Definition

Acne rosacea, also known as rosacea, is a chronic skin inflammation that causes redness, acne, and your facial blood vessels to be noticeable. This skin condition primarily manifests in the central part of the face. The signs and symptoms of rosacea may persist for several weeks to months. After that, the symptoms could go away temporarily, but they are not entirely gone. Rosacea is sometimes mistaken for acne.

Rosacea is non-infectious as it is not a result of poor personal hygiene, but rather inflammation of the skin. It is occasionally misdiagnosed as acne, resulting in ineffective treatment. Rosacea can be associated with various dermatological conditions including seborrhea, as well as eye disorders such as keratitis, which is inflammation of the cornea.

Rosacea has the potential to impact individuals of all ages, however, it is most prevalent among individuals between the ages of 30 and 60, particularly middle-aged women. Moreover, individuals with fair skin are more prone to developing rosacea. Currently, effective treatments to fully cure rosacea have not been found, however, therapy can help to provide relief and alleviate symptoms. 

Causes

The cause of rosacea remains uncertain, while several experts suggest that rosacea may be attributed to a hyperactive immune system response. Abnormal immune response can lead to inflammation and dilation of blood vessels and lymph vessels. Bacterial overgrowth on the skin can contribute to the development of skin inflammation.

The development of rosacea is believed to be influenced by a combination of genetic factors and variables in the environment. Rosacea is not attributed to poor cleanliness or personal hygiene issues, and it is not infectious.

The sudden manifestation of symptoms, or the exacerbation of symptoms in rosacea, is believed to be initiated by:

• Eating spicy cuisine and hot beverages
• Having red wine or other alcoholic beverages
• Being in a place with extreme temperatures
• Environmental contamination caused by air pollutants or the emissions from cigarette smoke
• Prolonged exposure to ultraviolet (UV) radiation
• Emotion
• Aerobic physical activity, such as running,
• Medicines that can induce the dilation of blood vessels, such as antihypertensive medications
• Makeup, skincare or hair products 

Risk factor

Rosacea can affect anyone, however, some factors could increase the likelihood of having the condition:

• You are female
• The skin is highly susceptible to sunburn
• You are 30 years of age or older
• Have a habit of smoking or drinking alcoholic beverages
• You have a relative who has previously experienced rosacea

Symptoms

Rosacea typically manifests as erythema (blushing, flushing) mostly found in the facial region. Rosacea can result in erythema in the central or middle area of your face. The visibility of this redness becomes less apparent for people with dark skin. In addition, blood vessels are visible around of the nose and cheekbones. Within the area of redness, you may observe little bumps resembling pimples, which could potentially contain purulent fluid. The facial skin may experience dryness and develop a crusty texture, accompanied by a sense of burning on the face.

Symptoms might manifest not only on the face but also on the eyes and nose. Eye problems may manifest as dryness, irritation, and swelling of the eyelids (ocular rosacea). The symptoms of eye problems can come before skin skin problems in certain individuals. The nose may also appear swollen. Rosacea can cause the skin surrounding the nose to thicken, resulting in a larger, bulbous appearance over time. This phenomenon is more prevalent in males than females.

The symptoms of rosacea typically manifest gradually, which are:

• Phase 1, known as pre-rosacea, is characterized by redness and mild discomfort in the skin around the cheeks and nose
• Phase 2, known as the vascular phase, is the increasing redness and swelling of the skin, accompanied by the visibility of many blood vessels
• Phase 3, which is characterized by inflammation, the presence of pimples or pustules (bumps filled with pus) in the reddened area of the face could be found
• Phase 4, often known as the thickening phase, refers to the stage when the skin affected by rosacea becomes thicker

There are four distinct classifications of rosacea, including:

• The first subtype (erythematotelangiectatic rosacea), is characterized by facial redness and the presence of small visible blood vessels on the face.
• The second subtype (papulopustular rosacea), is similar to acne but is not accompanied by blackheads and typically affects older women
• The third subtype (rhinophyma), is a rare form of rosacea characterized by the thickening of the skin on the nose, it commonly affects men
• The fourth subtype (ocular rosacea), is characterized by clinical symptoms that primarily affect the eye area, such as red eyes

Diagnosis

There is no definitive diagnostic test for rosacea. Before diagnosing rosacea, your doctor will do a thorough physical examination and evaluate your symptoms. Occasionally, specific testing is necessary to distinguish rosacea from other conditions such as lupus, psoriasis, allergic responses, or seborrheic dermatitis. If your symptoms also include ocular manifestations, your physician may recommend a referral to an ophthalmologist for additional assessment.

Management

The objective of rosacea treatment is to alleviate the problems and symptoms that you encounter. Treatment involves implementing a regimen of proper skincare practices and adhering to the doctor's prescribed medicine. The optimal approach to managing rosacea is to steer clear of factors that could exacerbate or trigger the symptoms.

Medicines

The physician could prescribe topical ointments and medicines specifically designed to address your concerns related to acne. If there are indications of bacterial infection in your skin, the physician might prescribe antibiotics to treat the condition. If the acne is sufficiently severe, your doctor may also prescribe medicines to relieve acne such as isotretinoin. This medication possesses significant potency, nevertheless, it is contraindicated for pregnant women.

Laser therapy

Laser therapy helps alleviate the symptoms associated with dilated blood vessels. You could consult a doctor to explore the various laser therapy choices available. Adverse effects of laser therapy for rosacea are facial swelling and erythema that could last for a few days. Applying a cold compress to the laser scar can aid in alleviating these symptoms while the wound is healing. The therapeutic benefits of laser therapy become apparent within a few weeks following the procedure. Repeating the laser treatment is necessary to maintain the condition of your skin.

Home-based Self Care

To alleviate the symptoms of rosacea, you can follow the steps described below:

• Identify the factors that likely trigger your rosacea, such as engaging in physical activities or consuming caffeine, and thereafter refrain from exposing yourself to these triggers
• Apply sunscreen with SPF 30 daily
• Avoid places with high temperatures or excessively humid conditions
• Shield your face from cold air
• Utilize skincare products that are mild or specifically formulated for sensitive skin
• If you are experiencing blepharitis, it is recommended to cleanse your eyelids at least once daily
• Minimize or eliminate stress
• If you find the redness to be unpleasant, you might use cosmetics to conceal the flushing, remember to consistently cleanse your face and remove any makeup after engaging in activities
• To prevent irritation, refrain from vigorously rubbing your skin while cleansing it with facial cleanser

   

  
  

Complications

The main complications that could occur if the rosacea is not treated include:

• Phymatous rosacea, also known as rhinophyma, is a condition characterized by a bulging nose that also hardens nose resulting from changes of the skin surrounding the nose. Medication alone is ineffective in treating rhinophyma. Medical professionals could carry out a dermabrasion procedure using laser therapy or surgery to reduce the thickening of the skin.
• Inflammatory eye diseases, such as keratitis or conjunctivitis (inflammation of the conjunctiva).
• The individual experiences a lack of self-confidence that could hamper their well-being and interactions with their surroundings. This may manifest as anxiety, depression, low self-esteem, and social withdrawal.

Individuals with rosacea frequently encounter comorbidities such as hypertension, cardiovascular disease, dyslipidemia, diabetes mellitus, migraine headaches, dementia, colitis, rheumatoid arthritis, and Helicobacter pylori infection.

Prevention

Once the risk factors have been identified, the subsequent action is to address and rectify the modifiable risk factors. Here are the recommended procedures you can follow:

• Refrain from consuming hot or spicy food
• Prevent spending too much time under the sun
• Stop your smoking habit
• Minimize drinking alcoholic beverages, instead, substitute alcohol with a daily intake of 2 liters or 8 glasses of water
• Avoid engaging in strenuous physical activity
• Ensure that you obtain an adequate amount of rest, approximately 6-8 hours every day
• Try to manage your stress
• Apply sunscreen before heading outdoors
• Use mild skincare products
• Refrain from using skin care products that contain alcohol, menthol, witch hazel, or exfoliating agents
• Apply facial moisturizer on your skin
• Ensure that you adhere to the prescribed medication regime provided by your doctor

Options you can take to avoid flare-ups of rosacea include:

• Protect your face from the sun by wearing a helmet or using SPF 30 sunscreen
• Lower stress and discover ways that effectively manage stress tailored to your needs
• Refrain from going to places with excessively high temperatures (such as bathing with warm water as opposed to hot water, drinking cold beverages, and using air conditioning)
• Observe the reaction of your skin to alcohol, spicy foods, and caffeine
• Be careful when you use hair and skin products
• If you have reason to believe that you may have rosacea, it is advisable to promptly consult a physician to reduce the risk of further complications that could happen

When to see a doctor?

If you are consistently experiencing symptoms on your face or eyes, it is advisable to consult a dermatologist for a thorough evaluation and suitable therapy.

If you have rosacea and you encounter any of the following symptoms, it is critical that you promptly get treatments in the emergency room:

• Eye discomfort
• Blurred vision
• Sensitive to light
• Having red eyes

These symptoms may indicate keratitis, which is inflammation of the cornea and necessitates prompt medical intervention.

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