Rosacea is a chronic skin disorder of the face in middle-aged and older people (usually between 30 and 60), which affects approximately 13 million people in the United States.
It tends to occur mostly on the face, and sometimes on the neck and upper chest. About 50 percent of the time it involves the eye area as well. It tends to occur more frequently in people with fair skin, and may be an inherited trait.
Doctors classify rosacea into four types depending on the symptoms. One of them is an early stage of periodic facial flushing and redness, called flare-ups. Women often get another type where swelling and flare-ups occur more and more frequently and eventually become permanent. Inflammatory roasacea is another type, typified by the appearance of pimples and pink bumps on the face, as well as small blood vessels showing under the skin. Finally, in some men with rosacea, the nose can develop rhinophyma (becomes enlarged, bulbous and red with thick knobby bumps).
Some people can have more than one type of rosacea at a time; others never develop more than one type.
No single factor adequately explains the pathogenesis of this disorder. A combination of environmental factors and genetic predisposition may cause it to develop. Some links have been established to a mite that lives in facial hair follicles, and possibly others to Helicobacter pylori, a bacterium (residing beneath the mucus layer next to the stomach) that has been associated with the occurrence of gastritis and peptic ulcers. Some researchers believe that something causes blood vessels to swell, creating flushing and redness.
The cheeks, nose, chin and at times, the entire face, may have a rosy hue. The nose may enlarge. There are few or no blackheads or whiteheads (comedones). Inflammatory red bumps (papules) are present as well as pus-filled bumps (pustules). There is a vascular component with telangiectasias (a lesion formed by a dilated capillary) and a tendency to flush easily with burning or stinging.
When the eyes are affected (in about 50 percent of the cases), symptoms may include burning and tearing or the feeling that there is a piece of grit in the eye. The eyelids may swell due to infection. Usually this condition does not impair vision.
Certain factors can make the flare-ups of rosacea worse, such as alcohol, heat, sunlight, cold, hot drinks, coughing and spicy foods, but they do not cause the condition.
Diagnosis is made clinically. Rosacea is distinguished from acne by age, the presence of a vascular component (flushing), and the absence of comedones (blackheads and whiteheads).
The goal of treatment is to improve appearance and keep the condition under control. It’s a good idea to keep a record of what factors seem to trigger the flare-ups as this may help your doctor determine the best course of treatment.
Your dermatologist may prescribe topical antibiotics such as metronidazole (gel or cream) or clindamycin (solution, gel or lotion). Five to eight weeks of treatment may be needed for a significant response.
Oral antibiotics may be tried if topical treatment fails. Commonly used ones used include tetracycline, minocycline, erythromycin, and doxycycline.
Isotretinoin is sometimes used for severe rosacea, but it is linked to a number of adverse side effects. In particular, women of childbearing age should not be or get pregnant while taking Isotretinoin as this medication can cause birth defects.
Electrosurgery and laser surgery can sometimes be used to treat redness and rhinophyma (enlargement of the nose). A satisfactory treatment for the skin lesions is a yellow light laser.
Avoiding the use of facial products that irritate your skin, along with consistent use of sunscreen with an SPF of 15 or higher is recommended for people with rosacea. It may help to minimize your stress level as well.
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