Rosacea

Cause

The cause of rosacea is unknown. The severity of rosacea can be influenced by external factors, making the symptoms increase. Examples are heat, sunlight, cosmetics, skin care products and some medicines. Medicines that contain corticosteroids (adrenal cortical hormones) can cause or worsen rosacea, both by internal use and when applied to the skin.
The role of food as a cause has never been demonstrated. But (temporary) worsening of redness may occur by drinking alcohol and eating spicy foods. Rosacea is not contagious.

Symptoms

The main signs and symptoms of rosacea are:

• Blush.
• Persistent redness in the face.
• Lumps.
• Pimples.
• Dilated blood vessels, which are visible as blotchy red rash on the skin.

These symptoms are especially visible at the cheeks, nose, forehead and chin. About half of the people with rosacea also suffer from eye diseases: inflammation of the eyelids, cornea and conjunctiva. This may cause, for example, dry or burning eyes, watery eyes and the sensation of sand in the eyes.
Apart from these symptoms, a person can also suffer from eczema, fluid retention in the skin (edema) and an increase in connective tissue in the skin, making the skin feel hard. The latter can, particularly in older men, lead to a ‘cauliflower nose’, but that’s rare. The skin can be extra sensitive to touch and external influences, such as heat.

Diagnosis

Usually, the doctor can easily recognize rosacea and no other examination is needed than the external inspection of the skin. All kinds of defects in the face, associated with redness, dilated blood vessels and/or papules, can sometimes cause confusion. Therefore, a skin biopsy will sometimes be required for microscopic tissue examination. In a single case, the dermatologist will do allergy tests to exclude an additional allergy for e.g. cosmetics.

Treatment

It’s not possible to cure rosacea. The treatment is focused on suppressing the symptoms. Upon lumps, pimples and/or eye symptoms, the following treatments are available:

• Lubricating with cream or gel. These are metronidazole cream, azelaic acid cream, sun-resistant creams and camouflage creams. Sometimes benzoyl peroxide gel is prescribed, a cure for acne.
• Tablets. Various drugs (including beta blockers) may be prescribed.
• Eye drops. In case of eye problems, artificial tear drops can help.

When there is a red thickened skin on the nose, laser treatment, freezing and plastic surgery are possible.

Prognosis

Although the symptoms of rosacea can be very nasty and cosmetically very inconvenient, rosacea is not a serious disease. Except in case of some eye defects, no complications occur. A satisfactory result is generally achieved with the treatments described above. Rosacea, however, has a tendency to come back after stopping the therapy with cream, gel, tablets or capsules. In most patients, the number of times that the disease flares up will reduce over years and also the severity of flare-ups will decrease.

Considerations

• Certain circumstances and factors worsen the symptoms of rosacea, for example: heat, cold, wind, hot drinks, effort, spicy foods, alcohol, emotions, skin cleansers, drugs that irritate the skin and drugs that cause or worsen blushing. If a person notices that one or more of these factors worsen the symptoms, it’s wise to avoid them.
• Use a good sunscreen (factor 30 or higher).
• Stay out of the wind, don’t go into a sauna or in a (very) hot shower.
• Adjust the diet.
• Don’t use make-up if this causes additional symptoms. There are camouflage creams that don’t irritate the skin.
• Don’t use skin cream with corticosteroids.

Facts

• The Latin word rosacea literally means ‘red as a rose’.
• The prevalence of rosacea is estimated at 4.5%.
• Women are more likely to have this condition than men.
• Rosacea occurs in adults from the age of 30 years.
• The condition is commonly seen in people originating from North-West Europe, especially in English, Scottish, Irish, Dutch, Belgian and French people.