Rosacea — an equal-opportunity skin disease

Rosacea is a common skin disease that affects 15-25 percent of all people to some degree. It often begins with a tendency to blush or flush more easily than other people. This flushing can develop into a constant redness, or “rosy” complexion.

It can also produce an acne-like bumpy, pustular eruption on the face, neck, ears, chest and back. Some term rosacea with bumps “acne rosacea,” although the term is not optimal as it may not appear pink on all persons of color. All people can develop rosacea.

Why should I care about rosacea?

Rosacea is common. According to the U.S. government, more than 14 million people are living with rosacea. While some people are more likely than others to get rosacea, anyone can get this skin disease.

Rosacea goes by other names such as adult onset acne and acne rosacea. Some doctors will call redness of the face without bumps just “rosacea,” and if there is redness with bumps they call it “acne rosacea.” In actuality, the terms are used interchangeably with or without bumps.

There has been some confusion about rosacea and its occurrence in skin of color. Contrary to popular belief, rosacea occurs in all skin types, but in skin of color the redness may appear more copper or violet in color tone. Children also get rosacea.

Women are a bit more likely than men to get rosacea. Women, however, are not as likely as men to get severe rosacea, especially an enlargement or roughening of the nose called “rhinophyma.”

What causes rosacea?

Scientists are still trying to find out what causes rosacea. By studying rosacea, scientists have found some important clues:

Rosacea runs in families. Many people who get rosacea also have family members who have rosacea. It is possible that people inherit genes for rosacea.

The immune system may play a role. Scientists found that most people with acne-like rosacea react to a bacterium (singular for bacteria) called bacillus oleronius. This reaction causes their immune system to overreact. Scientists still do not know whether this can cause rosacea.

A bug that causes infections in the intestines may play a role. This bug, H pylori, is common in people who have rosacea. Scientists cannot prove that H pylori can cause rosacea. Many people who do not have rosacea have an H pylori infection.

A mite that lives on everyone’s skin, demodex, may play a role. This mite likes to live on the nose and cheeks, and this is where rosacea often appears. Many studies found that people with rosacea have large numbers of this mite on their skin. The problem is that some people who do not have rosacea also have large numbers of this mite on their skin.

A protein that normally protects the skin from infection, cathelicidin, may cause the redness and swelling. How the body processes this protein may determine whether a person gets rosacea.

How is rosacea diagnosed?

To diagnose rosacea, a dermatologist examines the skin and eyes. Your dermatologist will also ask historical medical questions. Sometimes a skin biopsy may be required to make the exact diagnosis.

Rosacea symptoms:

• Facial redness, warmth and flushing: Over time, small vessels may become apparent, especially on and around the nose and on the cheeks.
• Facial bumps: These bumps may or may not contain pus. Oftentimes they can become painful.
• Eye problems: Rosacea can also affect the eyes and eyelids. This is termed “ocular rosacea.”
• Enlarged nose: Longstanding rosacea can cause an enlargement of the nose called rhinophyma. This occurs almost exclusively in men. Only a very small percentage of women develop rhinophyma.

Can rosacea be prevented?

Rosacea can be minimized by avoiding the factors that make it worse. Many everyday things can cause rosacea to flare. These include sunlight, stress, temperature changes, and many spicy foods and beverages including hot drinks and beverages containing caffeine and/or alcohol. Red wine is a notorious cause of rosacea flares.

It is very important to note that what causes one person’s rosacea to flare may not trigger a flare-up for another person. This is why dermatologists recommend that patients with rosacea learn what triggers their flare-ups. Avoiding these patient-specific triggers can reduce flare-ups rather than just avoiding an entire list of items.

How is rosacea treated?

To effectively manage rosacea, dermatologists usually recommend a combination of treatments tailored to the individual patient. This approach can stop rosacea from progressing and sometimes reverses rosacea. Rosacea is a chronic medical condition, and the goal is management and control rather than cure.

There are many non-steroidal, anti-inflammatory prescription topical lotions and creams that work well to manage rosacea. Cortisone creams may be prescribed to reduce redness short-term, but with improper use cortisone can cause other unwanted skin problems. It is therefore important to follow your physician’s directions, and it is best to use these creams only under the direction of a dermatologist.

Bumps and pustules can be treated with oral antibiotics and/or very low-dose prescription oral retinoids. Oral retinoid should not be used in patients where pregnancy could occur.

Retinoids are closely related to vitamin A. Persistent redness may be treated with light therapy and/or laser surgery. Our office is also now using a topical medicine commonly found in some nasal sprays that effectively reduces redness.

Oral medications, such as beta-blockers, can be used for extreme cases of flushing. Cosmetics also may be helpful. Green-tinted makeup may mask the redness. If either seborrheic dermatitis or true acne are present with rosacea, all two or three conditions must be treated.

For best results from a prescribed treatment plan, be sure to carefully follow the dermatologist’s treatment plan with regular visits to make sure the plan is working to your satisfaction.

Action steps for anyone with rosacea

When treatment begins at the first sign of rosacea, the treatment often controls the disease. Treating rosacea early also can stop it from getting worse. Rosacea can be more difficult to treat if it gets worse.

Rosacea may not go away on its own and tends to worsen over time. Some of these treatments contain ingredients that can cause rosacea to flare. Learn what triggers your rosacea and avoid the triggers.

• Wear a broad spectrum sunscreen.
• Minimize facial irritation.
• Use a gentle cleanser.
• Use a gentle moisturizer.
• Use your medicines as instructed.

Skin care plays an important role in keeping rosacea under control. Many skin-care products are too harsh, so if using a new product makes your condition worse, avoid them.

See a dermatologist and develop and follow a rosacea skin-care plan. Schedule regular visits to make sure the plan is working to your satisfaction.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.