For Many, a Red Face Means Rosacea

It is estimated that about 14 million Americans have rosacea, but many may not even be aware of it. For others, the skin condition can be a source of psychological, social, and occupational problems - it all depends on the severity of the symptoms.

If your face becomes red for no apparent reason -- you're not embarrassed and haven't just come in from the cold - you might be experiencing the symptoms of rosacea. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), rosacea "is characterized by redness, pimples and, in advanced stages, thickened skin. Rosacea usually affects the face; other parts of the upper body are only rarely involved."

"Rosacea is relatively common, although many people simply regard it as almost a normal variant," says Priya K. Young, MD, an Assistant Professor of Dermatology at the Medical College of Wisconsin. Dr. Young sees patients 17 and older at the Froedtert & The Medical College of Wisconsin Dermatology Clinic and at the Zablocki VA Medical Center.

Four Main Types
Dr. Young describes four forms of rosacea:

• The most common form, called telangiectasia or vascular rosacea, is characterized by persistent flushing and redness on the cheeks, nose, chin and forehead. Blood vessels under the skin of the face may dilate (enlarge), and be visible through the skin as tiny red lines. The face may be swollen slightly and feel warm, and be sensitive to lotions and cosmetics.
• Another inflammatory form of rosacea is characterized by papules (pink bumps) and pustules (blemishes or lesions similar to acne).
• A condition called rhinophyma also may develop in men, but rarely in women. Rhinophyma is characterized by a bulbous red nose resulting from enlargement of the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. W.C. Fields, the American comedian who starred in a number of classic films of the 1920s and '30s, appeared to have this condition. The actor was renowned for his appetite for alcohol, and perhaps for that reason, people commonly associate rhinophyma with heavy drinkers. But that's not necessarily true, says Dr. Young: "Alcohol consumption, by itself, is not a cause of rhinophyma. However, alcohol can trigger redness in some people. I've seen patients with rhinophyma who are non-drinkers."
• Conjunctivitis, or redness and tearing of the eye, is a form of rosacea; patients may describe it as a sensation that feels as if there is a foreign body in the eye. The skin may or may not be affected. Often they've been referred to the Dermatology Clinic by ophthalmologists, or eye specialists.

For some patients rosacea symptoms can be persistent and chronic, while others experience flare-ups. Factors that cause rosacea to flare up in one person may have no effect on another person. Triggers can include heat (including hot baths), strenuous exercise, sunlight, wind, very cold temperatures, hot or spicy foods and drinks, alcohol, or emotional stress. Although the condition is progressive, those with rosacea are generally healthy, Dr. Young notes.

"There is no known cause," she says. "It seems more prevalent among Caucasians with fair skin - typically the same group that has sun sensitivity." It may be genetic, some researchers suspect; others think it may be a disorder where blood vessels dilate too easily, resulting in flushing and redness. Researchers have not established a link between rosacea and bacteria or other organisms on the skin, in the hair follicles, or elsewhere in the body.

Medical and Surgical Treatments
Although rosacea cannot be cured, it can be treated and controlled with topical or systemic medications, as well as surgically, to improve the appearance of the skin.

Topical creams are primarily antibiotic, such as metronidazole, or sulfur preparations. In more severe cases, dermatologists often prescribe antibiotics that are taken by mouth, not for their bacterial-killing properties but for their anti-inflammatory properties.

"These antibiotics used to treat rosacea are not the newer antibiotics we use for treatment of severe infections," Dr. Young says. "They are the older drugs, and they're used in low doses, so there's less risk of resistance." The most common antibiotics used to treat rosacea are tetracycline, minocycline and doxycycline. Those with eye problems from rosacea are often treated with oral antibiotics.

Patients continue both topical and oral antibiotic therapies long-term, Dr. Young says, much the way patients with other chronic conditions like hypertension or diabetes keep their conditions controlled by using their medications daily.

"For those with visibly dilated blood vessels, the best treatment is laser surgery," she says. "They can get significant improvement that lasts for years." At The Froedtert & The Medical College Dermatology Clinic, the procedure is done with a V-Beam Pulsed Dye Laser. One of several types of lasers, it uses a concentrated beam of light that targets blood vessels in the skin. The light is converted into heat, destroying the blood vessel while leaving the surrounding skin undamaged. Treatments are brief and done as an outpatient procedure. Patients might require a series of treatments.

Patients with severe cases of rhinophyma can be treated with a carbon dioxide laser. In some severe cases, the nose can also be surgically reshaped.

It's not known whether rosacea can be prevented, but patients can take steps to ease their condition, Dr. Young says. If they recognize that certain foods, beverages, lotions, or cosmetics irritate their skin and trigger flare-ups, they would do well to avoid them. "Otherwise they should follow a healthy diet. As for daily skin care, she suggests patients use mild skin cleansers, lotions and cosmetics, because people with rosacea often have sensitive skin.

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.