipedia/commons/d/d9/Steroid_Rosacea.jpg

Erythematotelangiectatic rosacea features redness and flushing, with visible blood vessels.

Papulopustular rosacea involves redness, swelling, and breakouts that resemble acne.

Phymatous rosacea causes the skin to thicken and take on a bumpy texture.

Ocular rosacea causes redness and irritation in the eyes and swollen eyelids. The person may look as if they have a sty.

A condition known as steroid rosacea can result from long-term use of corticosteroids, specifically when used to treat dermatitis and vitiligo.

Permanent redness may develop and persist in the center of the face.

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Causes

Experts are not sure what causes rosacea. The following related factors are thought to contribute:

Abnormalities in facial blood vessels: Skin specialists (dermatologists) suggest that abnormalities in the blood vessels of the face cause the flushing, persistent redness, and visible blood vessels. What causes the inflammation of the blood vessels is still a mystery.

Light skin color: A much higher percentage of people with fair skin develop rosacea compared with other people.

Demodex folliculorum (microscopic mite): Demodex folliculorum lives on human skin and usually causes no problems. However, patients with rosacea have much higher numbers of these mites than others do. It is unclear whether the mites cause the rosacea, or whether the rosacea causes the overpopulation of the mites.

H. pylori bacteria: H. pylori, a bacteria found in the gut, stimulates the production of bradykinin, a small polypeptide known to cause blood vessels to dilate. Experts suggest that this bacterium may play a role in the development of rosacea.

Family history (inheritance, genes): Many patients with rosacea have a close relative with the condition.

Rosacea triggers

Some factors can aggravate rosacea or make it worse by increasing blood flow to the surface of the skin; these include:

hot foods or drinks

caffeine, spicy foods, and dairy products

extremes of temperature

sunlight, humidity, or wind

stress, anxiety, anger, embarrassment

vigorous exercise

hot baths or saunas

some medications, such as corticosteroids and drugs for treating high blood pressure

acute medical conditions, such as a cold, cough, or fever

some chronic medical conditions – such as hypertension (high blood pressure)

alcohol which can be a trigger for some people

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