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Rosacea

What is rosacea?

Rosacea is a common chronic inflammatory skin condition that affects the face, primarily on the cheeks, forehead, nose, and chin. There are numerous symptoms associated with rosacea. These areas may show redness and pimples, which can mimic the appearance of acne. While other symptoms include facial flushing, dry eyes, and chronic swelling of the nose. About one in every twenty Americans suffers from rosacea. Although incurable, certain therapies and lifestyle changes can help to alleviate signs and symptoms.

The exact mechanism of rosacea is not known. It is a chronic inflammation that is believed to be from an underlying dysregulation of the immune system, overgrowth of skin organisms, followed by irregular neurovascular signaling. The innate immune system, a part of the immune system that acts as the body’s first line of defense against infection, is consistently activated in these areas of the skin. One of the probable causes of this immune activation is the Demodex mite and the bacteria Staphylococcus epidermidis. The Demodex mite is a tiny organism that lives in the oil glands of the face. Although these organisms are normal flora for the skin, in susceptible individuals, they contribute to a higher than normal activation of the local immune system. Other environmental factors act in a similar manner to activate the immune system, including ultraviolet light, spicy foods, stress, exercise, and exposure to heat. Genetics also seems to play a role, as individuals of Celtic and Northern European descent are more likely to be affected by rosacea.

These genetic and environmental factors cause the skin to overact, resulting in the redness, flushing of the skin, and sensitivity. As the condition continues, more permanent changes can occur in the skin, such as growth of new blood vessels (telangiectasias) and an increase in growth of underlying tissues, (known as phymas). As these chronic skin changes progress, they can become more difficult to treat.

Who is at risk for rosacea?

Women with lighter skin are at higher risk for developing rosacea. The condition most commonly affects Caucasian women between the ages of 30 and 60. Other risk factors include a family history of rosacea.

What are the symptoms of rosacea?

  • Facial flushing
  • Persistent redness
  • Dilated blood vessels
  • Skin sensitivity
  • Swollen & red bumps
  • Dry & gritty sensation in the eyes
  • Enlarged & irregular nose

Triggers:

  • Sun exposure
  • Spicy foods
  • Temperature-hot foods and drinks
  • Exposure to extreme temperatures
  • Alcohol
  • Stress, emotional states
  • Intense physical exercise

Diagnosis & treatment of rosacea

Conditions that resemble rosacea should be evaluated by a board certified dermatologist. Numerous other skin conditions can appear similar, including acne, seborrheic dermatitis, cutaneous lupus, allergies contact dermatitis, and more. A physical examination and evaluation of medical history is important to differentiate these conditions. Left untreated, rosacea and its symptoms can become increasingly more severe.

Treatment depends on the severity of the condition and the areas affected. While the exact causes of rosacea are not clear, there are multiple therapies that can be utilized to minimize the signs and symptoms. Identifying and avoiding specific triggers will aid in exacerbating symptoms. A daily sunblock or protection from direct sunlight is important to reduce ultraviolet light exposure. Topical medications such as metronidazole and azelaic acid are useful in reducing the underlying inflammation in the skin. Whereas topical alpha-adrenergic receptor agonists like brimonidine will temporarily reduce the appearance of redness by constricting superficial blood vessels. Laser therapies are important to target and ablate more permanent redness and blood vessels in the skin. Dr. Schuering will develop a treatment plan that best suits you and your skin.


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