Rosacea

Rosacea usually begins as a redness of the cheeks, nose, chin or forehead that tends to come and go. Over time the redness can become persistent and visible blood vessels may appear. Bumps and pimples often develop if left untreated and in severe cases the nose may become swollen and bumpy from excess tissue. In many cases the eyes may feel irritated, often appearing watery or bloodshot.

Rosacea affects around 1.5 million Canadians and an estimated 16 million Americans; particularly those with fair skin. This chronic inflammatory disorder of the facial skin is often characterized by flare-ups and remissions, with the first signs usually occurring any time after age 30. Women tend to be more frequently diagnosed with the disease, while men tend to show more severe symptoms.

As the disease varies greatly across individuals, the following guideline is often used to diagnosis rosacea.

Presence of one or more of the following primary features:

• Bumps and pimples (papules and pustules)
• Flushing and persistent redness (erythema)
• Visible blood vessels (telangiectasia)

May include one or more of the following secondary features:

• Burning or stinging sensations on the face
• Raised red patches (plaques)
• Dry appearance (rough skin)
• Swelling (edema)
• Eye irritation (ocular manifestations)
• Peripheral location (affecting neck, chest, scalp or ears)
• Skin thickening (phymatous changes)

Since primary and secondary features often occur together, medical experts have categorized the most common signs and symptoms into subtypes:

• Subtype 1 (erythematotelangiectatic rosacea), characterized by flushing and persistent redness, and may also include visible blood vessels
• Subtype 2 (papulopustular rosacea), characterized by persistent redness with transient bumps and pimples
• Subtype 3 (phymatous rosacea), characterized by skin thickening, often resulting in an enlargement of the nose from excess tissue
• Subtype 4 (ocular rosacea), characterized by ocular manifestations such as dry eye, tearing and burning, swollen eyelids, recurrent styes and potential vision loss from corneal damage

Many individuals experience signs and symptoms from more than one subtype at the same time, often developing in succession. It is important to note that each sign or symptom can progress from mild to moderate to severe, without rosacea evolving from one subtype to another. As such, early diagnosis and treatment are key.

Currently there is no cure for rosacea and the cause of the disease is unknown. Various topical and oral medications are available and treatment should be tailored on an individual basis by a physician.