Doctor's Notes on Rosacea
Rosacea is a chronic inflammatory condition affecting the central face of adults (rare in children). Signs and symptoms include red faces (may include the forehead, cheeks, chin, nose and occasionally, the eyelids.). Raised red bumps and pustules may occur. Over time, scarring and skin thickening may be present.
The cause of rosacea is unknown. However, some researchers note that affected individuals have an unusual amount of vascular hyperreactivity that results in intense and prolonged facial flushing when exposed to certain stimuli like drinking hot liquids and other stimuli. Over time, the flushing becomes permanent due to persistent enlargement of small facial blood vessels.
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.
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).
Is your skin itchy, oozing, or breaking out? Moles, rashes, hives, and eczema are just a few of the more than 3,000 skin disorders that affect people every day. Changes in color or texture can result from inflammation, infection, or allergic reactions anywhere on the body. Some skin conditions can be minor, temporary, and easily treated -- while others can be very serious, and even deadly. Read on to see signs and symptoms of the most common skin disorders and learn how to identify them.
Rosacea : Test Your Medical IQ QuizQuestion
Rosacea usually first appears on the ________.See Answer
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.