Rosacea - Causes and Treatment

Rosacea is an inflammatory skin disease, chronic, incurable and primarily affects adults. Women are more affected, but it is in men the disease is usually more severe. Rosacea causes redness on the face and can produce small pustules, similar to acne, there also be called by some acne rosacea. If not treated properly, the disease tends to worsen over time.


What is rosacea

Rosacea is a relatively common disease that affects about 16 million people in the US. It usually appears after age 30 and is more common in women than in men. Children also may have rosacea, but is much rarer.

There is no statistical data on the disease in Brazil, but it most likely is less common than in northern countries, since rosacea affects preferably clear skinned people, those who do not usually get tanned ever, even if exposed to Sun. In this group, the prevalence of rosacea is as high as 10%. The disease is more common in people with English descent, Irish or Scottish. The fact of rosacea is more common in very white people does not mean, however, that it can not occur in individuals with darker skin.

Among the famous people with rosacea, we can mention the US former President Bill Clinton, actress Renee Zellweger and the late Princess Diana.

Rosacea is considered a chronic skin disease, incurable and is characterized by alternating periods of improvement and deterioration. Unlike common acne, most patients with rosacea not improved over the years, however, if left untreated, the disease tends to become more evident. Rosacea typically affects the central region of the face, causing persistent or transient redness in the areas of the forehead, cheeks and nose.

Rosacea is not considered contagious. There is no evidence that it can be transmitted through contact with the skin or objects used by the patient, such as towels or bedding.

Rosacea causes

The pathophysiological mechanisms leading to the development of rosacea are not yet fully understood. It is known that illness arises from a combination of several factors, including, abnormalities in the immune system, inflammatory reactions of skin microorganisms, ultraviolet injuries and dysfunction of blood vessels.

The most accepted theory at the moment is that the innate immune system, which is the first line of defense of our complex immune system, acts aberrantly when exposed to certain external stimuli, such as sunlight, physical or chemical trauma, or germs present on the skin. This abnormal response of the innate immune system causes skin inflammation and swelling over their small superficial blood vessels, leading to redness, warmth and appearance of small vessels on the face (best explain later).

Among the germs that may be related to rosacea, two stand out: the mite Demodex folliculorum and bacteria Bacillus olenorius, both normally present in our skin.

Rosacea symptoms

There are four major subtypes of rosacea:
  • Rosacea erythematous-telangiectasia.
  • Rosacea papular-pustular.
  • Rosacea fimatosa.
  • Ocular rosacea.

1. Rosacea erythematous-telangiectasia

The erythematous-telangiectasia rosacea usually presents as a persistent redness on the nose and cheeks and recurrent episodes of "flushing" which are heat waves, with intense redness in the face, which may or may not be accompanied by sweat. The presence of small blood vessels visible on the face, usually the cheek, called vascular telangiectasia or spider are also common. The dry skin is another feature of this form of rosacea.

2. Rosacea papular-pustular

The papular-pustular rosacea is characterized by the presence of papules and pustules located preferably in the central face. The lesions can be mistaken for common acne, but they are different because they are nodular and do not contain the characteristic black or white dots of blackheads and pimples.

3. Rosacea fimatosa

The fimatosa rosacea is characterized by hypertrophy and thickening of the skin, making it irregular. This is the most aesthetically troublesome form. The most common involvement is the nose, which is called rhinophyma, but can also be seen in other parts of the face such as the chin (gnatofima), forehead (glabelofima) or cheeks. The vast majority of patients with rosacea fimatosa are adult men.

4. Rosacea eye

Ocular involvement occurs in over 50 percent of patients with rosacea. Common manifestations include redness of the eye, sty, burning sensation or foreign body, dry eyes, blurred vision, itchy eyes or changes in lacrimation. Ocular rosacea may precede, follow or occur simultaneously with the skin lesions. Children and adults may be affected.

Triggering factors

Several factors have been associated with exacerbation of the symptoms of rosacea, including:
  • Exposure to very high or very low temperatures.
  • Exposure to the sun.
  • Hot drinks.
  • Spicy foods.
  • Alcohol.
  • Intense physical activity.
  • Skin irritation by makeup, creams or other topical products.
  • Stress, anxiety or nervousness.

Rosacea treatment

Although there is no cure for rosacea treatment can greatly alleviate the signs and symptoms. Most often, a combination of drug treatments and lifestyle changes are necessary to control the disease. The symptoms of rosacea can vary substantially from one patient to another, and therefore the treatment should be adjusted for each individual case.

The recognition of the triggering and aggravating factors is important for treatment. Daily use of sunscreen is necessary to prevent UV ray stimulate skin inflammation. In patients with papular-pustular rosacea, the correct distinction with acne vulgaris is essential because many drugs used in the treatment of acne can aggravate the lesions of rosacea.

Drugs own threads applying to the skin once or twice daily can help reduce inflammation and redness. Among the most common are tretinoin, benzoyl peroxide, azelaic acid and antibiotics such as doxycycline and metronidazole. In patients with erythematous-telangiectasia, the treatment with laser is an option.

Some antibiotics tablets possess anti-inflammatory properties and help to control inflammation and may be used in cases of papular-pustular rosacea. The most common are tetracycline, minocycline and erythromycin.

Isotretinoin is a medication commonly used in cases of severe acne, but is also useful in severe cases of rosacea, which do not respond to initial treatment.

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