Rosacea

Acne rosacea, often simply referred to as rosacea, is a common chronic inflammatory skin condition that primarily affects the face. It is characterized by redness, visible blood vessels, and sometimes small, red, pus-filled bumps that resemble acne.

Causes:

The exact cause of rosacea is unknown, but it is thought to be due to a combination of genetic and environmental factors. Several theories exist, and contributing factors may include:

• Genetics: Rosacea tends to run in families, suggesting a genetic predisposition.
• Abnormal blood vessel function: Blood vessels in the face may dilate too easily, leading to redness and flushing.
• Immune system dysfunction: An overactive immune response may contribute to inflammation.
• Microorganisms:
  • Demodex folliculorum mites: These microscopic mites naturally live on the skin, but people with rosacea may have a higher number of them, or an inflammatory reaction to them.
  • Helicobacter pylori bacteria: Some studies suggest a possible link between H. pylori (a bacterium that causes stomach ulcers) and rosacea, though the connection is not definitively proven.
• Environmental triggers: Various factors can trigger or worsen rosacea flare-ups:
  • Sunlight and wind exposure
  • Hot or cold temperatures
  • Stress
  • Hot beverages and spicy foods
  • Alcohol
  • Certain cosmetics or skin care products
  • Strenuous exercise

Symptoms:

Rosacea symptoms typically appear on the central face (cheeks, nose, forehead, chin) and can vary in type and severity. There are four main subtypes of rosacea, though individuals may experience symptoms from more than one:

• Erythematotelangiectatic Rosacea (ETR):
  • Persistent facial redness (erythema)
  • Visible small blood vessels (telangiectasias)
  • Flushing and blushing easily
  • Skin sensitivity, burning, or stinging
• Papulopustular Rosacea:
  • Persistent facial redness
  • Red bumps (papules) and pus-filled pimples (pustules) that resemble acne, but typically without blackheads (comedones)
• Phymatous Rosacea:
  • Thickening of the skin, especially on the nose (rhinophyma), leading to a bulbous appearance. This is more common in men.
  • Enlarged pores, bumpy skin texture.
• Ocular Rosacea:
  • Red, irritated, or watery eyes
  • Burning or stinging sensation in the eyes
  • Swollen eyelids
  • Sensitivity to light
  • Blurred vision

Diagnosis:

Rosacea is typically diagnosed based on a physical examination of the skin and a review of your medical history. There is no specific laboratory test for rosacea. The dermatologist will look for characteristic signs and symptoms.

• Medical history: The doctor will ask about your symptoms, triggers, and any family history of rosacea.
• Physical examination: The doctor will examine your skin, particularly your face, to identify the characteristic redness, bumps, visible blood vessels, and any skin thickening.
• Ruling out other conditions: The doctor may perform tests or ask questions to rule out other skin conditions that can look similar, such as acne, eczema, psoriasis, or allergic reactions.

Treatment:

While there is no cure for rosacea, various treatments can help control symptoms, reduce flare-ups, and improve the skin’s appearance. Treatment plans are often individualized based on the subtype and severity of rosacea.

• Lifestyle modifications and trigger avoidance:
  • Identify and avoid personal triggers (e.g., sun exposure, hot drinks, spicy foods, alcohol, stress).
  • Use gentle, non-irritating skin care products.
  • Protect skin from the sun with broad-spectrum sunscreen (SPF 30 or higher).
• Topical medications: Applied directly to the skin for mild to moderate symptoms.
  • Brimonidine gel or oxymetazoline cream: Reduce redness by constricting blood vessels.
  • Metronidazole cream/gel: Reduces inflammation and redness.
  • Azelaic acid cream/gel: Reduces redness and bumps.
  • Ivermectin cream: Targets Demodex mites and reduces inflammatory lesions.
• Oral medications: For more severe symptoms, papules, pustules, or ocular rosacea.
  • Oral antibiotics (e.g., doxycycline, tetracycline): Used for their anti-inflammatory effects, often at low doses.
  • Oral isotretinoin (Accutane): Reserved for severe, refractory cases, particularly phymatous rosacea.
• Procedures:
• Laser and light therapies (e.g., V-beam, IPL): Can reduce redness and visible blood vessels (telangiectasias).
• Electrocautery or surgical removal: Used for severe rhinophyma to reshape thickened skin.
• Ocular rosacea treatment:
  • Warm compresses, eyelid hygiene
  • Topical eye drops (e.g., cyclosporine)
  • Oral antibiotics

Managing rosacea is often a long-term process that requires patience and consistency. Working closely with a dermatologist is key to developing an effective treatment plan.