Everything you need to know about Rosacea

The National Rosacea Society is a fantastic source of information on this disease that impacts the skin of an extraordinary number of Americans. The American Academy of Dermatology is a good source too, and likely the source that many in our industry turn to first. The websites that both of these organizations run provide a great deal amount of information, and stay up on the latest research in the field. Much of that will be shared by top doctors in the field at SCALE 2019 Music City in May. Until then, we will use our platform here to give you the basics of what you need to know if you are unfamiliar with rosacea.

What Is Rosacea

As noted by the American Academy of Dermatology:

Rosacea (rose-AY-sha) is a common skin disease. It often begins with a tendency to blush or flush more easily than other people. The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be red all the time.

Rosacea can cause more than redness. There are so many signs and symptoms that rosacea has four subtypes:

1. Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels.
2. Papulopustular rosacea: Redness, swelling, and acne-like breakouts.
3. Phymatous rosacea: Skin thickens and has a bumpy texture.
4. Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty.

With time, people who have rosacea often see permanent redness in the center of their face.

The National Rosacea Society Adds:

Rosacea (pronounced “roh-ZAY-sha”) is a chronic but treatable condition that primarily affects the central face, and is often characterized by flare-ups and remissions. 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. Various secondary signs and symptoms may also develop but are not diagnostic…The presence of either of these signs is diagnostic of rosacea.

1. Persistent Redness. Persistent facial redness is the most common individual sign of rosacea, and may resemble a blush or sunburn that does not go away.
2. Skin Thickening. The skin may thicken and enlarge from excess tissue, most commonly on the nose (known as rhinophyma, pronounced “rye-no-FY-muh”). This condition is less common, but can lead to facial disfigurement and inadequate nasal airflow if severe.

Who is Impacted by Rosacea

A lot of people have rosacea. In the US alone this is about 14 million people, and 415 million people world wide, most of whom are between 30 and 40. This includes some of the most powerful and famous people in the world, like Bill Clinton and Princess Diana. (Source). The National Rosacea Foundation notes that: “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.” (Source). That said, there is not a known cause of the disease, though there are some studies linking the presence of demodex. (Source). Nor is there a cure.

Rosacea can complicate cosmetic procedures and other cosmetic treatments can be used to correct the physical appearance changes that rosacea can bring on.

Treating Rosacea

Although the disease cannot be completely eliminated, there are many promising treatments for rosacea. These include topical medications that help to address the redness and skin thickening that comes with a diagnosis, or doctor-prescribed medical intervention.

Bumps and pimples often receive initial treatment with oral and topical therapy to bring the condition under immediate control, followed by long-term use of an anti-inflammatory therapy alone to maintain remission. Therapies specific for rosacea are now available in various formulations that can be selected for each patient. When appropriate, lasers, intense pulsed light sources or other medical and surgical devices may be used to remove visible blood vessels or correct disfigurement of the nose. Ocular rosacea may be treated with anti-inflammatory medications and other therapy, and recommendations from an eye doctor may be needed. (Source).

There are also a number of novel and emerging therapies, some of which are outlined in Clinical effectiveness of novel rosacea therapies, published in Current Opinion in Pharmacology, and notes that “The topical alpha adrenergic agonist oxymetazoline reduces rosacea-related erythema. Topical ivermectin improves lesion count, inflammation, and maintenance of remission of rosacea compared to topical metronidazole. Procedural therapies including pulsed dye laser, radiofrequency, and dual frequency ultrasound are promising as both monotherapies or in combination. Although there are several effective treatment modalities for rosacea management, treatments options should be tailored for the specific clinical scenario.”

There are also lifestyle triggers that can be avoided. For some people this may be sun exposure, others diet, or contact with some product or fabric. When someone’s rosacea begins to dramatically impact their appearance there are alternative cosmetic treatments, like plastic surgery to help the nose regain some of its pre-disorder shape. Non-surgical rhinoplasty may be a solution in some cases. Each case will likely be different and each rosacea patient should be treated as an individual.  But for each there is the hope of better skin and a more pleasant appearance.