Rosacea, misnamed acne rosacea, is a chronic skin disease, usually affecting the middle aged and affecting the flush area of the face. Rosacea is characterized by red color, dilated superficial blood vessels and reddish or pus filled bumps.
Rosacea affects females more than males, though the severity of the disease is found to be more in males. The centre of the face, nose, chin and forehead are typically affected in rosacea. Some times eyes are also affected, with redness, watering or even corneal ulceration. Thickening of the nose known as rhinophyma causes marked deformity in some patients.
What is the Cause of Rosacea?
The exact cause of rosacea is still not clear. There seems to be a genetic predisposition to abnormal reactivity of blood vessels in the facial skin, which may be triggered by sun exposure and hair follicle infestation with the mite known as Demodex follicularum. Other causes cited are- reactivity caused by gastrointestinal diseases including infection with H.pylori and some medications that cause dilatation of blood vessels.
How is Rosacea Different from Acne?
Due to the resemblance to acne lesions, rosacea is also known as acne rosacea, a misnomer. The following are the main differences between acne and rosacea:
- Acne is a disease of teenage, while rosacea affects the middleaged (30-50 years)
- Acne sufferers usually grow out of the acne, while rosacea starts and remains through adult life.
- Rosacea usually affects the fair skinned but acne affects all skin types
- There are hormonal causes for acne, but no such etiology is elicited in rosacea.
- Black heads and whiteheads are hallmarks of normal acne, while these are not seen in rosacea.
- In rosacea the underlying skin is red and dilated blood vessels can be seen . The skin in acne around the pimples are usually normal.
What are the Triggering/Aggravating Factors of Rosacea?
Anything that increases the body heat and dilates blood vessels on the facial skin can act as a trigger or aggravating factor in rosacea. Direct exposure to sun light is the worst aggravating factor of rosacea. Other major aggravating factors are alcohol, extreme heat and cold, hot and spicy food, hot coffee, topical steroid applications, vasodilator drugs used to treat conditions like high blood pressure etc. People who have rosacea and migraine both have been found to have exacerbation of the rosacea during a migraine attack. Stress is thought to be a major triggering and aggravating cause for rosacea.
What is the Treatment for Rosacea?
- The first step of course is the avoidance of triggers as outlined above.
- Oral Tetracyclines, especially Doxycycline is very effective in controlling the acute attacks of rosacea.
- Metronidazole, as topical gel and cream and oral metronidazole are particularly effective in the treatment of rosacea.
- Oral isotretinoin has proved effective in many resistant cases, but is not a first line treatment.
- Laser treatment is effective in getting rid of the dilated blood vessels and reducing the redness and bumps.
Rosacea Management Tips
- Regular sun protection is mandatory for rosacea patients
- Avoid hot, spicy food . Alcohol is strictly forbidden
- Use a regular stress management program
- Topical steroid creams should be avoided on the face
- Overzealous cleansing can worsen rosacea. Clean the face with a mild soap and normal tap water twice daily.
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