Rosacea

Definition

Rosacea is a skin disorder that causes chronic redness of the face. It can also cause swelling, tiny pimples, and the appearance of broken blood vessels. Rosacea usually affects the cheeks, forehead, chin, and nose, but the ears, chest, and back may also be affected. More than half of people with rosacea also have mild eye symptoms, including redness, burning, and watering—the so-called "ocular rosacea."

Rosacea Rash

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Causes

The cause of rosacea is unknown, although several theories exist. Factors that can cause flushing or blushing may trigger flare-ups in people with rosacea.

These factors include:

  • Very hot or spicy foods
  • Caffeine
  • Alcohol
  • Sun exposure
  • Extreme temperatures (very hot or very cold)
  • Exercise
  • Emotional stress or social embarrassment
  • Rubbing, scrubbing, or massaging the face
  • Irritating cosmetics and other toiletries

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for rosacea include:

  • Sex: female
  • Age: between 30 and 60 years old
  • Fair skin
  • Having family members who have rosacea

Symptoms

The symptoms of rosacea vary from person to person. They include:

  • Frequent flushing on the face and neck
  • Redness and swelling on the face
  • Small pink bumps and/or pimples
  • Thin red lines showing the small blood vessels of the face
  • Redness, burning, dryness, and tearing of the eyes
  • An enlarged, bulbous red nose (less common, affecting men more than women)

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your skin will also be examined. You may be referred to a doctor who specializes in skin disorders (a dermatologist). Do not try to diagnose or treat yourself, because certain over-the-counter medications could make your condition worse.

Treatment

Rosacea generally can't be cured, but it can be controlled. There are several ways to manage rosacea. Your doctor may recommend more than one, depending on your condition.

Medications

Prescription medications for rosacea include:

  • Antibiotics applied to the skin
  • Other topical treatments such as azelaic acid or tretinoin (Retin-A)
  • Antibiotics taken by mouth

In more severe cases, medications may sometimes include:

  • Oral isotretinoin (Accutane)
  • Oral methotrexate, dapsone, primaquine, chloroquine, or oral prednisone

*Topical cortisone is generally avoided on the face, as it can make rosacea worse in the long run, although it can be effective as very short-term treatment.

Treatment for redness or flushing may include:

  • Clonidine in low doses
  • Beta blockers (certain types)

Surgery

The following procedures minimize redness, enlarged blood vessels, and an enlarged nose:

  • Electrosurgery—uses a tiny electric needle
  • Laser surgery—uses a laser

Prevention

Preventing rosacea can be difficult, because the exact cause is unknown. However, if you have rosacea, there are several steps you can take to control the condition:

  • Avoid things that may trigger flushing or blushing, such as certain foods, alcohol, and exposure to the sun.
  • Protect your skin from the sun with clothing, hats, or sunscreen with a sun protection factor (SPF) of 15 or higher.
  • Exercise in a cool environment to avoid overheating.
  • Avoid anything that irritates your skin:
    • Apply topical medications, moisturizers, and cosmetics very gently.
    • Use cleansers, moisturizers, cosmetics, and other toiletries that are gentle and alcohol-free.

RESOURCES:

American Academy of Dermatology
http://www.aad.org

National Rosacea Society
http://www.rosacea.org

CANADIAN RESOURCES:

Canadian Dermatology Association
http://www.dermatology.ca/english/

Dermatologists.ca
http://www.dermatologists.ca/index.html

References:

American Academy of Dermatology website. Available at: http://www.aad.org .

National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: http://www.niams.nih.gov/ .

Tanzi EL, Weinberg JM. The ocular manifestations of rosacea. Cutis. 2001;68:112-114. Review.

Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004;51:327-341;quiz 342-344. Review.

Pelle MT, Crawford GH, James WD. Rosacea: II therapy. J Am Acad Dermatol. 2004;51:499-512;quiz 513-514. Review.



Last reviewed December 2007 by Ross Zeltser, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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