Rosacea overview

The manifestations and course of rosacea may vary considerably among individuals. Such variations have been empirically grouped into several subtypes. Most rosacea cases fall into one of the subtypes. However, a combination of subtypes may be seen in the same person.

• Erythematotelangiectatic rosacea: Mainly vascular manifestations. Permanent redness (erythema) with a tendency to flush easily. Visibly dilated blood vessels (telangiectasias) are common. Skin is often dry; burning or itching sensations are common. Triggers of flushes include emotional stress, alcohol, spicy foods, heat, cold, exercise and so forth.
• Papulopustular rosacea: Characterized by some permanent redness with red bumps (papules) and/or pus filled pimples (pustules). Pustules typically last one to four days. Telangiectasias may also be present. Papulopustular rosacea can be easily confused with acne. This type is most commonly found in middle aged women.
• Phymatous rosacea: Characterized by thickening skin, irregular surface nodularities, and enlargement. Phymatous rosacea is most commonly associated with rhinophyma, an enlargement of the nose. It may also affect chin, forehead, one or both ears, and/or the eyelids. Telangiectasias may also be present.
• Ocular rosacea: Characterized by red, dry and irritated eyes and eyelids. May involve symptoms such as foreign body sensations, itching and burning. Ocular rosacea may develop before any skin manifestations are may develop concurrently with other types.

What causes rosacea?

To put it in one phrase, the cause of rosacea is unknown. However, this is clearly a complex condition where several factors seem to play a role.

• Vasculature: Rosacea is associated with the increase in the number and responsiveness of blood vessels. However, what causes such vascular changes in not entirely clear. Some possibilities include prolonged inflammation, irritation, UV damage and so forth.
• Skin matrix degeneration: Rosacea is associated with the increase in the degradation of the key structural components of the skin matrix, including collagen, elastin and glucosaminoglycans. However, it is unclear whether susceptibility to skin matrix degeneration is the originating factor or a consequence of rosacea.
• Environmental damage: Some experts believe that various forms of environmental damage to the skin are the initial trigger of vascular changes and skin matrix degeneration. Environmental damage may include ultraviolet radiation, cold, wind and so forth.
• Skin irritants: Continuous exposure to skin irritants can definitely contribute and possibly cause rosacea in some cases. Improper use of some common skin treatments (e.g. benzoyl peroxide for acne, acidic peels for exfoliation or tretinoin for wrinkles) may cause chronic skin irritation potentially leading to rosacea.
• Diet: Some foods and beverages, such as spices or alcohol, are known to trigger rosacea flare-ups in some people. However, there is no evidence (except perhaps for heavy alcohol consumption) that they play a role in the initial development of rosacea.
• Inflammation: Inflammatory skin conditions, such as eczema or dermatitis, may contribute to later development of rosacea in susceptible individuals.
• Microorganisms: Demodex, tiny mites that normally inhibit hair follicles, may contribute to rosacea. Demodex mites appear to prefer the skin affected by rosacea and their excessive growth may affect the immune response that perpetuates some aspects of rosacea. However, it is unclear whether Demodex play a role in the initial development of rosacea and not just its persistence.
• Heredity: Rosacea appears to have a genetic component as it is seen mainly in fair skinned people of European descent.

Prevention

Rosacea primarily affects fair skinned people of European descent. For that group, preventive efforts may be worthwhile. In particular, avoiding and minimizing all forms of skin damage, irritation and inflammation is likely to reduce the risk of developing rosacea. As luck would have it, the same measures are consistent with preventing premature skin aging. See our article on minimizing skin damage.

Treatment

At present, there is no cure for rosacea. However, it can be treated with varying degree of success. Optimal treatment depends in the subtype of rosacea, individual responsiveness and other factors. See our Rosacea Treatment article.