Rosacea

September 26, 2011

Rosacea is a common facial skin condition that most frequently affects fair-skinned Caucasian women and men of northern European ancestry. While the precise etiology (cause) of rosacea is unknown, it is probably due to some combination of factors in predisposed individuals resulting in an abnormality of the blood supply to the skin (cutaneous vasculature). The earliest sign of rosacea is recurrent episodes of flushing that may be triggered by a variety of exacerbating factors including hot beverages, spicy foods, alcohol, sunlight, or emotional stress. Over time, the redness of the skin (erythema) may become permanent rather than episodic and more inflammatory changes ensue including swelling (edema), bumps (papules), and blisters (pustules). Phymas, disfiguring fibrotic changes in the skin, are a late stage of rosacea and are seen more commonly in men. An index of suspicion should be maintained for rosacea that affects the eye area (ocular rosacea), which is common and often unrecognized, but has the potential to cause discomfort as well as possible corneal ulceration.

Avoidance of irritating stimuli that cause flushing is an essential first step of treating rosacea. A frequent complaint of rosacea patients is hyperirritability of the skin characterized by stinging and burning with application of topical preparations. Avoidance of products that produce this symptom and employing gentle skin care can also improve the condition. Daily use of a gentle moisturizer with a broad-spectrum, nonchemical sunscreen is essential. Skin atrophy as a result of chronic sun damage can further accentuate the prominent blood vessels. Cosmetics can be used if they are mild and do not irritate the skin; the use of cosmetics to camouflage the redness and blemishes goes a long way toward benefiting self-esteem in this highly visible condition.

Therapy of rosacea has included both topical and systemic agents, with treatment regimens based primarily on disease severity. Antibiotics are the most common prescription drugs for rosacea, and most dermatologists employ a tiered approach based on the severity of the condition. Topical metronidazole products are the most common first-line therapies. Combination therapy with systemic antibiotics, particularly those in the tetracyc-line class, is prescribed for inflammatory lesions as well as ocular involvement. Rosacea fulminans, a severe inflammatory variant of rosacea seen most commonly in young women, may require oral corticosteroids or the retin medication, isotretinoin. Swelling of the nose with fibrosis resulting in a bulbous appearance, known as rhinophyma, is much more commonly seen in men. Rosacea tends to be cyclic in nature and systemic medications can often be tapered while maintaining a regimen of gentle skin care, daily sunscreen, and avoidance of known factors that trigger flares. Recognition and treatment of rosacea early in its onset provides the most favorable long-term prognosis.

See Also: Edema, Skin disorders

Suggested Reading

  • Quarterman, M. J., Johnson, D. W., Abele, D. C., et al. (1997). Ocular rosacea: Signs, symptoms, and tear studies before and after treatment with doxycycline. Archives of Dermatology, 133, 49—54.
  • Torok, H. M. (2000). Rosacea skin care. Cutis, 66, 14-16.
  • Wilkin, J. K. (1994). Rosacea: Pathophysiology and treatment. Archives of Dermatology, 130, 359-362.

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