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Medical Author:

Gary W. Cole, MD, FAAD

Gary W. Cole, MD, FAAD

Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Ultimately, the cause of rosacea is unknown, but it is generally agreed that affected people have an unusual degree of vascular hyper-reactivity in that they tend to manifest vigorous and prolonged facial flushing in response to the ingestion of hot liquids. After a time, the flushing becomes permanent due to persistent enlargement of small facial blood vessels (telangiectasia).

It seems likely that genes also play some role in this condition. The frequency of rosacea has been estimated to be as high as 10% of an adult Swedish population. It is said to be most common among in those of Celtic ancestry and is less common in darkly pigmented races. In a recently published study, a family history of rosacea, smoking, and sensitivity to sunlight were the only significant predictive factors for rosacea.

Many people with rosacea seem to have a lowered threshold for facial irritation. This predisposition seems to be correlated with elevated levels of certain inflammatory chemicals and a defective barrier function of the skin. When the skin's normal barrier function is restored, levels of these inflammatory substances decrease to normal.

There seems to be no association between the presence of Helicobacter pylori (bacteria that cause inflammation and ulcer development) in the gastrointestinal tract and rosacea, as had been proposed by some authors.

Excessive use of potent topical steroids on facial skin can induce a rosacea-like condition. Although the relationship to rosacea is controversial, some people have facial follicles that are infested by a mite, Demodex folliculorum, which may cause signs and symptoms that are easily confused with rosacea. This diagnosis can be made by a physician and then treated successfully with appropriate topical medications (permethrin cream).

High levels of serum ferritin, an iron-carrying protein found in serum, may play a role in the exacerbation of certain cases of rosacea.

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