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What Is Rosacea?

  • Rosacea (commonly referred to as adult acne) is a chronic inflammatory condition affecting the central face of adults (it is rare in children) and manifested by redness of the forehead, eyelids, cheeks, nose, and chin.
  • Rosacea is often accompanied by inflammatory papules (raised bumps) and pustules (bumps containing pus), or rarely with enlargement of the connective tissues beneath the skin (termed phymatous rosacea), including the nasal tissues (known as rhinophyma).

What Causes Rosacea?

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 a number of stimuli including 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 genetic factors 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 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 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.

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).

What Are the Symptoms and Signs of Rosacea?

People with rosacea have red faces often accompanied by inflammatory papules and pustules. The skin changes can be similar to acne, but comedones (blackheads) are not present. Occasionally, the eyelids and conjunctiva (lining of the eye) can become involved, resulting in eye irritation and rarely chronic corneal damage. Rarely, there is fibrosis (scarring) of the connective tissue of the facial skin associated with hypertrophy (enlargement) of the sebaceous glands, resulting in a thickened appearance. Thickening of the skin of the nose (rhinophyma) can be cosmetically debilitating.

When Should I Call the Doctor about Rosacea?

Adults with persistently red facial skin associated with red bumps (papules and pustules) should visit a physician. This is especially true if the eyelids are involved.

How Is Rosacea Diagnosed?

The correct diagnosis requires the presence of persistent facial redness that may be accompanied by inflammatory papules and pustules. There are no confirmatory laboratory tests to diagnose rosacea, although occasionally a skin biopsy will be necessary to support the diagnosis.

Rosacea may be confused with a variety of other conditions, including systemic lupus erythematosus, seborrheic dermatitis, commonly cutaneous sarcoidosis. Since the diagnosis of rosacea depends upon its clinical appearance, it may be necessary to perform certain laboratory tests to exclude some of these other conditions.

Medically Reviewed by a Doctor on 11/22/2016

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