What is Rosacea?

What is Rosacea?

What is Rosacea?

Rosacea is a chronic skin disease, the main presentation of which are skin redness and the formation of tubercles, abscesses, and other lesions on the face. Approximately half of Rosacea cases are accompanied by eye lesions.

Causes of Rosacea and Demodex. What is Demodicosis?

The exact cause of Rosacea is still unknown. It is posited that the reason for Rosacea development is facial vascular hypersensitivity to various events. In Rosacea patients, arteries located just under the surface of the skin dilate in response to stimuli, whereas in healthy people, these stimuli do not cause any reaction.

It was previously thought that the main cause of Rosacea is a microscopic mite, Demodex (Demodex folliculorum), dwelling on the face in the sebaceous glands of hair follicles. It was assumed that this "subdermal tick" caused demodicosis, a disease that triggers Rosacea. It is now known that this mite can also be detected in healthy people. Most scientists consider Demodex to be of secondary importance in the development of Rosacea. The presence of Demodex is a consequence, not the cause, of skin changes. The existence of Demodicosis has long been debunked, but some doctors still continue their fight against these mites, considering them to be the cause of the infection, and ignoring other possible causes of facial lesions.

There is a theory that links Rosacea with gastritis that blames the development of Rosacea on the same bacterium, Helicobacter pylori, that causes gastritis.

Rosacea can also be triggered by some medications (drug-caused Rosacea ), including corticosteroid ointments that cannot be applied to the face (steroid Rosacea).

Who is at risk for Rosacea

Rosacea most often affects women during the perimenopausal period, and people of both genders between ages of 30 and 50. It is believed that the northern nations are more genetically predisposed to developing Rosacea. People with fair skin, blond or red hair colour, and blue eyes are more prone to the appearance of Rosacea.

Other risk factors include:

  • gastrointestinal disease (often gastritis)
  • malfunction of the endocrine system (ovarian failure, menopausal syndrome, diabetes, and others)
  • immune disorders, although this is still debated.

It is believed that Rosacea can be aggravated by being in too-hot or too-cold spaces, by the wind, consumption of hot foods and drinks, alcohol, spicy foods, prolonged sun exposure, and emotional outbursts. It should be noted, however, that the last factor is not universally accepted by researchers.

Signs and symptoms of Rosacea

The main symptoms of Rosacea are:

  1. Persistent facial flushing: redness mostly covers the middle of the face (forehead, nose, chin and cheeks); may spread to chest and back.
  2. Facial acne: small pinkish bumps (papules) will form on reddened skin in the beginning; they will eventually turn into pustules (pimples, blackheads).
  3. Thickening of the skin in reddened areas: mostly developing in late-stage disease.
  4. Dilation of blood vessels and appearance of spider veins (telangiectasia)
  5. Rhinophyma: persistent redness and fibrous thickening of the nose. It is more common in men.
  6. Eye lesions: occur in about half of Rosacea cases. Eye lesions manifest with redness, dryness, sharp pain, sensation of a foreign body or sand in the eyes, lacrimation.

Also possible are sensations of itching, burning, and skin tightening.

There exist complex classifications and algorithms that identify forms and stages of Rosacea based on symptoms, which then leads to determination of the severity of the disease. While Rosacea does not go away on its own, its symptoms can disappear for a while, and then reappear.

Rosacea should be taken into consideration, if the face reddens easily or frequently, or darkly reddens upon consumption of spicy foods, hot drinks, and alcohol, or during very cold or very hot weather, and if the skin suddenly become highly sensitive to hair spray, soap, or facial skin care. Remember that these signs point not at the imaginary demodicosis, but the start of a chronic progressive disease that needs to be stopped in time.

How is Rosacea diagnosed? Why look for Demodex?

In most cases, a doctor can diagnose rosacea based simply on the patient's appearance. In some instances, it might be necessary to test the microflora of the skin and assess vascular condition. In women, to distinguish rosacea from similar skin conditions, blood tests may be performed.

Simply finding the Demodex mite on facial skin cannot serve as a basis for rosacea diagnosis. There is no need to look for the "subcutaneous mite" in case of any changes on the face; in most cases, the mite has nothing to do with them.

What to do with the Rosacea diagnosis?

Rosacea can be progressive and transition into more serious stages, which are difficult to treat, such as widespread spider veins (telangiectasia) and rhinophyma. Therefore, appearance of pink acne is definitely a reason to seek immediate dermatological treatment.

A timely diagnosis can not only help overcome current Rosacea symptoms, but also prevent disease progression. There is still no cure for Rosacea, but according to the National Rosacea Society in the USA, in 87% of more than 1000 surveyed patient cases, it is possible to control the appearance of Rosacea acne. The thing to definitely avoid is self-medication upon discovery of the "subcutaneous mite," especially in the absence of lesions.

Rosacea Treatment

Rosacea treatment may be topical or system-wide. Topical treatments include the use of various ointments and creams (old formulations contained Ichthyol, Naftalan oil, or metronidazole); traditional methods included cold compresses (made from infusions of yarrow, celandine, and other medicinal herbs). While ointments and creams contain some antiseptics to suppress facial microbial growth (which is the cause of inflammation and pustules), cold compresses had an anti-inflammatory effect and reduced redness.

For a long time, lacking a truly effective Rosacea treatment and in the absence of reliable knowledge about the disease, dermatologists used a wide variety of prescriptions and formulations. Many of them are still in use today, and are favoured by self-medicating patients, but many of them are far from effective.

The main forms of Rosacea are frequently treated with antibiotics, but the complexity and safety of the drugs require they be prescribed by a doctor. There are even "more serious" treatment methods, used in the most difficult of cases.

In general, a treatment course can take anywhere from several weeks to several months; Rosacea is a chronic disease, which does not disappear immediately. Recently, treatment of Rosacea and elimination of spider veins in later stages included methods such as electrocauterization (the use of a weak electric current) and cryotherapy (the use of liquid nitrogen); dermabrasion and lasers are also employed. In addition, some natural, plant-based creams have also been successfully used for treatment of Rosacea (Anti Pimples Cream from HiLee). The use of many other methods is still in testing stages, and doctors recommend against experimenting with them.

Modern dermatology uses a combined method of treatment, choosing options based on symptoms and stage of disease. In our clinic, Rosacea is treated by both dermatologists and cosmetologists, which allows to concurrently control the disease, while removing its symptoms and restoring affected the skin.

Preventing Rosacea

To prevent Rosacea, dermatologists recommend protecting facial skin by avoiding irritation or overexposure to the sun, and preventing exposure to too-hot or too-cold temperatures. Also suggested are abstention from hot drinks, spices, and alcohol. Additionally, hair products should not be sprayed on facial skin, and usage of cosmetics and facial care without alcohols or irritants is encouraged.