Rosacea: Causes, Diagnosis and Management

Rosacea is a common medical condition which affects the skin of the face. The blood vessel of the face becomes visible causing redness and there can be the presence of the pus-filled bumps also. This is untreatable condition and the symptoms appear for a period of weeks or months and then disappear for a while and they appear again later but the condition can be managed and controlled to reduce the duration and intensity of the symptoms.

It can occur in anyone but it usually affects the women belonging to the middle age having fair skin.

According to the US government, there are more than 14 million people living with this condition.

Signs and Symptoms of Rosacea

It usually affects the middle third of the face.

• Reddening of face: The central third of your face that is skin over the nose and the cheeks becomes red due to the dilation of the small blood vessels. The skin can also become swollen, sensitive to touch
• Acne like bumps: Many people suffering from rosacea develops bumps like swelling over the face similar to acne. They can be painful or filled with the pus and sometimes there are raised plaques
• Eye Problems: it usually affects about half the people suffering from rosacea. The eyes are either watery or dry having burning sensation. Patient becomes sensitive to the light.
• Thickening of skin leading to the enlargement of the skin: Skin becomes thicken especially that of nose. Thus, the nose become bulbous and medically it is known as rhinophyma.

The symptoms are so diverse the rosacea can be confused easily with allergy, sunburn or acne

Causes of Rosacea

The cause of rosacea is not known but the studies shows that the condition depends upon both the genetic as well as environmental factors. Contrast to belief of many people, it is not due to poor hygiene but there are number of factors that can worsen your symptoms like

• Drinking alcohol
• Eating spicy food
• Emotional stress
• Exposure to extreme of temperatures, sunlight
• Having the intestinal bacteria Helicobacter pylori
• Risk factors for Rosacea
• Not everyone develops rosacea but the following factors make you more prone to it
• Being a woman belonging to the middle age
• Having fair skin
• Family history
• Smoking

Complications of Rosacea

If rosacea is left unmanaged, the severity and frequency of the symptoms increases. The complications include

• Increase in the size of the sebaceous gland
• Conjunctivitis and development of cysts in the eyelids
• The signs and symptoms can spread beyond the facial skin extending to the ears, neck or the back

Diagnosis of Rosacea

Your doctor will use your medical history and the skin examination to make out any diagnosis. No test is required to male out the diagnosis but test can be used to rule out any other conditions which looks similar to rosacea like lupus, psoriasis or eczema

Medical history: your doctor will ask you certain questions about your signs and symptoms whether they are occurring cyclically or not.

Physical examination: Your doctor or dermatologist will look for the affected skin of the face. In unusual conditions a biopsy may be required in which some tissue of the skin is taken out and studied

Medical tests: They are only required when your dermatologist is suspecting another disease to be the cause of the patient’s symptoms.

Management of Rosacea

Since the rosacea is untreatable therefore the goal of the treatment is to reduce the symptoms and limiting the worsening of the symptoms. The management includes medications, laser therapy, lifestyle changes and reducing the triggers. Your doctor will recommend you the most appropriate treatment plan based on the severity and type of the symptoms.

Medications: Mild rosacea may not require treatment unless it is bothering the patient. The choice of medications depends upon the type of the symptoms like

• Topical medications to reduce the redness, your doctor can prescribe you Brimonidine gel and oxymetazoline hydrochloride cream to apply on the affected part of the skin. It reduces the redness for 12 hours by constricting the vessels. Azelaic acid and some topical antibiotics like metronidazole gel, also be used to reduce the redness as well as acne like breakouts
• Oral antibiotics: They can be prescribed in moderate rosacea and includes tetracycline, low dose doxycycline or minocycline. They work by reducing the inflammation.
• Topical steroids: Sometimes short course of topical steroids can be prescribed to reduce the inflammation but long-term course is always avoided.
• Isotretinoin: It is infrequently prescribed for the rosacea but clinicians might suggest it when other therapies are failing. It cannot be given in pregnancy

Laser or intense pulsated light therapy: Therapy treat the visible blood vessels and requires multiple clinical visits. Some patient found it discomforting.

Lifestyle changes: Some modifications in your lifestyle can help you controlling the symptoms like

• Using over the counter skin cleansers which are not harsh like soaps
• By knowing and avoiding the triggers which increases your symptoms
• Using sun protections cream or wide brimmed hat because sunlight can trigger your rosacea

References:

• Dahl MV. Rosacea: Pathogenesis, clinical features and diagnosis
• Goldsmith LA, et al., eds. Rosacea. In: Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York, N.Y. 
• Questions and answers about rosacea. National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Aldrich N, et al. Genetic vs environmental factors that correlate with rosacea: A cohort-based survey of twins. JAMA Dermatology.
• https://www.aad.org