Rosacea: The Adult Acne Mimicker

Written by Paul M. Graham, D.O.

For a majority of people, rosacea can cause a significant amount of stress and limit social interactions on a daily basis. According to the National Rosacea Society, 16 million people are currently suffering from some form of this common skin condition. Rosacea is a chronic inflammatory disorder of the skin characterized by persistent redness on the cheeks, nose, forehead, and chin with or without the presence inflamed bumps. This condition most commonly affects lighter-skinned women between the ages of 30 to 50, but may also affect men specifically the form that involves the nose. Common features of rosacea include the formation of tiny blood vessels (telangiectasis), inflamed papules and pustules, and flushing.

There are four types of rosacea that are currently recognized: erythrotelangiectatic, papulopustular, rhinophymatous, and ocular.

• Erythrotelangiectatic Rosacea
  • Prolonged history of facial flushing
  • Sensitive skin with rough texture and mild scaling
  • New blood vessel formation
  • Persistent redness on the mid-cheek during the day

 

• Papulopustular Rosacea
  • Intense redness on the central face
  • Presence of inflamed papules and pustules
  • Flushing
  • Swollen, edematous skin

 

• Rhinophymatous Rosacea
  • Thickening and nodule formation of the nose
  • New blood vessel formation
  • Presence of significantly inflamed pustules and cyst on the central face
  • Generalized background redness of the nose

 

• Ocular Rosacea
  • Dryness and increased eye irritation
  • Blurred vision, eye flushing, and tearing
  • New blood vessel formation on the whites of the eye
  • The presence of styes (painful, inflamed bumps on the eyelash margin)

The exact cause of rosacea still is not completely clear, but according to current research, it is thought to be due to elevated levels of cell signaling molecules induced by various external stimuli. These signaling molecules cause blood vessels to dilate and increase in density over time, contributing to the presence of lasting central facial redness. Additionally, these signaling molecules cause the accumulation of immune cells leading to inflamed papules and pustules.

One feature that helps differentiate rosacea from acne is the lack of comedones (clogged pores/blackheads) on the central face. The papulopustular variant may also be due to the presence of a microscopic mite called, Demodex. This mite lives on the skin of most people, but a subset of individuals will become “allergic” to this organism and develop small pustules on the skin’s surface. This inflammation is induced by a bacteria that lives on the mite itself and causes the body to respond by upregulating inflammation in the area.

Early diagnosis of rosacea is important as it will lead to a reduction of permanent blood vessel formation and central facial redness. The diagnosis can be made after conducting a thorough history and physical exam by your dermatologist. Early diagnosis and treatment is key to improving the quality of life with those suffering from this frustrating and chronic skin condition.

Treatment of rosacea varies based on the type of the disease. Those individuals suffering from erythrotelangiectatic rosacea benefit from the avoidance of rosacea triggers, which includes limiting exposure to the sun’s UV rays, spicy foods, hot beverages, consumption of alcohol, and significant life stress. Although these triggers play a big role in our daily lives, they have been shown to progressively worsen rosacea, with the sun being the worst culprit. Sunscreen in rosacea patients is absolutely imperative to limit new blood vessel formation and central facial redness. Additionally, limiting alcohol intake will reduce the presence of flushing which may lead to an overall reduction in redness. More targeted treatment may include the use of light and laser devices to specifically eliminate blood vessels and background redness.

Papulopustular rosacea is commonly treated with topical prescription medications that reduce inflammation and limit new papule/pustule formation. These medications include topical antibiotics and anti-inflammatory agents. Your dermatologist will decide which medication is right for you. For moderate to severe cases, low-dose oral antibiotics may be recommended and are effective in controlling the condition. In severe cases, oral prednisone may be required for a short period of time to reduce inflammation.

Rhinophymatous rosacea is treated with topical and oral antibiotics in addition to surgical correction of the shape of the nose. Early initiation of antibiotics and anti-inflammatories may limit long-term nasal deformation.

Ocular rosacea is commonly treated with oral antibiotics to reduce the formation of new blood vessel formation on the eye itself. A referral to an ophthalmologist may be warranted to prevent long-term damage to the eye.

If you or someone you know is currently suffering from this chronic skin condition, we recommend that you schedule an appointment with a dermatologist to help control and limit the severity of rosacea. Click here to locate a board-certified dermatologist near you: Find A Dermatologist

References:

1. https://www.rosacea.org
2. James, W. D., Elston, D. M., Berger, T. G., & Andrews, G. C. (2011). Andrews’ Diseases of the skin: Clinical Dermatology. London: Saunders/ Elsevier.

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