Rosacea

Rosacea is more than just occasional facial redness. It is a complex skin disorder with multiple clinical presentations and triggers. Unlike acne, rosacea does not involve blackheads, and it tends to follow a pattern of flare-ups and remissions. It can affect the cheeks, nose, chin, forehead, and, in some cases, the eyes. The condition is not contagious, and although its exact cause remains unclear, a combination of genetic, environmental, and vascular factors is believed to play a role.

Rosacea is classified into several subtypes, each with distinct characteristics. Some people may have signs of more than one type of rosacea at the same time.
Subtypes:

• Redness and visible blood vessels (erythematotelangiectatic rosacea) – This kind of rosacea mainly causes frequent or long-lasting facial redness, especially on the cheeks, nose, chin, or forehead. The skin may feel hot, sting, or burn. Tiny blood vessels can become visible over time.
• Bumps and pimples type (acne rosacea) – This type causes red bumps and sometimes pus-filled pimples, usually on the central face. The skin may be very sensitive, swollen, or irritated.
• Thickening skin type (phymatous rosacea) – In this form, the skin becomes thicker and may look bumpy, especially on the nose. The nose may slowly get larger and have a bulb-like shape. This type is more common in men.
• Eye-related type (Ocular Rosacea) – This type affects the eyes. People may have red, dry, irritated eyes or eyelids. It can feel like something is in the eye, and vision may be affected in more severe cases.

While the exact cause of rosacea remains unknown, several factors are believed to contribute to its development. These include:

• Genetics: Rosacea tends to run in families, suggesting a hereditary component.
• Immune system response: An overactive immune response may lead to inflammation.
• Microorganisms: The presence of Demodex mites on the skin and Helicobacter pylori bacteria in the gut have been associated with rosacea in some studies.
• Vascular dysfunction: Abnormalities in facial blood vessels may contribute to the redness and flushing characteristic of rosacea.
• Environmental triggers: Heat, sun exposure, wind, spicy foods, alcohol, caffeine, and emotional stress can all exacerbate symptoms.

Certain skincare products and medications, especially those that dilate blood vessels, may also trigger flare-ups. Identifying and avoiding these triggers is essential for long-term management.

The signs and symptoms of rosacea vary depending on the subtype and severity of the condition. Most people experience one or more of the following:

• Persistent facial redness or flushing
• Visible small blood vessels on the cheeks and nose
• Red bumps or pustules that resemble acne but without blackheads
• Burning, stinging, or itching sensations on the face
• Dry, sensitive, or swollen skin
• Enlarged pores or skin thickening over time
• Red, irritated, or watery eyes in ocular rosacea

Rosacea tends to progress over time, particularly if not treated. Early recognition and intervention can help minimize its impact and prevent complications, such as rhinophyma or eye damage.

Rosacea is typically diagnosed during a clinical skin examination. Dr. Brian Hibler, a board-certified dermatologist, evaluates the patient’s medical history, symptoms, skin appearance, and potential triggers. There is no specific laboratory test for rosacea, so diagnosis is based on physical signs and patient-reported experiences. In some cases, Dr. Hibler may perform additional tests to rule out other skin conditions that mimic rosacea, such as acne vulgaris, seborrheic dermatitis, or lupus.

Fortunately, there are many treatment options available for patients with rosacea. The exact treatment depends upon the constellation of symptoms patients are presenting with. Topical treatments can be used for acne rosacea and to reduce redness and flushing. Laser treatments, including IPL and vascular lasers (Vbeam®, KTP), can be used to reduce facial redness and improve the cosmetic appearance. These lasers may also provide benefit for patients with ocular rosacea, improving meibomian gland function and alleviating dry eye symptoms.

With proper treatment and consistent skincare, most individuals with rosacea can achieve significant improvement in their symptoms. While rosacea is a chronic condition that may never fully resolve, long-term control is possible. Early intervention, patient education, and a customized treatment plan can dramatically reduce the frequency and severity of flare-ups.