Rosacea

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Overview

Rosacea, sometimes called adult acne, is a chronic inflammation of the face of unknown cause and without a permanent cure. Four different types of rosacea have been described:

  • "Red face" rosacea, with a tendency to face flushing (or blushing), which can progress to a persistent redness of the nose or central face
  • "Acne"-like bumps and/or pus-filled lesions (papulopustular rosacea), with or without a red face or flushing
  • Rhinophyma – slow enlargement of oil glands and skin thickening of the nose and sometimes other face areas, usually in men
  • Eye problems (ocular rosacea), which may occur before skin changes – a burning or gritty feeling may be present as well as reddening of the eyes and lids

Who's at risk?

Adults between 30 and 60 are most often affected by rosacea; it is more common in women and in fair-skinned individuals, although dark-skinned people may also be affected. About 14 million Americans have rosacea. In most people rosacea comes and goes periodically; in some it gets worse with time.

Frequent triggers (things that increase face blood flow) of rosacea include sunlight, hot drinks, spicy foods, alcohol, exercise, hot baths or saunas, temperature extremes, and emotional stress. Prolonged use of cortisone creams on the face can also lead to rosacea. Some drugs may worsen flushing (nasal steroids, amiodarone, high doses of some B vitamins, tamoxifen, and rifampin).

Signs and Symptoms

  • Persistent or recurrent redness of the central face ("high color," "ruddy"), sometimes with swelling
  • Pimples or red bumps on the face (but no blackheads or whiteheads)
  • Red, bulb-shaped nose
  • Small blood vessels (or veins) on the central face
  • Burning or gritty feeling in eyes with or without red eyelids
Mild rosacea – occasional blushing and/or only rare pimples
Moderate rosacea – frequent blushing, persistent face redness and/or a few pimples almost all the time
Severe rosacea – lots of pimples or bumps all the time and/or red, uncomfortable eyes all the time and/or large bulbous nose and/or lots of blood vessels on the face, all of which can be bothersome in appearance

Self-Care Guidelines

Identify and minimize any exposure that triggers episodes of rosacea, such as:

  • Sunlight – use a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or more on your face.
  • Avoid drinking hot liquids and alcohol, eating spicy foods, and excessive heat exposure.
  • Protect the face in winter with a scarf or mask.
  • Avoid facial products with alcohol or other skin irritants (astringents, toners, sorbic acid, menthol, camphor), and use mild cleansers for the face.
  • Fair-skinned people may find a green- or yellow-tinted makeup helps to hide redness.
  • Cool compresses, gel masks, and central face massage may be of some benefit.
  • Benzoyl peroxide may help some people but can also be easily irritating to the skin.
  • Nicomide T is a combination of a vitamin (nicotinamide) and zinc available in cream and gel form, which may be helpful.
Eye rosacea can be treated with warm water compresses 2–4 times a day followed by gentle cleaning of the eyelid rims with baby shampoo on a Q-tip® and application of the topical antibiotic bacitracin/polymyxin B (but discontinue this if there is any worsening, as there can be rare allergic reactions to bacitracin).

When to Seek Medical Care

If you have severe changes in appearance or symptoms that interfere with your daily life, you should seek care. If you have severe, persistent flushing, there are other possible causes of flushing requiring laboratory tests; see your doctor.

Treatments Your Physician May Prescribe

  • Antibiotics - Topical antibiotics include creams or solutions with either metronidazole, erythromycin, sulfur, sodium sulfacetamide, azelaic acid, or benzoyl peroxide. If these are not helpful, oral antibiotics can be very effective (tetracyclines, erythromycin, ampicillin, or metronidazole).
  • Nicomide is a combination pill with niacinamide and zinc, which may help.
  • Isotretinoin is a strong medicine used for very severe cases of rosacea and has many side effects.
  • Surgical treatment with lasers or electrocautery can reduce the visibility of blood vessels and the extra nose tissue in rhinophyma.

Trusted Links

MedlinePlus: Rosacea

References

Bolognia, Jean L., ed. Dermatology, pp.545-551. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.688, 2364, 2412. New York: McGraw-Hill, 2003.