Usually seen in adults, and more common in women than men, rosacea is a disease affecting the central skin of the face mostly where people flush.
By: Dr. Steven Kazenoff
Usually seen in adults, and more common in women than men, rosacea (pronounced ROSE-AY-SHAH) is a disease affecting the central skin of the face mostly where people flush.
Although it can affect any skin type, it is more common among those with fair skin. The condition often develops during the third and fourth decades of life, peaking in the fifth decade, but it can strike at any age. People who typically develop rosacea have a history of flushing or blushing more easily than others.
Unfortunately, rosacea is often mistaken for a sunburn, a change in complexion or acne and people put off seeing a doctor.
While rosacea cannot be cured, and its specific cause is unknown, it can be controlled. As with all conditions, getting medical help early and following a specific treatment program are keys to dealing with it successfully.
Rosacea usually starts with redness on the cheeks and over time can worsen to include additional symptoms and parts of the face, including the eyes.
Rarely, it can spread to include the area behind the ears, the scalp, and the V-shaped area of the chest. Up to 40 percent of rosacea sufferers complain of ocular problems including a gritty sensation in the eyes, bloodshot, watery eyes and a dry, burning sensation. Changes that accompany the condition are often gradual, making it difficult to recognize rosacea in its early stages.
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‘The late Hollywood actor W.C. Fields is perhaps the most famous sufferer, and it was his fondness for alcohol that helped to mistakenly link rosacea with alcoholism. While it is true that drinking alcohol can make rosacea worse, the condition can affect people who never drink alcohol.’ Dr. Steven Kazenoff
Dermatologist The Medical Center at Princeton |
Physicians treat patients according to which of the three stages of rosacea they are in.
In Stage I, the symptoms include redness. The color looks like a blush or sunburn and is caused by flushing. Flushing occurs when a larger amount of blood flows through vessels quickly and the vessels expand under the skin to handle the flow. Gradually, the redness becomes more noticeable and will not go away. While a normal blush disappears in minutes, a rosacea blush may persist for hours or days. Facial skin may get very dry.
In Stage II rosacea, the flush may be followed by pimples. These pimples may be inflamed papules that are small, red and solid, or they may be pus-filled pustules similar to teen-age acne. This similarity gives rise to the condition’s nickname as "adult acne" or "acne rosacea." One difference is that people with rosacea normally do not have the blackhead or whitehead type of pimples that can mark the teen-age face.
A small percentage of sufferers, particularly men, may develop Stage III rosacea with accompanying tissue hyperplasia. This is marked by thickened facial contours, resembling the peel of an orange, inflamed skin and enlarged oil glands. Patients may eventually get small knobby bumps, called rhinophyma, on the nose, causing the nose to look swollen. The late Hollywood actor W.C. Fields is perhaps the most famous sufferer, and it was his fondness for alcohol that helped to mistakenly link rosacea with alcoholism. While it is true that drinking alcohol can make rosacea worse, the condition can affect people who never drink alcohol.
Although the cause is unknown, the flushing that marks rosacea can be triggered by many things, including hot drinks, strong sunlight, extreme heat or cold, spicy foods, stress, hard exercise, dairy products, certain fruits, some medicines and even menopause. Facial flushing can make symptoms worse, sometimes causing flare-ups in patients whose rosacea was under control with medications.
Pinpointing what causes flushing and avoiding it is crucial in helping control the condition. Of course, what bothers one person may not cause a problem in another, so it is important to keep track of individual triggers.
Rosacea is a chronic condition, and for most people, symptoms come and go in cycles. Although the condition may go into remission for a while without treatment, it is often followed by a worsening of symptoms that progresses over time. Because it is easy to mistake skin disorders and use non-prescription acne medications that may irritate dry, sensitive skin, it is essential to see your doctor.
Treatment can lessen or get rid of symptoms, and early treatment can keep the condition from getting worse, even preventing blood vessels from enlarging or rhinophyma from developing. Some prescription medications control redness and reduce the number of papules and pustules. There are topical applications that are applied directly to the skin and others that are taken orally. Within several weeks, most cases improve, though once the symptoms have cleared, patients may need to continue taking medication to keep rosacea under control.
Without regular treatment, redness and pimples can return. Another reason to seek treatment early is that once red lines appear, they can only be covered up by makeup or removed by a surgical method. Surgery can also be used to correct a nose enlarged by rhinophyma.
The care, cleansing and moisturizing of the face is particularly important when you have rosacea. The best success comes from following a regular cleansing and medication routine. Use only mild products on the face and avoid products that contain alcohol or irritants. When needed, use a good quality moisturizer. If you are using a topical medication, apply moisturizer only after the medication has dried.
Because the sun is a culprit, get in the habit of using a sunscreen with a sun protection factor of at least 15. In general, choose facial products that will not clog pores look for the word "noncomedogenic" on the package. Avoid products that contain alcohol, acetone or oil, paying careful attention to the labels of hair sprays and astringents.
Should you find that your facial skin is showing signs of a persistent flush, or that you are experiencing redness, irritation, or breakouts, call your dermatologist and make an appointment. Remember that early treatment can help prevent a worsening of symptoms. For more information, look up the National Rosacea Society’s excellent website at www.rosacea.org.
Dr. Steven Kazenoff is a dermatologist on staff at The Medical Center at Princeton. Health Matters appears Fridays in the Lifestyle section of The Princeton Packet and is contributed by The Medical Center at Princeton.