CLINICAL DERMATOLOGY > ROSACEA
What is rosacea?
Rosacea, or acne rosacea, is a chronic inflammatory disease with periods of improvement and worsening of unknown cause, and that affects the skin and sometimes the eyes. Symptoms are typically located on the face and rarely on other areas, such as torso or neck. It manifests as an initially temporary redness that later becomes more persistent with the appearance of vascular dilatations and, sometimes, red puss-filled pimples similar to those of juvenile acne. Rosacea affects millions of people around the world, yet incidence is more common in women than in men, although the latter show more severe cases. Maximum incidence occurs in adults aged 30 to 60 and it is more frequent in fair-skinned people.
What causes rosacea?
Its exact cause is unknown. It is believed that vascular hyperactivity results in an individual’s predisposition to developing the condition. In other words, the blood vessels on some people’s faces dilate easily in response to certain stimuli, thus causing facial redness.
What factors can worsen or trigger breakouts?
Individuals with rosacea recognise some stimuli as triggers for facial redness. Factors that cause redness in some patients may not affect others and could be one or several of the following:
- Heat, cold, or wind
- Very hot living spaces or sudden temperature changes
- Very hot and spicy food and drinks, fermented cheese, and alcohol
- Sun exposure
- Anxiety and stress
- Prolonged use of topical corticoids
- Some women might notice onset or worsening of the disease during menopause.
How does rosacea appear?
Temporary episodes of facial redness occur at first in relation to one or more of the factors mentioned above. However, not everyone who gets red in hot or stressful situations ends up having rosacea. In time, facial redness is persistent in some cases and the small blood vessels of the facial skin dilate and remain as red or purple lines on the nose and cheeks (telangiectasias). This is known as vascular rosacea. Red pus-filled pimples (papules and pustules) appear at times during the disease’s progression. This is called inflammatory rosacea. In more advanced stages, there can be a thickening of the skin in the forehead, chin, cheeks, and especially the nose, which in some men becomes red and covered with telangiectasias. It is called rhinophyma and in rare cases can be the only manifestation of rosacea. Many rosacea patients notice intolerance to various cosmetics and topical medications (applied to the skin).
How does rosacea affect the eyes?
There is a 50% chance that a person with rosacea will suffer from effects not just on the skin, but also in the eyes. Patients experience redness, stinging, burning sensation, tearing, heightened sensitivity to light, or inflammation of the eyelids. The impact on the eyes is not related to the severity of the impact on the face.
How does it progress? Can it be cured?
The evolution is chronic, with worsening episodes. Although there are no curative treatments, these breakouts can be treated and controlled. The goal of the treatment is to control the symptoms and improve the appearance of the skin. This treatment should be prescribed by your doctor and it may require months to see improvement. Applying inadequate cosmetics or medications not indicated by your doctor worsens and maintains the disease.
What is the treatment for rosacea?
The symptoms and signs of rosacea vary greatly from one patient to another and treatment is indicated for each particular case, as each person responds differently. An effective treatment in one patient may not be effective in another.
Treatments are effective for papules and pustules, while the redness of the skin is more difficult to eliminate. Common treatments include oral or topical antibiotics. This does not mean that rosacea is a bacterial infection. The efficiency of the antibiotic is most likely due to its anti-inflammatory action and to the effect it has on normal bacteria on the skin, whose role in rosacea is being studied. The dermatologist will usually recommend an oral antibiotic (Tetracycline or Erythromycin) or topical antibiotic (Metronidazole, Erythromycin, or Clindamycin). More severe cases may require oral retinoids. Treatment is prolonged and may require modifications indicated by your doctor according to its evolution. Sometimes surgery or laser treatments are used to correct rhinophyma or telangiectasias.
How does the patient contribute to the success of the treatment?
The affected person has a very important role in the control and evolution of their rosacea. The patient should follow the indicated treatment prescribed by their doctor and also:
- Avoid any situations that cause facial redness. It is helpful to note potential triggers to help identify aggravating factors.
- Use sunscreen daily with a 15 or higher sunscreen and avoid direct and prolonged sun exposure.
- Clean skin with soap-free mild cleansers.
- Avoid excessively oily cosmetics or cosmetics containing alcohol (lotions, tonics, perfumes, aftershaves).
Corticoids or other topical medications should not be used without prior consultation.
Diagnosis and treatment of rosacea in Valencia
• Dr. Gabriel Serrano Sanmiguel