Rosacea is a chronic rash involving the central face that most often affects those aged 30 to 60. It is common in those with fair skin, blue eyes and Celtic origins. It may be transient, recurrent or persistent and is characterized by its color, red.
Although once known as “acne rosacea”, this is incorrect, as it is unrelated to acne.
What are the clinical features of rosacea?
Rosacea results in red spots (papules) and sometimes pustules. They are dome-shaped rather than pointed and unlike acne, there are no blackheads, whiteheads or nodules. Rosacea may also result in red areas, scaling (rosacea dermatitis) and swelling.
Characteristics of rosacea include:
- Frequent blushing or flushing
- A red face due to persistent redness and/or prominent blood vessels
- Red papules and pustules on the nose, forehead, cheeks and chin often follow rarely, the trunk and upper limbs may also be affected
- Dry and flaky facial skin
- Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)
- Sensitive skin: burning and stinging, especially in reaction to make-up, sunscreens and other facial creams
- Red, sore or gritty eyelid margins including papules and styes, and sore or tired eyes
- Enlarged unshapely nose with prominent pores and fibrous thickening
- Firm swelling of other facial areas including the eyelids
- Persistent redness and swelling or solid edema of the upper face due to lymphatic obstruction
How is rosacea diagnosed?
In most cases, no investigations are required and the diagnosis of rosacea is made clinically. Occasionally a skin biopsy is performed, which shows chronic inflammation and vascular changes.
What is the treatment for rosacea?
- Where possible, reduce factors causing facial flushing.
- Avoid oil-based facial creams. Use water-based make-up.
- Never apply a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased production of nitric oxide).
- Protect yourself from the sun. Use light oil-free facial sunscreens.
- Keep your face cool to reduce flushing: minimize your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms.
- Some people find they can reduce facial redness for short periods by holding an ice block in their mouth, between the gum and cheek
Medications to reduce flushing
Surgery for rhinophyma