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Rosacea is a chronic skin disease characterized by redness and swelling which is primarily localized on the face. Other areas that can be affected are the scalp, neck, ears, chest and back.

Studies show that those afflicted with rosacea may first notice a tendency to flush or blush easily. This condition can occur over a long period of time and it often progresses to a persistent redness, pimples and visible blood vessels in the center of the face that can eventually involve the cheeks, forehead, chin and nose. Diagnosis of rosacea presents a big problem because it is easily confused with other skin conditions, such as acne and sunburn or seborrheic dermatitis. Rosacea sufferers often report periods of depression stemming from cosmetic disfigurement, painful burning sensations, and decreases in quality of life.

Incidence

Approximately 14 million people in the United States have rosacea. It most often affects adults between the ages of 30 and 60. According to some recent studies conducted on more than 2,000 rosacea sufferers, 44 percent reported that their symptoms had first appeared in their 30s and 40s, and 43 percent first experienced rosacea after age 50. Research has also found that only 27 percent of Americans had heard of rosacea. Because of its alarming, acne-like effect on personal appearance, it can cause devastating psychological and social problems.

Types of rosacea

There are four identified rosacea subtypes and patients may have more than one subtype present.

Erythematotelangiectatic rosacea
This type of rosacea is characterized by permanent redness with a tendency to flush and blush easily. It is also common to have small blood vessels visible near the surface of the skin and possibly burning or itching sensations.
This phase may sometimes be referred to as pre-rosacea.

Papulopustular rosacea
Unlike the previous type, Papulopustular rosacea is characterized by some permanent redness with red bumps filled with pus. These skin changes typically last 1-4 days. This subtype can be easily confused with acne. Rosacea may also be accompanied by oily skin and dandruff.

Phymatous rosacea
This subtype is most commonly associated with rhinophyma, an enlargement of the nose. Symptoms include skin thickening, irregular surface nodules, and enlargement. Phymatous rosacea appears on the nose, chin, forehead, cheeks, and ears. 

Ocular rosacea
The most common symptoms of ocular rosacea are red, dry and irritated eyes and eyelids. Some other symptoms include foreign body sensations, itching and burning. Rosacea may cause the inner skin of the eyelids to become inflamed or appear scaly, a condition known as conjunctivitis.

Causes

The precise pathogenesis of rosacea still remains unknown.

Blood vessels damage
Most experts believe that rosacea is a disorder where the blood vessels become damaged when repeatedly dilated. The damage causes the vessels to dilate too easily and stay dilated for longer periods of time, sometimes even permanently.

Heredity
Research has shown that rosacea also has a hereditary component. Those that are fair-skinned have a higher genetic predisposition for developing this condition. Women are more commonly affected but when men develop rosacea it tends to be more severe.

Infective etiology

Some experts are saying that the cause of rosacea could be a chronic bacterial infection in the gastrointestinal system caused by the Helicobacter pylori. Some other claim that it has something to do with infection with tiny mites (Demodex folliculorum) living in human hair follicles. They may play a role by clogging up sebaceous gland openings. None of these theories have been conclusively proved.
Alcohol does not cause rosacea, although it may worsen it.

Triggers of rosacea

There are several possible triggers of rosacea and some of the most common are:

  • exposure to temperature extremes
  • strenuous exercise
  • heat from sunlight
  • severe sunburn
  • stress
  • cold wind
  • hot baths, saunas
  • moving to a warm or hot environment from a cold one
  • some foods and drinks such as alcohol, foods high in histamine and spicy food
  • certain medications and topical irritants
  • some acne and wrinkle treatments that include microdermabrasion, chemical peels, high dosages of Isotretinoin, benzoyl peroxide and Tretinoin
  • use of topical or nasal steroids

Psychological effects

Experts believe that the social and emotional effects of rosacea are worse than the physical symptoms. In fact, a controlled study on this subject has shown that:

  • nearly 70 percent of rosacea patients said it lowered their self-confidence and self-esteem
  • 41 percent said the condition caused them to avoid public contact or cancel social engagements

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