Rosacea can be defined as a chronic condition that occurs at the level of the skin, being characterized by a number of characteristic changes. As you will have the opportunity to read below, there are a number of rosacea symptoms that point towards the diagnosis. It is important to understand and remember that this condition can be diagnosed in people of various ages but it is more common indeed in women. Despite extensive studies, the exact cause of rosacea has yet to be identified; however, a number of triggering factors have been identified. As for the treatment, this depends on how severe the condition actually is.
Rosacea Subtypes & Symptoms
According to the specialists in the field, rosacea can be classified into four different subtypes, each with its own set of rosacea symptoms. These are presented in detail, in the paragraphs that follow.
First subtype (Erythematotelangiectatic Rosacea)
- Permanent facial redness (also known as erythema)
- The person blushes more easily in comparison to other people (flushing)
- The superficial blood vessels at the level of the skin are dilated, being more visible than normal (telangiectasia)
- One might report a burning or stinging sensation
- Itchiness might be present among the symptoms
- Dryness, flakiness and increased sensitivity at the level of the skin
- The condition can extend beyond the face, affecting other areas of the body (scalp, neck, ears, upper back, thorax)
Second Subtype (Papulopustular Rosacea)
- Permanent facial redness
- The person might present papules on the skin, with an intense red color
- It is possible that pustules filled with purulent material also appear at the level of the skin (these are present on the skin for a couple of days)
- Because of the presentation, the condition might be wrongfully diagnosed as acne
Third Subtype (Phymatous Rosacea)
- Nose enlargement (rhinophyma)
- The skin at the level of the nose might become thickened and exhibit an irregular surface, due to the granulomatous infiltration
- Other parts of the face can present similar changes (chin, forehead, cheeks, eyelids and even ears)
- The person might also present dilated blood vessels (telangiectasias)
Fourth Subtype (Ocular Rosacea)
- Affectation of the ocular area (eyes and eyelids)
- Redness and inflammation
- Dilated blood vessels (telangiectasias)
- Dryness and irritation present as part of the symptomatology
- The person might describe the sensation of having a foreign body in the eye
- Burning or stinging sensation
- Increased sensitivity to light (photophobia)
- Increased risk of infection at the level of the affected eye/eyelid
- May progress to affect the cornea; in this case, the person will suffer from impaired vision and even complete vision loss.
Rosacea and Chronic Disease
A study undertaken in 2015, by the specialists at John Hopkins University, managed to demonstrate that rosacea is present in patients who suffer from various chronic systemic disorders (such as cancer, heart conditions or even allergies). The study analyzed the medical history of patients who suffered from rosacea, in comparison to those who did not have such a diagnosis. It was discovered that rosacea is found in association with chronic disorders, such as: allergies, asthma, GERD,
hypertension, diabetes, urinary tract infections and hormonal disorders.
The same study revealed that more severe cases of rosacea are found in patients who present serious chronic conditions, such as cardiovascular disease, diabetes or metabolic syndrome. Moderate/severe rosacea is also more common in those who have high cholesterol levels, hypertension or gastroesophageal reflux.
An interesting connection was made between the appearance of skin cancer and rosacea. The study demonstrated that cancerous lesions at the level of the skin are more common in patients who have been diagnosed with mild forms of rosacea (as opposed to moderate or severe). Knowing all of these associations is important, especially when it comes to making the difference between specific rosacea symptoms and manifestations of the underlying chronic condition.
How is Rosacea Treated?
As it was mentioned at the beginning of the article, the treatment of rosacea depends on the severity of the condition and also on the subtype. It is worth mentioning that there is no treatment that can actually cure rosacea, with the solutions presented below being employed for the management of the condition.
1. Avoidance of Triggering Factors
The symptoms of rosacea can be triggered by a number of factors, including the exposure to extreme temperatures/sun, feeling stressed or eating certain foods. Medication can induce rosacea manifestations, as well as caffeine-based beverages and feelings of anxiety. The avoidance of triggering factors can be one of the best methods of keeping the condition under control.
Antibiotic treatments, whether administered orally or topically, can keep the symptoms of rosacea under control. Tetracycline and doxycycline might be prescribed, as they can reduce the inflammation and eliminate any lesions present at the level of the face. AHA acids can help with the facial redness and also make any papules or pustules less visible, while topical alpha agonists are recommended for the flushing.
One of the most common alpha agonists recommended for patients suffering from rosacea is brimonidine. According to a study undertaken by the Charles Institute of Dermatology (University College Dublin), the topical brimonidine gel is one of the most effective methods of managing the manifestations of rosacea. Acting as a vasoconstrictor, it improves the general aspect of the skin, eliminating the facial redness and making the dilated blood vessels less visible.
In trying to identify the exact cause of rosacea, a number of theories have been proposed. One of the theories placed the cause of rosacea in being the overgrowth of microscopic mites at the level of the skin. All healthy people present these mites on the skin (Dermodex); however, in patients with rosacea, these are believed to proliferate and cause all of the above-mentioned problems. As a study presented in The British Journal of Dermatology has pointed out, Ivermectin might improve the symptoms of patients who suffer from rosacea (thus confirming the mite theory).
Ivermectin is commonly administered in patients who suffer from lice but it does wonders on those who have rosacea. It seems that its efficiency has been connected to its anti-inflammatory and anti-parasitic properties. The study compared the topical application of Ivermectin with the one of Metronidazole; it was discovered that Ivermectin allowed for a more efficient management of rosacea manifestations, in comparison to Metronidazole. Patients also presented fewer side-effects, tolerating the administration of Ivermectin in a more effective manner.
The laser-based treatment has been shown to be particularly effective in patients diagnosed with rosacea, whether we are talking about the single wave-length or intense pulsed light technology. Patients require several sessions in order to notice the first results and, in time, the facial redness can be eliminated altogether. The treatment might have to be repeated from time to time, so as to address new manifestations (dilated blood vessels).
In 2014, experts belonging to the American Academy of Dermatology have spoken about probiotics having a potential benefit to offer for patients with rosacea. After extensive studies, it was demonstrated that regular probiotic use might help patients suffering from this chronic skin condition to have clearer skin. The application of topical probiotics has been shown to improve the redness, as well as any lesions present on the skin; this is because these are capable of modulating the response of the immune system, making it less aggressive on the skin.
As for oral probiotics, these work by reducing the inflammation at the level of the gastrointestinal tract, which we all know to be responsible for flare-ups at the level of the skin. Patients were recommended to include more foods that contain live active cultures in their diets or take daily probiotic supplements (as adjuvants to the existent treatment for rosacea).
5. Topical Kanuka Honey
A study undertaken by a team of scientists in New Zealand and published online (BMJ Open), demonstrated that a topical solution containing medical-grade kanuka honey (90%) and glycerin (10%) can serve as treatment for rosacea. The study was performed on 138 people who were diagnosed with this chronic skin condition and kanuka honey was chosen as a potential topical treatment, given its anti-bacterial and anti-inflammatory properties. The idea of choosing this solution was based on the infection theory as well and also on the fact that inflammation is one of the manifestations of rosacea. The administration of this topical solution improved the symptomatology experienced by patients with rosacea, being well-tolerated.
When it comes to rosacea symptoms, it is important not to rush into making a diagnosis. Instead, it is recommended to take the medical history of the patient and perform the pertinent investigations for a correct diagnosis. As for the treatment, as you have seen, there are a number of solutions available for keeping the condition under control. The current research is encouraging and, hopefully, scientists will be able to come up with a cure for rosacea in the near future. In the meantime, it is highly important to avoid triggering factors, especially the chronic or prolonged exposure to the sun or extreme temperatures (quite harmful for the skin).