Detailed Information on Rosacea

"Pre-Rosacea" (Stage I) in a young woman.

The redness seen in rosacea is from dilated blood vessels in the upper layers of the skin, which are more visible in patients with thinner or fair skin. Flare-ups may be caused by various triggers, including sun exposure, changes in temperature, spicy foods, certain skin care products, and alcohol intake. Rosacea is not caused by drinking, but alcohol consumption dilates blood vessels in the skin which may aggravate the condition.

Stage II Rosacea

Rosacea almost alway presents early on as a tendency to flush and blush, and may progress to one of 4 general stages, There's a predilection for certain facial areas, including the cheeks, chin, nose, and centeral forehead. The nose is especially likely to be affected in men, and in some cases, rhinophyma may present without other the other classic signs of erythema, telangiectasia, and pustule formation elsewhere on the face

The first sign of rosacea is a tendency to flush and blush easily, occuring as early as childhood, with the skin returning to baseline color and texture after the episode Repeated dilatation of blood vessels in the area eventually leads to telangiectasia and erythema, sometimes with a sensation of burning and itching in the affected areas.
Telangiectasia worsen, erythem deepens, and papules and pustules form , sometimes with mild swelling in the affected areas, especially the cheeks.

In end stage rosacea, chronic inflammatory changes in the skin induce hypertrophy of the sebaceous glands and fibroplasia, most commonly on the nose (rhinophyma), and in other affected areas.

Stage III Rosacea

The etiology of rosacea remains unclear. Theories include impaired venous flow with vasodilatation, hypersensitivity to Demodex folliculorum mites found in increased numbers in the pores of rosacea patients, and autonomic dysfunction with abnormal vascular responses to environmental triggers. Solar exposure with degradation of collagen in skin and vessel walls may contribute to exacerbations, but is not a necessary condtion for the development of the disease.

Rosacea symptoms may be intermittent, with spontaneous improvement for a time, followed by exacerbation, often induced by solar exposure, food triggers, alcohol, and stress. Not every patient will progress to end-stage rosacea-in most patients it remains more of a cosmetic than a functional problem.

A percentage of patients with rosacea will experience eye symptoms, including itching, tenderness, or a sensation of grittiness or dryness, and can even cause visual impariment from corneal inflammation and vascular infiltration.

Severe Stage IV Rosacea with deforming rhinophyma

Some other common skin conditions that can be confused with rosacea include seborrheic dermatitis, common acne, allergies, lupus, and sun damage, and these conditions may often co-exist with rosacea.

Treatment of Rosacea: Not every patient with facial redness will progress through all the stages of rosacea, and in most cases, the redness will not cause symptoms other than unsightliness.

Avoiding triggers is the first step in treating rosacea. Spicy foods, alcohol, skin irritants, and sun exposure all can cause a flare up. Patients should use a good quality zinc oxide sunscreen whenever they're outdoors, regardless of weather or season. Most patients with rosacea can readily identify and avoid these triggers

Topical treatments for rosacea include antibiotic creams or gels, which act not by their antibacterial properties, but by their anti-inflammatory effects. Oral antibiotics may be given in some cases, again, primarily for their anti-inflammatory effects.

Metronidazole, clindamycin, and erythromicin are the most commonly used topical agents, usually applied in a gel formulation. Azelaic acid (Azelex, Finacea) is a newer dicarboxylic agent used for papulopustular rosacea. The exact mechanism of action is unknown.

Oral medications include tetracycline antibiotics such as doxyclycline or metronidazole. Doxycycline may be prescribed at doses considerably lower than that used for bacterial infections, for it's anti-inflammatory effects on papules and pustules of moderate rosacea. In severe cases, isotretinoin (Accutane) may be prescribed.

Here's a before and after look at one of our rosacea laser treatments...