All about rosacea – symptoms, causes, treatment

Definition

Rosacea is a common, chronic and in several cases – life-disruptive skin disorder that mainly affects facial skin, although it can also appear on scalp, neck, ears or chest. The most frequently appearing sign of Rosacea is facial erythema (or facial redness) and skin inflammation, which can also be accompanied by pimples, pustules or bumps on the skin. Such symptoms make Rosacea very easy to misdiagnose (at least in its initial stages), and confuse with regular Acne.

Don’t confuse it with acne

Another characteristic thing about disease is its recurrent periods of flare-ups and remissions. The redness that appears on one’s forehead, nose, cheeks or chin is likely to come and go, but without the right treatment – the condition is likely to progress and develop new symptoms. People suffering from Rosacea ought to bear in mind that this condition is cyclic and a sudden remission of its symptoms shouldn’t be confused with a full recovery. Over time, Rosacea tends to be progressive (i.e. its symptoms become more severe), which is another reason to start treatment immediately.

The more advanced cases of Rosacea, aside from facial redness and Rosacea Acne, also involve the appearance of visible blood vessels, bumpy and swollen nose or even bloodshot, watery and strongly irritated eyes. Altogether, it is categorised into four different subtypes – according to the severity of the disease, as well as to the occurring Rosacea symptoms.

Rosacea typically starts at the age of 30 or older, and 4 out of 5 sufferers are women. Contemporary science hasn’t yet come up with an effective cure for Rosacea, nor are the causes for this skin disorder fully understood. However, modern treatment and medical therapy give  patients a chance to get it under control and even reverse its symptoms. Because of uncertainty regarding Rosacea aetiology and relative difficulty in giving the right diagnosis, everyone who is concerned about his/ her lasting condition of redness on face should allow the possibility of being affected by the disease, and is advised to be checked by a dermatologist or other qualified skin specialist.

Rosacea causes and triggers – what are the known causes and triggers for the flare up of Rosacea symptoms?

Scientists, clinicians and people affected by disease are often in disagreement as to what the actual causes of this skin disorder are, and what triggers the periods of flare-ups in existing conditions of Rosacea. It generally agrees that it is caused by a combination of genetic (hereditary) and environmental factors, though further research is needed to confirm to what extent.

As with many diseases that aren’t yet fully comprehended, there are several myths regarding Rosacea causes that have arisen in the past few years. One of them is the large impact of alcohol which some doctors see as the main culprit in the progression of Rosacea, yet the most recent studies have shown that alcohol is just one of the number of factors that could trigger or worsen this skin disorder, and people that don’t drink alcohol at all are similarly likely to get affected.

Among the confirmed factors that are likely to exacerbate Rosacea are, for instance, certain medications for blood pressure (i.e. drugs which dilate blood vessels) or foods high in histamine, such as beer, yoghurt, bacon, red wine, cured pork, aged cheese, etc. These products could cause persistent erythema also in individuals who don’t suffer from Rosacea but are affected by different skin condition – histamine intolerance.

The Rosacea aggravating factors are the cause for increased blood flow to the skin’s surface, which results in a fare-up of this skin disease. Please refer to the list below for a full view on different Rosacea triggers and causes. The list is formed based on one survey conducted by US-based National Rosacea Survey that asked over 1000 Rosacea patients about different factors that influence their skin condition (the percentage points constitute a positive check to a given factor):

•     Excessive alcohol consumptionExposure to sun – 81%
•     Emotional stress, embarrassment or anger – 79%
•     Hot weather – 75%
•     Wind – 57%
•     Strenuous physical exercise – 56%
•     Excessive alcohol consumption – 52%
•     Hot baths and saunas – 51%
•     Cold weather – 46%
•     Spicy or hot foods – 45%
•     High humidity – 44%

as well as

•     Indoor heat – 41%
•     Using certain skincare products – 41%
•     Consumption of heated beverages – 36%
•     Using certain cosmetics – 27%
•     Taking certain medications (mostly stimulants) – 15%
•     Various medical conditions – 15%
•     Consumption of
  •  certain fruits – 13%
  •  marinated meats – 10%
  • certain vegetables – 9%
  • dairy products 8%

The most common signs and symptoms of the skin disease of Rosacea

What’s interesting about Rosacea is that most of the people don’t ever get diagnosed, and given their mild Rosacea symptoms – they don’t even suspect to have it! Since there is no single, standardised test for Rosacea, it’s sometimes very hard to confirm this skin disorder without a specialised diagnosis. In most of the cases, a visual inspection is all it takes to confirm a Rosacea condition, but quite frequently it gets confused with something else – usually with seborrhoeic Dermatitis or Acne Vulgaris, which also might be coexistent with Rosacea. The Rosacea “trademark” symptoms (such as rash, redness or bumps on the skin) appearing on scalp, ears or neck suggest that the condition has been misdiagnosed, or that one deals with more than just one skin disease. In some very rare cases, however, Rosacea signs appear in these skin areas as well.

The most frequently appearing signs of Rosacea include:

• Red areas on the face (erythema)
• Small, reddish bumps, pustules or papules appearing on the nose, cheeks, forehead or chin (however not identical to whiteheads or blackheads)
• Red and bulbous nose (rhinophyma)
• Visible small blood vessels appearing on the nose and cheeks (telangiectasia)
• Gritty or burning sensation in the eyes (ocular rosacea)
• Tendency for having blushing or flushing skin – even without any justifiable reason.

How to gain certainty that we’re dealing with Rosacea?

As is the case with many other skin diseases, Rosacea can substantially vary between individuals, and some symptoms that occur in one case might not show up at all in the other. This skin disorder is currently the subject of countless research conducted by scientists all over the world. The most recent consensus between 17 top worldwide specialists on Rosacea was worked out during one of the panels. There they have agreed that in order to be doubtless about a given Rosacea diagnosis; at least one of the presented below primary signs need to be present (with possible development of several other secondary signs).

The Eye Primary signs and symptoms of Rosacea:

• Eye irritation – it is a symptom that appears in people with advanced Rosacea, this condition is called ocular Rosacea – the eyes become watery and irritated, or even bloodshot. It might also affect the eyelids – they become swollen and red, with commonly appearing styes. In the most severe cases of ocular Rosacea there also might be corneal damage, leading to vision loss, shouldn’t the appropriate medical support be provided.
• Burning or Stinging sensations – these symptoms are often associated with disease. They appear on the face and may also develop the feeling of tightness or itching.
• Facial dryness – the facial skin in its central part may be rough and appear very dry.
• Plaques – these are the small, raised red patches on the skin. Them might develop without causing any changes to the surrounding skin.
• Skin thickening – excess tissue might cause the skin to enlarge and thicken. This usually happens around the nose in the more advanced stages of this skin disease (phymatous Rosacea). The condition is called rhinophyma and in most cases it affects men rather than women.
• Facial swelling – otherwise known as edema. It might occur on its own or accompany other Rosacea symptoms.
• Rosacea signs and symptoms that appear beyond the facial area – they can also appear on ears, scalp, cheeks or neck.

Other potential signs and symptoms of Rosacea:

• Skin flushing – people that suffer from Rosacea tend to have a history of flushing or blushing. This Face redness can be cyclic; it is also one of the first signs of this skin disorder.
• Persistent or recurring redness – this is the most commonly occurring Rosacea symptom. It often resembles a blush or sunburn that stays permanently.
• Skin bumps, pustules and pimples – affected skin often develops pus-filled pustules, pimples or small red bumps. They can be easily taken for Acne, but blackheads are completely absent; and the condition is associated by a stinging or burning sensation.
•  Visible blood vessels – another common symptom of it – blood vessels on the skin become visible.

Who is the most vulnerable to Rosacea?

Nobody is fully immune to the skin disorder of Rosacea but certain groups of people are more likely to develop its symptoms. In total, Rosacea concerns 7% -14% of adult population in Britain (according to different independent studies) and about 70% to 80% of all the affected are women. The group that is most vulnerable includes women between the age of 30 and 60 – especially those who are going through menopause. Nevertheless, some of the most severe cases, especially those that include the appearance of bulbous Rosacea Nose, are actually found among men.

Rosacea is sometimes nicknamed “the curse of the Celts”. That’s because this skin condition is believed to primarily occur among people of north-western European descent. However,  the most recent studies dispute this opinion. In general, anyone with tendency to blushing or flushing skin and with pale complexion is at a bigger risk of developing Rosacea.

Rosacea subtypes – different subtypes of disease according to the most common classifications.

The most common classification of Rosacea divides it into 4 separate subtypes:

  Subtype 1. Erythematotelgiectatic Rosacea: it is a condition characterised by blushing and flushing on the face, as well as by permanent erythema (redness) that is most often found in people with sensitive skin. Common in this subtype of Rosacea are small, widened blood vessels that become visible near the skin surface (telangiectasia) – they often tend to cause intense burning or itching sensation. The skin is likely to become flaky and very dry. The above symptoms might also occur on skin areas other than the face: scalp, ears, neck, chest or upper back.

Subtype 3. Phymatous Rosacea: in this subtype we can observe enlargement of the nose (rhinophyma) – a condition that usually happens to men. The symptoms include irregular surface nodularities and thickening of the skin around the nose. Phymatous Rosacea can also be found on the forehead (metophyma), chin (gnathophyma); eyelids (blepharophyma), ears (otophyma) and eyelids. Telangiectasia (visible blood vessels) can also be present in this subtype.

Subtype 4. Ocular Rosacea: the subtype of Rosacea that attacks eyes and eyelids. The eyes are dry, red, gritty, watery and irritated. Moreover, cysts might develop on the eyelids. Several other symptoms might also occur: sensitivity to light, foreign body sensations, burning, stinging or itching. Ocular Rosacea occurs in about half of the Rosacea cases of subtypes 1-3. The most severe cases of this Rosacea subtype also involve blurred vision or complete loss of vision.

Rosacea can also be classified according to the phases in which it appears:

• Pre-rosacea: a tendency to frequently blushing and Flushing Skin that gradually progresses to become persistent redness in the most central area of the face (especially around the nose).
• Vascular Rosacea: in this phase there is a visible worsening of the initial skin condition of Rosacea. The person affected might notice telangiectasia – visible blood vessels that appear on the nose and cheeks. Possible additional signs include dandruff and oily skin.
• Inflammatory Rosacea: in this phase red bumps, pimples, pustules and papules appear and often persist. They might spread across the entire face: chin, forehead, cheeks, nose, etc.
• Ocular Rosacea – eye Rosacea and it occurs to about half of the long-time Rosacea sufferers.
• Rhinophyma: it occurs in later phases of Rosacea – usually affecting middle-aged men, and it’s manifested by red and bulbous; enlarged nose with possibly raised bumps (papules).

A few useful tips on smart Rosacea care

Apart from getting a quick and reliable diagnosis, and undergoing proper anti-Rosacea treatment, it is also imperative to introduce smart skin care for the best possible management of this skin disorder. Avoiding the previously listed disease triggers and causes alone most likely won’t be enough to cause remission of Rosacea in all but the mildest of cases. Nevertheless, one should acquaint him/herself well with the factors that might be responsible for flare-ups in their particular case of Rosacea, for which we recommend keeping a journal that can facilitate identification of the most harmful triggers in this given case.

Freezing

The latest publications on Rosacea discuss managing pre-trigger events, e.g. warm room flushing can be directly influenced by long-time exposure to the cool environment. Since temperature differences are among the most detrimental culprits that could cause a flare up of Rosacea; it is a good idea to let the body get used to a higher (or lower) temperature of a new environment before we reach for a hot (or cold) drink. For example, when entering home from the freezing outside, it’s best to wait 10 to 15 minutes before having a cup of tea or coffee.

The skin condition of Rosacea “doesn’t like” cold and wind, as well as sauna or solarium, and above all – any influence of the sun, which destroys the fragile blood vessels. Not only does a suntan not protect the dilated blood vessels, but it also dramatically worsens the general condition of the skin. Exposure to the sun is the most frequently mentioned cause for flare-ups of Rosacea, and avoiding excessive sun exposure is strongly encouraged. One needs to protect the skin with creams that have natural filters (the ones that contain titanium dioxide and zinc oxide), which also provide protection from fluorescent light. Similarly, negative to the health of the skin is the impact of air conditioning, which dries the skin and might cause allergies to certain creams.

No less important is the role of a person’s diet – avoid stodgy or spicy foods, as well as any products that are rich in histamine. Trying to stay away from hot meals and drinks or alcohol, as these factors can exacerbate and perpetuate your existing erythema. To some people even a glass of red wine might be harmful as it can have the negative impact on one’s skin condition.

In the majority of Rosacea cases in Britain, the skin disease doesn’t enter the stage of permanent remission, which means that the affected person needs to manage his/ her lifestyle, in a way, that it doesn’t collide with the restrictions that Rosacea brings. The main goal of this lifestyle management is to improve the chances of maintaining remission for a long as possible, by identifying the most harmful factors and avoiding contacts with those, which trigger flare-ups of Rosacea or aggravate an existing condition of this skin disease.

To a great number of people the Rosacea proves to be a very distressing and often embarrassing condition. Rosacea can also cause lots of psychological damage. Frustration, anxiety, self-consciousness or withdrawal are the feelings that people suffering from Rosacea feel.

The suggestions below will help you better cope with this troublesome skin disorder:

Find a strong support group. The help of family and friends in these difficult moments can prove to be crucial, but many of times – you might need support of other people who are affected by the same or similar symptoms of Rosacea. Being in a support group, or even having contact with other Rosacea sufferers online, may turn out to be very comforting. Search the internet or ask your doctor about living support groups, internet forums about Rosacea or face-to-face supports – chances are you won’t have any problems in finding one in your area.

Rosacea research – what are the possible prospects for an effective Rosacea treatment in the future?

Cathelicidins

According to a known dermatologist, Professor Richard L. Gallo, patients suffering from Rosacea have elevated levels of cathelicidin (a peptide) and also of SCTEs (stratum corneum tryptic enzymes). That means, that treating the disease was effective only becasue of the use of  certain SCTEs.

Intestinal bacteria

The results of one of the most recent studies on disease triggers suggested that intestinal bacteria could play a significant role in causing flare-ups of this skin disease. Group of pacients took part in the study. Them were subjected to a hydrogen breath test, which was to detect the occurrence of the so-called SIBO (small intestinal bacterial overgrowth). The study then went on with introducing different Rosacea treatments to which the patients reacted differently, depending on whether they had previously tested hydrogen-positive or negative.

The results of the study suggest that the most appropriate antibiotic therapy varies from patient to patient and that intestinal bacteria seem to have the capability of mediation in various symptoms. This might explain why some of the patients on a reduced carbohydrate diet experienced improvement in their symptoms (i.e. their Rosace condition was more likely to go into remission). This kind of diet restricts the available material that is necessary for the process of bacterial fermentation, which in turn reduces the population of intestinal bacteria.

Demodex mites

Several studies of Demodex mites and different types of Rosacea have shown that a number of Rosacea sufferers; (especially those suffering from steroid-induced Rosacea) have increased numbers of the mite population. Mites tend to play a bigger role in switching on other Rosacea triggers when in the large number. However, one needs to take into account that on certain occasions a skin condition; known as demodicidosis (mange) may closely resemble Rosacea symptoms.