Rosacea

Rosacea (also called Acne Rosacea) is estimated to affect some 40 – 50 million people worldwide. It is often confused with – and can co-exist with common acne or seborrheic dermatitis. It is much more prevalent in women and people of north-western European descent, and usually peaks around the age of 30 – 50 years old. Heredity seems to play a role in the likelihood of developing the disease.

Many famous people have the disease and include ex-president Bill Clinton, J.P. Morgan (of JPMorgan Chase), W.C. Fields (see rhinophyma below), Rosie O’Donnell, and Mariah Carey.

Symptoms

Symptoms usually start with flushing and/or redness (erythema) on the central part of the face, including the cheeks, nose and forehead. Occasionally, it can also appear on the chest, ears, neck and scalp. As the disease progresses, additional symptoms can develop such as dilation of facial superficial blood vessels (telangiectasias); small, reddish colored bumps; burning or stinging sensations; and in more severe cases the disease can morph into a condition known as rhinophyma which is a reddish, lobulated nose.

In most cases, symptoms seem to come and go. Sufferers can experience periods of weeks, months or years where symptoms can disappear, and then just as suddenly reappear for extended periods of time.

Often times, this skin condition is confused with – and appears to look similar to acne vulgaris. This is the main reason why it is often referred to as “adult acne.” If left untreated, the disease tends to worsen over time.

One manifestation of the disease seen in about 50% of the people with the condition is a burning and dryness of the eyes; eyelid redness and scaling (conjunctivitis); and increased light sensitivity. This condition is referred to as ocular rosacea and if left untreated can lead to a serious eye complication called rosacea keratitis.

Although the cause of rosacea is still not clear, several factors are considered to contribute to the occurrence of this skin condition. Emotional duress (i.e. stress, fear, and anxiety), weather changes, temperature extremes, sun exposure, exercise, alcohol, spicy food, heredity, intestinal bacteria, caffeine, acne treatments, and topical steroids are suspected flare-up triggers.

Treatment

Since the disease seems to worsen over time, the sooner you seek treatment, the better success you will have in early control of the disease. A combined program of lifestyle changes (avoiding the triggers listed above) and medication/therapy is often the most effective course of treatment. Severity and progression of the skin condition will usually dictate a particular control therapy.

For redness, inflammation and bumps (papules, pustules), topical and/or oral antibiotics are usually the preferred choice by dermatologists. Topicals include medications like metronidazole or azelaic acid (Finacea or Skinoren gel). Sometimes alternating these two medications (one in the morning, the other at night) can prove quite effective.

Oral antibiotics can include tetracycline, doxycycline and minocycline. If the reddish bumps persist (severe cases), then low dosages of isotretinoin, a cystic acne medication may be prescribed.

Another treatment option for skin redness (erythema) is vascular laser (single wavelength) or Intense Pulsed Light (broad wavelength). Sometimes, several treatments over a period of several months can dramatically improve the appearance of your skin and may completely eliminate the redness. Periodic treatments are usually recommended to maintain long-term results.

One final option may be Photodynamic Therapy (PDT). This form of light (blue) therapy is enhanced with the use of a topical photosensitizer (aminolevulonic acid). Although not a conventional therapy option, some rosacea patients have reported periods of complete remission (months to years) from the disease following this treatment.

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