Recently I had a 40-year-old patient come in complaining that her face is always red. She noted that her dad had a similar appearance. She had not noted any pimples or pus bumps on her face. She was just red. She reported it was worse with exercise, hot and cold weather, and with certain types of food. She occasionally had burning and tingling which accompanied the increased redness. She was diagnosed with erythematotelangiectatic rosacea.
Rosacea is a relatively common skin disorder affecting adults. It occurs principally in women between the ages of 30 and 50 but can affect men as well. It presents with persistent redness of the face, specifically the cheeks and nose, and occasionally the forehead. Rosacea has at least four clinical subtypes. These include papulopustular, erythematotelangiectatic, phymatous (glandular) and ocular rosacea.
- Papulopustular rosacea – this subtype is often referred to as “adult acne.” It presents with red bumps and pus bumps (whiteheads) on the affected skin. There can also be substantial background redness of the central face. A history of flushing or blushing is common in patients with papulopustular rosacea. There can be underlying swelling of the skin causing a more “full” appearance to the affected skin. Burning or stinging of the skin is less common in this subtype.
- Erythematotelangiectatic rosacea – this subtype is likely associated with genetic tendencies toward flushing or blushing reactions. These reactions can occur to numerous and varied stimuli such as cold and heat, spicy food, hot drinks, alcohol consumption, emotional stress, exercise and exposure to hot water. This subtype of rosacea is frequently accompanied by a burning or stinging sensation which is most notable during the flushing response of full facial redness. Skin changes can occur over time and include prominently visible blood vessels (telangiectasia), scaling and roughness.
- Phymatous rosacea – also known as glandular rosacea is characterized by swelling and edema of the skin and a more coarse texture of the skin. There are red bumps and white heads present as well but these are typically larger, more red and deeper in the skin. The central face is most commonly affected with the chin more common in women and the nose more common in men. Over time, the sustained inflammation which causes the red bumps and white heads can cause permanent enlargement of oil glands and underlying tissues to create a bulbous, round and swollen appearance to the nose or cheeks.
- Ocular rosacea – this subtype can be found in isolation affecting only the eyes or can occur in combination with any of the other subtypes of rosacea. It is characterized by keratitis, iritis and episcleritis. This means that specific parts of the eye become inflamed and as a result itching, burning, stinging or painful gritty sensations can occur. Light sensitivity and a “something is stuck in my eye” feeling can also be present. Ocular rosacea occurs equally in men and women. It is important to bring up any eye concerns you may have if you are discussing the possibility of having rosacea with your dermatologist as eye finding can affect treatment options.
The cause of rosacea remains unknown but research has demonstrated elevations in the levels of specific markers associated with inflammation. Most treatments applied topically or taken by mouth are designed to disrupt these abnormal elevations and reduce inflammation. There are numerous topical treatments for rosacea. Oral doxycycline may also be used for more severe cases and for ocular involvement. New creams have been developed to apply for redness and laser treatments can also help reduce or completely eliminate underlying redness and visible blood vessels.
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