Rosacea: Types, Signs, Causes And Treatment Of This Chronic Inflammatory Skin Condition

What is rosacea, i.e., a red face? You must have often seen redness on some faces. Some people also have red spots on the face. Usually, people start finding home remedies for the treatment of redness on the face. It can be a disease of rosacea if the face becomes red. Rosacea disease is a widespread skin disease. Rosacea is a medical severe dermatological condition that is often misunderstood. Rosacea causes redness across the nose, and cheeks appear as if you always have the ‘rosy glow’ on the cheeks. The very first signs of rosacea are the tendency to blush or appear flushed very easily. Often untreated and under-recognized rosacea worsens with time and causes permanent red patches to appear on the cheeks, forehead and chin along with acne-like uncomfortable bumps. Apart from being a cosmetic deterrent, the sensitive and tender skin because of rosacea diminishes life quality and causes emotional distress. This emotional blow to the self-esteem further triggers the body’s inflammatory rosacea response, which also worsens the face's redness. This vicious spiral into flare-ups further disrupts the daily function. Rosacea can be easy managed with timely diagnosis and active treatments. In most cases, it is seen that Rosacea disease occurs in people above 30 years of age. It appears that there are red spots with redness on the face in some people. Rosacea disease can also cause eye irritation and eye pain. Some people feel that redness on the face means an excess of blood in the body (but it's just a myth).

What are the different types of Rosacea?

Rosacea has been classified as an inflammatory disorder, and there are for major types:

Erythematotelangiectatic Rosacea: This is the most common type of rosacea. The common characteristics are:

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• Persistent flushing of skin which lasts for more than 10 minutes
• Redness in the centre of the face
• Enlarged and visible small blood vessels under the skin
• Caused by environmental triggers
• Swollen and sensitive skin which gives a feeling of burning on the application of topical agents
• Sensitive and dry skin subject to scaling and roughness
• Looks like chronic sun damage and, if not treated, can result in permanent redness and spreading to other parts of the skin.

Papulopustular Rosacea: This is the second most common subtype of rosacea and the characteristics are:

• Stubborn redness in the central face area
• Bumps, pimples and nodules resembling the whitehead like pustules
• Blemishes, red and swollen bumps on the area where the skin is very red
• Acne-like breakouts appear on cheeks, chin, and forehead, but they come and go at a random rate.
• Oily and sensitive skin
• The appearance of evident spider veins
• The appearance of plaques on the skin
• Blemishes spread to the scalp, neck and chest area

Phymatous Rosacea: This type is not common in women, mostly affects men, and slowly develops over the years. In this subtype:

• The skin thickens and gets a bumpy texture, especially around the nose, causing rhinophyma.
• The skin scars easily and becomes swollen and discoloured easily
• In worse conditions, the skin on the chin, forehead, cheeks and ears and eyelids also thickens
• The pores look very large, and the skin becomes oily.

Ocular Rosacea: This subtype of rosacea affects the eye region and is characterized by:

• The bloodshot and watery appearance of eyes
• Constant foreign body sensation in the eye
• Burning, stinging and itchiness in the eyes
• Photosensitivity and blurred vision
• Cyst in eyelids
• Dry eyes
• Broken blood vessels in the eyes

What are the symptoms of Rosacea?

The very first symptom of rosacea that most people notice is the flushing of the skin. Other symptoms include:

• Constant redness
• Swollen red bumps that look like acne but might contain pus
• The skin feels hot and tender at all times.
• Dry and irritated eyes that become swollen and red
• Swollen eyelids
• Enlarged bulbous looking nose

Rosacea goes undiagnosed because so many people fail to pay heed to the typical initial symptoms and mistake them for something else like acne, allergies, seasonal effects, etc.

What are the causes of rosacea?

Rosacea is an inflammatory disorder caused by the abnormal behaviour of our innate immune response system. The specific cause of rosacea is undiscovered, but researchers have identified many triggers that can cause the biological condition. Identifying the triggers helps treat and manage the disease and improve the patient’s quality of life. Some common triggers/ causes of Rosacea include:

• Genetics, i.e. you can inherit the genes for rosacea from your family.
• It can be because of a bug H pylorus, which causes infections in the intestines.
• Skin mite like the Demodex may cause rosacea to appear on the skin.
• Malfunction of skin protection protein cathelicidin can also trigger rosacea.
• Menopause
• Sun exposure
• Emotional stress
• Cold weather
• Heavy exercise
• Heated beverages
• Alcohol consumption
• Spicy foods
• Dairy
• Foods with histamine in them such as tomatoes, legumes, chocolate etc.

Rosacea protection and avoidance

You can protect your skin by identifying the triggers and:

• Wearing sun protection at all times with an SPF of 50 and higher. Wear sunscreen that contains zinc oxide, titanium dioxide that offers extra protection
• Stay out of midday sun and wear a wide-brimmed hat.
• Reduce stress by decluttering your life and practising hobbies, medications, and yoga.
• Avoid overheating the skin, i.e. hot skin baths, wear cool clothes, and then sip a cold drink if you feel overheated.
• Avoid any hot beverages that trigger flare-ups. Switch the hot tea with cooling lemon tea
• Change the alcohol preferences, i.e. prefer white wine to red wine; add soda to beer to reduce the alcohol content etc.
• Cut down on spicy food.
• Be extra careful in selecting skin and hair care products, and stop using astringents and toners.
• Switch to light liquid-based foundations for makeup
• Protect the skin from windburn and cold by covering the face with a silk or acrylic scarf.
• Do not exercise in the heat. Try changing your exercise routine to low intensity and involve more swimming
• Take medication and treatments regularly

Rosacea treatment

There is no one way to give a diagnosis for rosacea. The dermatologist will provide you with a treatment plan based on the symptoms and examining your skin. The treatment for rosacea is a combination of skincare and prescription medications that control the signs and symptoms. Some standard treatment options include:

• Medications such as topical drugs Brimonidine and oxymetazoline, Azelaic acid and metronidazole.
• Oral antibiotics
• Acne treatments like isotretinoin
• Laser and light-based therapies
• Identifying and avoiding triggers.

What are the Risk Factors of Rosacea?

Anyone can have rosacea, but you are at high risk if you are:

• An adult between the age of 30-60 years
• Rosacea runs in your family.
• You have light coloured skin.
• You are an addicted smoker.
• Rosacea conduces to be extra critical in men and gradually worsens with age if not treated in time.

(With inputs from Dr Rinky Kapoor, Consultant Dermatologist, Cosmetic Dermatologist & Dermato-Surgeon, The Esthetic Clinics)

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