Rosacea is more common in women than men, but in men, the symptoms can be more severe. It can also become progressively worse.
Leaving it untreated can cause significant damage, not only to the skin, but to the eyes as well. Since rosacea is a vascular disorder, it can cause the small blood vessels on your nose and cheeks to swell. Without treatment, these can become prominent — and permanent.
Small red solid bumps or pus-filled pimples resembling acne develop. However, unlike acne, rosacea does not cause blackheads. Affected skin may burn, sting, or feel tight. Rosacea can cause the skin to thicken on the nose, giving it a bulbous appearance. This is more common in men than women. The bumps and pimples, as well as skin thickening, that accompany rosacea cause pores to enlarge and become more visible.
Although rosacea can affect all segments of the population and all skin types, individuals with fair skin who tend to flush or blush easily are believed to be at greatest risk. The disorder is more frequently diagnosed in women, but tends to be more severe in men. There is also evidence that rosacea may tend to run in families, and may be especially prevalent in people of northern or eastern European descent. In surveys by the National Rosacea Society NRS , nearly 90 percent of rosacea patients said this condition had lowered their self-confidence and self-esteem, and 41 percent reported it had caused them to avoid public contact or cancel social engagements.
Among those with severe rosacea, nearly 88 percent said the disorder had adversely affected their professional interactions, and nearly 51 percent said they had even missed work because of their condition. The good news is that well over 70 percent reported medical treatment had improved their emotional and social well-being.
While the cause of rosacea is unknown and there is no cure, knowledge of its signs and symptoms has advanced to where they can be effectively controlled with medical therapy and lifestyle changes. Individuals who suspect they may have rosacea are urged to see a dermatologist or other qualified physician for diagnosis and appropriate treatment — before the disorder becomes increasingly severe and intrusive on daily life. Rosacea can vary substantially from one individual to another, and in most cases some rather than all of the potential signs and symptoms appear.
According to a consensus committee and review panel of 28 medical experts worldwide, diagnosis requires at least one diagnostic sign or two major signs of rosacea. In rare cases, rosacea signs and symptoms may also develop beyond the face, most commonly on the neck, chest, scalp or ears. Although the cause of rosacea remains unknown, researchers have now identified major elements of the disease process that may lead to significant advances in its treatment.
Recent studies have shown that the facial redness is likely to be the start of an inflammatory continuum initiated by a combination of neurovascular dysregulation and the innate immune system. The role of the innate immune system in rosacea has been the focus of groundbreaking studies funded by the NRS, including the discovery of irregularities of key microbiological components known as cathelicidins.
Further research has now demonstrated that a marked increase in mast cells, located at the interface between the nervous system and vascular system, is a common link in all major presentations of the disorder. Beyond neurovascular and immune system factors, the presence of a microscopic mite called Demodex folliculorum has been considered as a potential contributor to rosacea. This mite is a normal inhabitant of human skin, but has been found to be substantially more abundant in the facial skin of rosacea patients.
Researchers have also discovered that two genetic variants of the human genome may be associated with the disorder. Other recent studies that have found associations between rosacea and increased risk for a growing number of potentially serious systemic diseases, suggesting that rosacea may be an outcome of systemic inflammation.
Although causal relationships have not been determined, these have included cardiovascular disease, gastrointestinal disease, neurological and autoimmune diseases and certain cancers.
Because the signs and symptoms of rosacea vary from one patient to another, treatment must be tailored by a physician for each individual case. Helicobacter pylori seropositivity has been associated with various dermatologic disorders, including rosacea. Several studies have demonstrated high prevalence rates of H pylori in rosacea patients, some even in comparison with age- and sex-matched controls. Laboratory studies and histopathologic examination via skin biopsy may be needed to differentiate between rosacea and rosacealike conditions.
Common Rosacealike Conditions. Systemic lupus erythematosus SLE is a chronic inflammatory disease that has protean clinical manifestations and follows a relapsing and remitting course. The affected skin generally feels warm and appears slightly edematous.
The erythema may last for hours to days and often recurs, particularly with sun exposure. The malar erythema of SLE can be confused with the redness of erythematotelangiectatic rosacea. Nevertheless, the color of the skin in SLE has a violaceous quality and may show a more abrupt cutoff, especially at its most lateral margins. Marzano et al 15 reported 4 cases in which lupus erythematosus was misdiagnosed as rosacea.
All 4 patients presented with erythema that was localized to the central face along with a few raised, smooth, round, erythematous to violaceous papules over the malar areas and the forehead. This presentation evolved rapidly and was aggravated by sun exposure. The patients were all treated with medication for rosacea but showed no improvement.
These patients originally presented with limited skin involvement in the absence of any systemic sign or symptoms of SLE. Dermatomyositis DM is an inflammatory myopathy characterized by varying degrees of muscle weakness and distinctive skin erythema Figure 1 ; however, some patients lack muscular involvement and initially present with skin manifestations only. Sontheimer16 described criteria for defining skin involvement in DM. With the exception of the heliotrope rash, facial erythema has drawn little attention in prior studies of DM-associated skin manifestations.
Therefore, Okiyama et al17 performed a retrospective study on the skin manifestations of DM in 33 patients. The investigators observed that MVE in the seborrheic area of the face was most frequent. Figure 1. Macular violaceous erythema of the face in a patient with dermatomyositis. Rosacea is a chronic disorder, rather than a short-term condition, and is often characterized by relapses and remissions.
A retrospective study of 48 previously diagnosed rosacea patients found that 52 percent still had active rosacea, with an average ongoing duration of 13 years.
The remaining 48 percent had cleared, and the average duration of their rosacea had been nine years. While at present there is no cure for rosacea, its symptoms can usually be controlled with medical therapy and lifestyle modifications.
Moreover, studies have shown that rosacea patients who continue therapy for the long term are less likely to experience a recurrence of symptoms. As with most disorders, there is no formal medical specialty devoted to rosacea alone.
The appropriate specialist for rosacea is a dermatologist, who specializes in diseases of the skin, or for those with eye symptoms, an ophthalmologist. Visit the Physician Finder section to identify a dermatologist or ophthalmologist in your area.
As a member of the National Rosacea Society NRS , from time to time you may be given an opportunity to participate in research to help improve treatment or patient care.
If you have not done so, this is one more reason to join the NRS today. Although the incidence of rosacea in adolescents and children is infrequent, such cases have been documented in the medical literature. Eyelid styes may be one form. Rosacea often runs in families , and rosacea sufferers would be wise to be on the lookout for early signs in children in order to seek diagnosis and treatment before the condition worsens. The National Rosacea Society is the world's largest support organization for rosacea, offering information and educational services to hundreds of thousands of rosacea patients and health professionals each year.
While face-to-face support groups are not well established, rosacea sufferers can find online chat groups and forums through Facebook and rosacea-support. Facial burning, stinging and itching are commonly reported by many rosacea patients. Certain rosacea sufferers may also experience some swelling edema in the face that may become noticeable as early as the initial stage of the disease. The same flushing that brings on rosacea's redness can be associated with a build-up of fluid in the tissues of the face.
It often occurs above the nasolabial folds — the creases from the nose to each side of the mouth — and can cause a "baggy cheek" appearance. It is also believed that in some patients this swelling process may contribute to the development of excess tissue on the nose rhinophyma , causing it to become bulbous and bumpy.
If you experience any of these symptoms, discuss them with your physician. For a complete description of the signs and symptoms of rosacea, visit the All About Rosacea page. Rosacea can present itself in different ways for different individuals. Rosacea patients may exhibit varying levels of severity of symptoms over different areas of the face.
Patients have often reported that the disorder actually began with a red spot or patch on one cheek or another part of the face, and then spread to other areas. On the other hand, many rosacea patients exhibit similar symptoms on both sides of their faces. Rosacea and regular acne, called acne vulgaris, usually appear separately, but some patients are affected by both.
While both conditions in adults are often informally referred to as "adult acne," they are two separate diseases , each requiring different therapy. Acne vulgaris is associated with plugging of the ducts of the oil glands, resulting in blackheads and pimples on the face and sometimes also the back, shoulders or chest.
Rosacea seems to be linked to the vascular network of the central facial skin and causes redness, bumps, pimples and other symptoms that rarely go beyond the face. Special care is necessary in treating patients with both conditions because some standard medications for acne vulgaris can make rosacea worse. It has been estimated that approximately half of all rosacea sufferers may appear to experience dry skin. With treatment, this dryness often eases along with disappearance of papules and pustules.
To combat dry, flaky skin, use a moisturizer daily after cleansing and applying medication. You also may wish to check with your dermatologist to see which medication is best for your skin type, since some have a drying effect and others are more moisturizing.
There is no standard skin type for rosacea patients. Many sufferers experience dry, flaky skin, while others may have normal or oily skin, or both. The key is to identify your skin type and use medication and skin-care products that are suitable for you.
It is not unusual for seborrheic dermatitis to appear concurrently with rosacea. Seborrhea manifests as reddish-yellow greasy scaling in the central third of the face. Scalp, eyebrows and beard may have fine flakes of white scale, dandruff or patches of thicker, greasy yellow scale. Eruptions may also appear beyond the face. To learn more, visit the Seborrhea page. No, nothing in the medical literature links rosacea and atopic dermatitis, or eczema. The two diseases may share some symptoms, but also have many differences.
Rosacea is more common in fair-skinned individuals and nearly always affects the face only, causing such signs and symptoms as redness, visible blood vessels, bumps and pimples and sometimes swelling of the nose from excess tissue.
Atopic eczema is more common in individuals with dry skin and can appear in various areas of the body, producing red scaling and crusted or weeping pustules that itch fiercely. However, a recent NRS survey found than 55 percent of rosacea patients said they had experienced another skin disorder.
Discoid lupus is a chronic, scarring skin disease. Another form, systemic lupus, is characterized by a variety of signs, including some in the vascular system. Because lupus can cause a reddish skin rash that spreads across the bridge of the nose and face, often in a butterfly pattern, it can appear similar to rosacea. However, while both rashes can be smooth in texture, the presence of bumps and pimples, which rarely occur in a lupus flare, may help differentiate the diseases.
In addition, lupus is almost always accompanied by other symptoms not associated with rosacea, such as fever, arthritis and signs of renal, lung or heart involvement. A dermatologist can usually quickly tell the difference between a butterfly rash of lupus and rosacea. Moreover, unlike lupus, as many as 50 percent of rosacea patients may also have ocular signs. Visually, an eye affected by rosacea often appears watery or bloodshot. Sufferers may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.
No medical evidence has linked rosacea directly with skin cancer. Rosacea sufferers may be more likely to develop skin cancer later in life because of their frequent light complexions and propensity to injury from ultra-violet radiation from the sun. It is important that you consult your dermatologist if you have any signs of possible skin cancer, such as a mole that is enlarged or asymmetric or that has an irregular border or varying color. Although unrelated to rosacea, skin cancer is a potentially fatal disease whose incidence has been on the rise.
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