Rosacea

In this article:

• What Is Rosacea?
• Types of rosacea
  • Subtype 1: Facial redness
  • Subtype 2: Acne-like breakouts
  • Subtype 3: Thickening skin
  • Subtype 4: In the eyes
• Symptoms
• When to see a doctor
• What causes rosacea?
• Risk factors for rosacea
• References

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What Is Rosacea?

Rosacea is a name of the face inflammatory condition, which is usually chronic with good and bad periods. While the location of the redness and rash is the same for everyone, the character of the skin inflammation can vary significantly from person to person, and also can change for the same person overtime.

In addition to the skin, the eyes can be affected. More than half of patients with rosacea have eye dryness, redness, tearing, tingling/burning sensation, foreign-body sensation, light sensitivity, and blurred vision.

Rosacea is not an infection. As a matter of fact, there are still debates between scientists on what exactly is causing this face inflammation. Genetics, immune reaction, microorganisms, environmental factors, and neurovascular dysregulation are among the known factors for the development of rosacea. In addition, it is known that ultraviolet (UV) exposure is a trigger for rosacea. 

Rosacea is annoying and difficult to get rid of, but overall, it does not cause other health problems. Rarely it can be associated with other diseases. Rosacea can cause significant anxiety, embarrassment, and depression and can have a significant impact on the quality of life. That is why it is important to see a dermatology specialist or a medical spa cosmetologist. While home remedies might work, the professional treatment still works better in many cases.

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Types of rosacea

Rosacea has many “faces”. There are four clinical subtypes of rosacea based on the predominant signs and symptoms: erythemato-telangiectatic, papulopustular, phymatous, and ocular. The subtypes are not mutually exclusive. Patients can present with features of multiple subtypes, and the predominant features and areas of involvement can change over time.

Based on the latest diagnostic guidelines by the National Rosacea Society Expert Committee, one of the following clinical presentations is considered diagnostic for rosacea:

1. Fixed centrofacial erythema in a characteristic pattern that may periodically intensify
2. Phymatous changes
3. Two of the following major criteria below are also considered diagnostic:
4. Flushing
5. Papules and pustules
6. Telangiectasia

Subtype 1: Facial redness

The erythematotelengiectatic subtype, which presents with persistent redness (erythema) with intermittent flushing of nose and cheeks, is usually the first clinical manifestation of rosacea.

Subtype 2: Acne-like breakouts

In the papulopustular form, patients present with eruptions of papules and pustules on the affected area on the face. This subtype is sometimes called “adult acne” due to the similarity in the appearance of lesions. Notably, rosacea lacks comedones, helping to differentiate it from true acne.

Subtype 3: Thickening skin

The phymatous subtype manifests with fibrosis and hypertrophy of sebaceous glands. It is typically seen on the nose of male patients (rhinophyma), but can also affect the cheeks, chin, and neck. Although phyma is typically a late manifestation of rosacea, cases with no prior skin changes have been reported. 

Subtype 4: In the eyes

Ocular rosacea presents with:

• Excessive tearing, 
• Dry eye, 
• Gritty sensation, 
• Intense itching (pruritus), 
• Eyelid gland blockage (hordeola and blepharitis).

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Symptoms

When to see a doctor

Rosacea is usually not life-threatening, but a life-destroying condition. The psychological discomfort with the red face can be so bad, it can cause depression and anxiety. If you feel you can not longer live with rosacea – see a dermatologist or cosmetician. They can offer plenty of treatment options.

If you are concerned that rosacea is only a tip of the iceberg, or a red flag of something wrong with your body – you can seek a Natural Doctor or a Functional Doctor. These practitioners might dig deeper and recommend global changes to what you eat or how you live. 

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What causes rosacea?

While rosacea is known for centuries, no one really knows what causes it. Recently, there is a lot of interest to the skin bacteria. Many scientists started paying attention to the little good bugs that live peacefully on our skin protecting us from all bad microbes and inflammation.

So, what we know is that rosacea does not affect everyone. There are certain factors that make you more or less susceptible to this condition:

1. Genetic
2. Nutrition and food allergies
3. Parasitic skin and gut infections. Demodex mites appear to play a role in rosacea as they are seen in higher numbers on rosacea-affected skin, though it is not clear if this is a cause or consequence of rosacea. Helicobacter pylori is another organism with reported association with rosacea (it resides in the stomach).
4. Neurovascular dysregulation
5. Autoimmune inflammation
6. Environmental toxins and exposures

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Risk factors for rosacea

As we discussed, doctors really do not know for sure who will develop rosacea and who will not. But there are some factors that tend to be true for the whole population:

1. It favors adults between 30 and 50 years of age 
2. Affects females more than males
3. It is more commonly diagnosed in individuals with fair skin, affecting more than 10% of Whites
4. Exposure to sunlight can be one of the triggers or causes
5. Good nutrition and probiotics seem to fix the problem or make it less pronounced
6. Extreme temperatures, spices, and alcohol bring up the rash and redness.

Stress is definitely involved. Now, it is difficult to say if stress leads to the development of the disease, or just makes it more pronounced.

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References:

Evidence-based update on rosacea comorbidities and their common physiologic pathways. Holmes AD, Spoendlin J, Chien AL, Baldwin H, Chang ALS. J Am Acad Dermatol. 2018 Jan;78(1):156-166. [PubMed]

Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. Marson JW, Baldwin HE. Int J Dermatol. 2020 Jun;59(6):e175-e182. [PubMed]

Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Thiboutot D, Anderson R, Cook-Bolden F, Draelos Z, Gallo RL, Granstein RD, Kang S, Macsai M, Gold LS, Tan J. J Am Acad Dermatol. 2020 Jun;82(6):1501-1510. [PubMed]

van Zuuren EJ. Rosacea. N Engl J Med. 2017 Nov 02;377(18):1754-1764. [PubMed]

Ahn CS, Huang WW. Rosacea Pathogenesis. Dermatol Clin. 2018 Apr;36(2):81-86. [PubMed]

Rainer BM, Kang S, Chien AL. Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017;9(1):e1361574. [PMC free article] [PubMed]

Gravina A, Federico A, Ruocco E, Lo Schiavo A, Masarone M, Tuccillo C, Peccerillo F, Miranda A, Romano L, de Sio C, de Sio I, Persico M, Ruocco V, Riegler G, Loguercio C, Romano M. Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United European Gastroenterol J. 2015 Feb;3(1):17-24. [PMC free article] [PubMed]

Wang YA, James WD. Update on rosacea classification and its controversies. Cutis. 2019 Jul;104(1):70-73. [PubMed]

Helm KF, Menz J, Gibson LE, Dicken CH. A clinical and histopathologic study of granulomatous rosacea. J Am Acad Dermatol. 1991 Dec;25(6 Pt 1):1038-43. [PubMed]

Del Rosso JQ. Adjunctive skin care in the management of rosacea: cleansers, moisturizers, and photoprotectants. Cutis. 2005 Mar;75(3 Suppl):17-21; discussion 33-6. [PubMed]

Bhat YJ, Manzoor S, Qayoom S. Steroid-induced rosacea: a clinical study of 200 patients. Indian J Dermatol. 2011 Jan;56(1):30-2. [PMC free article] [PubMed]