Rosacea

Rosacea. Left untreated, rosacea can get worse.
Rosacea (rose-AY-sha) is a common skin disease. It often begins with a tendency to blush or flush more easily than other people.
The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be red all the time.
Rosacea can cause more than redness. There are so many signs and symptoms that rosacea has four subtypes:

• Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels.
• Papulopustular rosacea: Redness, swelling, and acne-like breakouts.
• Phymatous rosacea: Skin thickens and has a bumpy texture.
• Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty.

With time, people who have rosacea often see permanent redness in the center of their face.
Famous faces of rosacea
If you are living with rosacea, you are in good company. Some famous people have struggled with rosacea:

• Rosacea can affect quality of life. Rosacea can affect more than the skin and eyes. Because rosacea is a chronic (long-lasting) skin disease, it can reduce a person’s quality of life. Many people report problems at work, in their marriage, and with meeting new people. Surveys and studies report that living with rosacea can cause:
• Feelings of frustration and embarrassment: In surveys conducted by the National Rosacea Society, 41 percent said their rosacea caused them to avoid public contact or cancel social engagements.
• Worry: People worry that their rosacea will get worse or cause scars. People worry about side effects from medicine used to treat rosacea.
• Low self-esteem: Surveys conducted by the National Rosacea Society found that almost 70 percent of people living with rosacea said that the condition lowered their self-confidence and self-esteem.
• Work-related problems: Surveys conducted by the National Rosacea Society find that when rosacea is severe, 70 percent of people say the disease affects their interactions at work. Nearly 30 percent say that rosacea causes them to miss work.
• Anxiety and depression: Living with a skin condition that flares unexpectedly can cause people to believe you have a drinking problem. This can cause anxiety and depression.

Treatment seems to improve a person’s quality of life. Studies show that when people have fewer signs and symptoms of rosacea, their quality of life improves.

Who gets rosacea?

Rosacea is common. According to the U.S. government, more than 14 million people are living with rosacea. Most people who get rosacea are:

• Between 30 and 50 years of age.
• Fair-skinned, and often have blonde hair and blue eyes.
• From Celtic or Scandinavian ancestry.
• Likely to have someone in their family tree with rosacea or severe acne.
• Likely to have had lots of acne — or acne cysts and/or nodules.

Women are a bit more likely than men to get rosacea. Women, however, are not as likely as men to get severe rosacea.
Some people are more likely to get rosacea, but anyone can get this skin disease. People of all colors get rosacea. Children get rosacea.

What causes rosacea?

Scientists are still trying to find out what causes rosacea. By studying rosacea, scientists have found some important clues:

• Rosacea runs in families. Many people who get rosacea have family members who have rosacea. It is possible that people inherit genes for rosacea.
• The immune system may play a role. Scientists found that most people with acne-like rosacea react to a bacterium (singular for bacteria) called bacillus oleronius. This reaction causes their immune system to overreact. Scientists still do not know whether this can cause rosacea.
• A bug that causes infections in the intestines may play a role. This bug, H pylori, is common in people who have rosacea. Scientists cannot prove that H pylori can cause rosacea. Many people who do not have rosacea have an H pylori infection.
• A mite that lives on everyone’s skin, demodex, may play a role. This mite likes to live on the nose and cheeks, and this is where rosacea often appears. Many studies found that people with rosacea have large numbers of this mite on their skin. The problem is some people who do not have rosacea also have large numbers of this mite on their skin.
• A protein that normally protects the skin from infection, cathelicidin, may cause the redness and swelling. How the body processes this protein may determine whether a person gets rosacea.

Diagnosis, treatment, and outcome

How do dermatologists diagnose rosacea?

To diagnose rosacea, a dermatologist examines the skin and eyes. Your dermatologist also will ask questions.

How do dermatologists treat rosacea?

To treat rosacea, a dermatologist first finds all of the patient’s signs and symptoms of rosacea. This is crucial because different signs and symptoms need different treatment.

Treatment for the skin includes:

• Medicine that is applied to the rosacea.
• Sunscreen (wearing it every day can help prevent flare-ups).
• An emollient to help repair the skin.
• Lasers and other light treatments.
• Antibiotics (applied to the skin and pills)

Dermatologists can remove the thickening skin that appears on the nose and other parts of the face with:

• Lasers.
• Dermabrasion (procedure that removes skin).
• Electrocautery (procedure that sends electric current into the skin to treat it)

When rosacea affects the eyes, a dermatologist may give you instructions for washing the eyelids several times a day and a prescription for eye medicine.

Outcome

There is no cure for rosacea. People often have rosacea for years.
In one study, researchers asked 48 people who had seen a dermatologist for rosacea about their rosacea. More than half (52 percent) had rosacea that came and went. These people had had rosacea for an average of 13 years. The rest of the people (48 percent) had seen their rosacea clear. People who saw their rosacea clear had rosacea for an average of 9 years.

Some people have rosacea flare-ups for life. Treatment can prevent the rosacea from getting worse. Treatment also can reduce the acne-like breakouts, redness, and the number of flare-ups.

To get the best results, people with rosacea also should learn what triggers their rosacea, try to avoid these triggers, and follow a rosacea skin-care plan.
If you believe that you might have rosacea or have been diagnosed with rosacea, the following tips can help:
See a dermatologist. This is important for the following reasons:

• When treatment begins at the first sign of rosacea, treatment often controls the disease. Control means that you will not see the rosacea. You also will not feel the symptoms such as burning and itching.
• Treating rosacea early also can stop it from getting worse. Rosacea can be more difficult to treat if it gets worse.
• Rosacea may not go away on its own and tends to worsen over time.
• Different types of rosacea require different types of treatment.
• Treatment available without a prescription can make rosacea worse. Some of these treatments contain ingredients that can cause rosacea to flare.

Learn what triggers your rosacea. Many everyday things can cause rosacea to flare. These include sunlight, stress, and many foods and beverages.

What causes one person’s rosacea to flare may not trigger a flare-up for another person. This is why dermatologists recommend that patients with rosacea learn what triggers their flare-ups. Avoiding these triggers can reduce flare-ups.

Follow a rosacea skin-care plan. Skin care plays an important role in keeping rosacea under control. Many skin care products are too harsh. This can make rosacea worse.