Rosacea
Definition
Rosacea is a non-infectious inflammatory condition of the
facial skin.
Incidence, Age and SexUp to 10% of the population may be
affected by rosacea at some stage in their life. It is an
under diagnosed condition. The commonest age of onset is
in the fourth and fifth decade. Any adult however may develop
this condition at any age. It affects males and females
with equal incidence.
Causes and Prevention
Rosacea appears more commonly in those with Celtic skin
types. It can be hereditary. The red flushing which is one
of the characteristics of the condition may be triggered
by a number of different factors. Often these trigger factors
will vary considerably from individual to individual. Some
of the common trigger factors are:
• Hot food and drinks (temperature)
• Alcohol
• Caffeine
• Spicy foods
• Stress
• Temperature changes
• Sun exposure
• Wind exposure
• Embarrassment
These factors are potential aggravating factors but are
not the cause of the condition.
Symptoms
After a period of intermittent facial flushing, the skin
becomes persistently red with the development of tiny broken
thread veins (telangiectasia) over the affected area. These
flushing attacks can be extremely uncomfortable for some
individuals with sensations ranging from burning to intense
pain. Where the condition starts it tends to stay. The commonest
area of involvement is on the cheeks. Other areas which
may be involved include the nose, chin and central forehead.
Some rosacea sufferers may only experience facial flushing
and redness, but the majority will also experience small
outbreaks of acne-like spots within the affected area. These
are often described as being small pimples although occasionally
some individuals may develop larger pus-like spots.
Complications of the Disorder
Many people believe that their facial redness is purely
a cosmetic problem and do not seek advice about it. However,
it is important to treat this condition early to prevent
long term side effects which include permanent thread veins
(telangiectasia); rhinophyma (enlargement of the nose);
persistent swelling (oedema) of the face or eye discomfort.
Tests
There are no specific tests for rosacea. The diagnosis is
usually made clinically. Rosacea however can be confused
with acne or seborrhoeic eczema (dermatitis). Some people
however do have both rosacea and seborrhoeic eczema co-existing.
Treatment
Mild rosacea may benefit from reducing exposure to the trigger
factors described above. However in practice avoidance of
these trigger factors has very little benefit for the majority
of sufferers.
In mild rosacea antibiotics applied to the skin (topical
antibiotics) are commonly used. In general Metronidazole
is used and needs to be applied sparingly to the whole affected
area.
With severer disease, antibiotics by mouth are used. Antibiotics
tend to improve the acne-like component of the disease within
8 weeks of treatment. If this is not achieved then a change
of antibiotic or an alteration of dosage may be indicated.
The flushing and redness tends to respond slowly to antibiotics
often requiring at least a 6 month course of treatment.
Severe flushing may be difficult to control. Occasionally
some patients may benefit from Clonidine to help to reduce
the flushing attacks.
With severe cases of acne rosacea with many pustular lesions
which has not responded to higher dose antibiotic treatment
then a hospital only prescribable drug called Roaccutane
can be considered. Roaccutane however has many potential
side effects and therefore has to be considered carefully
before usage.
Rhinophyma (gross enlargement of the nose) can be treated
either surgically by a shaving type of operation which can
be performed under local anaesthetic, or by reshaping of
the nose using an ultrapulse CO2 laser. If this is required
then the rosacea should be actively treated and brought
under control before any surgical intervention is considered.
Outcome
Rosacea may be self-limiting burning itself out within a
4 to 5 year period. However some people may experience long
term problems. Treatment is usually effective at bringing
the condition under control, but recurrences may occur subsequently
even after many years requiring further treatment.
When rosacea affects predominantly the nose there is a false
belief that individuals may be alcoholics which is totally
untrue. This can result in psychological distress which
may require active help. Camouflage can be used to try and
conceal the redness but in practice the key to managing
rosacea is one of controlling the skin condition.
