Rosacea is a chronic but treatable disease that mainly affects the central part of the face and is typically characterized by sudden flare-ups and remissions. Although rosacea can develop in different ways and at any age, studies have found that it usually begins after the age of 30 and appears as flushing or redness on the cheeks, nose, chin, or forehead.
As time passes, the redness becomes more severe and persistent, and may lead to the development of telangiectasia. Inflammation and papules often occur if left untreated, and in severe cases – particularly in men – excess tissue may develop on the nose, causing swelling and an uneven appearance. In up to 50% of patients, the eyes are also affected, causing discomfort, tearing, or redness.
Although rosacea can affect people of different ages and skin types, those with fair skin, a tendency to flush or blush easily, and women are more likely to develop it. There is also evidence that rosacea patients have a genetic predisposition and may be more common in populations of Northern or Eastern European ancestry.
In a survey, nearly 90% of rosacea patients reported that the condition lowered their self-confidence and self-esteem, and 41% said it led them to avoid public contact or cancel social activities. Among patients with severe rosacea, almost 88% said the disease had a negative impact on their professional interactions, and nearly 51% said they even missed work because of their condition. The good news is that more than 70% of people said that treatment improved their emotional and social problems.
Although the cause of rosacea is not yet clear and there is no cure, the medical community has developed an understanding of its symptoms that enables effective control through medication and lifestyle changes. People who suspect they have rosacea should seek diagnosis and appropriate treatment from a doctor before the disease becomes more severe and begins to affect their daily lives.
How to manage: Rosacea problems vary greatly among patients, and in most cases, only a portion of potential signs and symptoms will appear. According to a consensus committee and review panel of 28 medical experts worldwide, a diagnosis requires at least one diagnostic sign or two primary rosacea symptoms.
Diagnostic Signs of Rosacea: The appearance of any of these signs is sufficient for a diagnosis of rosacea:
Persistent redness: Persistent facial redness is the most common sign of rosacea and resembles a blush or sunburn that won’t go away. Thickened skin: Thickening and enlargement of skin tissue most commonly occur on the nose (known as rhinophyma). While this condition is rare, if severe, it can lead to facial disfigurement and breathing difficulties.
Primary Symptoms of Rosacea: The appearance of at least two of the following symptoms is required for a diagnosis of rosacea:
Flushing: Many rosacea patients have a history of frequent blushing or flushing of the face. This facial redness may be accompanied by a feeling of heat, warmth, or burning and is usually an early sign of the disease. Papules: Red papules or pustules often occur. While these may resemble acne, there are no blackheads present and they may have a burning or stinging sensation. Telangiectasia: In many people with rosacea, prominent and visible small blood vessels called telangiectasia occur on the cheeks, nose, and other areas of the central face. Eye irritation: In many rosacea patients, the eyes may be irritated and appear watery or bloodshot, a condition known as ocular rosacea. The eyelids may also become red and swollen, and styes may occur. Crusting and scaling may accumulate around the eyelids or eyelashes, and patients may notice visible vessels around the edge of the eyelid
These may appear together with one or more diagnostic or primary symptoms.
Burning or stinging The face may frequently experience a burning or stinging sensation. It may also experience itching or tightness.
Swelling Facial swelling, known as edema, may occur together with other symptoms of rosacea or independently. Raised red patches may occur without any change in the surrounding skin.
Dryness Rough and scaly skin may appear in the central facial area. In rare cases, rosacea symptoms may also appear outside of the face, most commonly on the neck, chest, scalp, or ears.
Causes of Rosacea
Although the cause of rosacea is unclear, researchers have identified major factors in the disease process that may lead to significant progress in the treatment of rosacea in the future. Recent studies have found that facial redness may start as a result of the combination of neurovascular dysregulation and congenital immune system, leading to inflammation. The researchers also found that a significant increase in mast cells located between the nervous and vascular systems was one of the main causes.
Apart from neurovascular and immune system factors, the Demodex folliculorum mite is considered a potential factor in rosacea. This mite is a normal bacterium on human skin but has been found in significantly greater amounts in the facial skin of rosacea patients. Researchers have also found that two genetic variations in the human genome may be associated with this disease. Recent other studies have found an association between rosacea and an increased risk of potential severe systemic diseases, indicating that rosacea may be a result of systemic inflammation. Although causality has not been established, these associations include cardiovascular diseases, gastrointestinal diseases, neurological and autoimmune diseases, and certain cancers.
Treatment of Rosacea
As the signs and symptoms of rosacea vary from patient to patient, they must be treated by a physician for each case.
A range of oral and topical medications may be used to treat various symptoms and signs associated with the disease. Physicians may prescribe medications specifically to control redness. Acne and papules are typically treated with oral or topical medication, followed by long-term anti-inflammatory therapy to maintain remission. Physicians may also use pulsed dye lasers, such as the VBeam Perfecta pulsed dye laser, to eliminate newly-formed blood vessels or improve a ruddy nose. Eye rosacea may be treated with anti-inflammatory medication and may require follow-up by an ophthalmologist.
Patients should consult with their physician to ensure that their skin care regimen is compatible with rosacea. A gentle skin care regimen can also help control rosacea. Patients are advised to clean their faces with a gentle, non-abrasive cleanser, rinse with warm water, and pat dry with a thick cotton towel. They should avoid pulling, rubbing, or using rough towels.
Patients may use non-irritating skincare products as needed and are advised to use a UVA/UVB sunscreen with an SPF of 30 or higher to protect their skin from sunlight. Physical sunscreens containing zinc or titanium dioxide are recommended. Rosacea patients should avoid any skincare products that cause stinging, burning, or redness.
Cosmetics may be used to conceal the redness or papules of rosacea. A green-tinted primer may be used to counteract redness, followed by a natural yellow-tinted foundation to avoid pink or orange tones.
In addition to long-term medication therapy, rosacea patients can also increase their chances of maintaining remission by recognizing and avoiding trigger factors, which are often associated with lifestyle and environmental factors that trigger or exacerbate their rosacea condition. However, identifying these factors is a personal process, as the factors that cause one person’s rosacea to flare up suddenly may have
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