Rosacea on the Rise: Revealing Reasons for So Many Red Faces


Rosacea on the Rise 16 Revealing Reasons for So Many Red Faces


Most people have heard of the skin condition known as rosacea, and even more so today. So, is rosacea on the rise, or are we simply becoming more aware of it? In April 2010, the National Rosacea Society announced that the number of Americans suffering from rosacea had risen to 16 million. They had previously estimated 14 million sufferers.

Unfortunately, epidemiological studies indicate that the incidence may be much higher. Untold millions may be in temporary remission, while others may not even be aware they have this skin condition at all.

What is Rosacea?

RosaceaRosacea a common skin disease that typically begins between the ages of 30 and 60. At first the victim’s face starts reddening more frequently than normal. The redness usually begins in the nose and cheeks, and may slowly spread to the forehead and chin. It can eventually redden the ears, chest and even the back. Over time, many people suffering from rosacea develop permanent redness in the center of their faces.

Dr. Jonathan Wilkin, chairman of the National Rosacea Society medical advisory board, states, “Many people assume that rosacea is simply a sunburn or complexion problem that will eventually go away, and fail to realize they have a chronic condition that may get worse without medical treatment and lifestyle modifications.”

So, Dr. Wilkin considers recognizing the symptoms of rosacea as critical. What should you watch for? Rosacea can cause more than redness. It may vary substantially from patient to patient. As we shall see below many signs and symptoms warn of its coming. They have led to the division of the condition into four subgroups.

Understanding the Types of Rosacea

 The most common types of rosacea include:

  • Erythematotelangiectatic Rosacea: If the long name is throwing you a curve ball, don’t worry. The only name you need to remember for this subgroup is “facial redness.”

Watch for flushing and facial redness. You may see small blood vessels become visible and feel stinging, burning and swelling. Roughness and scaling of the skin may occur.

  • Populopustular Rosacea: This type includes redness with bumps and pimples. Along with persistent redness sufferers of this subgroup experience bumps called papules, and pimples called pustules. Some raised red patches called plaque may also appear on some patients.
  • Phymatous Rosacea: This type causes a red or enlarged nose called rhinophyma. The enlargement of the nose by excess tissue, which may include thickening of the skin and irregular surface modules. In rare cases the condition may also develop in areas other than the nose. This condition primarily affects men.

Ocular rosaceaNote: It was this condition, not alcohol, that caused famous actor W.C. Fields’ trademark bulbous nose.

  • Ocular rosacea: Red, irritated eyes mark this type of rosacea. Ocular rosacea makes the eyes feel irritated or “sandy,” and they can look bloodshot or watery. The eyelids may become swollen and sty-like cysts may form. Extreme cases of this condition can lead to corneal damage and thus, reduced vision.

The victim may pass from one subgroup to the other, especially if they don’t undergo treatment. Rosacea usually begins with the redness described in the first subgroup. It eventually becomes ruddier and remains longer each time it appears.

If left untreated, other symptoms may appear, such as visible blood vessels followed by bumps and acme-like pustules. Additional tissue may cause the nose to become swollen and bumpy.

The Negative Face of Rosacea

Let’s again listen to Dr. Wilkin, chairman of the National Rosacea Society medical advisory board:

negative impact“It’s especially important for people to know about rosacea, not only because of its potential for the development of other skin and serious eye effects, but its negative impact on personal appearance can be even more devastating to their emotional, social and professional lives.”

Of more than 1,200 rosacea patients surveyed by the National Rosacea Society, over 76 percent said their self-confidence and self-esteem had suffered due to their condition. As many as 41 percent of the patients said they avoided public contact or cancelled social engagements because of it.

Nearly 70 percent of those with severe symptoms blamed it for affecting their professional lives unfavorably. Almost 30 percent admitted they had even missed work because of its effect on their personal appearance.

Common misconceptions about rosacea sufferers add to their humiliation. People blame red faces and noses, especially when the latter is swollen, on heavy drinking. While alcohol may aggravate the condition, teetotalers share symptoms equally severe. Another common myth claims poor hygiene causes rosacea while in fact it is unrelated to personal cleanliness.

The Numerous Faces of Rosacea

Rosacea, of course, is not isolated to the United States. Studies in other countries tell us the incidence of the condition abroad.

fair-skinnedA study by Dr. Maeve McAleer and her colleagues at the School of Public Health and Population Science of University College in Dublin showed that 14.4 percent of 1,000 subjects in Ireland had rosacea. According to a 1989 study 10 percent of 800 office workers examined in Sweden suffered from rosacea, 14 percent of the women and six percent of the men.

“While the incidence rates are high,” opines Dr. Wilkin, “rosacea is more commonly seen in fair-skinned individuals, and an assessment of rosacea in the U.S. must take into account the diversity of its population.”

At an NRS research workshop, Dr. Alexa Boer Kimball of Harvard Medical School presented a study of photos of 2,933 random U.S. women volunteers. The prevalence of rosacea among them, without regard to ethnicity, was 9.6 percent. The incidence among only the Caucasian women was 16 percent, in keeping with the rates found in the Irish and Swedish studies.

Here is Dr. Wilkin’s assessment of the studies:

pimples“In actuality, all of these studies may understate the true incidence of rosacea because they examined only the presence of signs and symptoms at the time of the study, while rosacea is often a chronic underlying condition whose outward signs and symptoms are characterized by relapses and remissions. Thus, at any given time, millions of additional rosacea sufferers may simply be in temporary remission.”

The cause of rosacea is unknown. Yet, researchers recognize a lot of the elements of lifestyles and the environment responsible for awakening an angry onset of rosacea. We’ll examine some of those in detail in due time.

“The good news is,” says Dr. Wilkin, “that although the incidence of rosacea has increased in the United States, medical therapy is available to bring many aspects of rosacea under control.” Those with any of the warning signs given below, especially if they are persistent, should see a dermatologist for diagnosis and medical treatment:

  • Redness on the nose, cheeks, chin or forehead.
  • Visible small blood vessels on the face.
  • Bumps or pimples on the face.
  • Irritated or watery eyes.

Know Your Management Options for Rosacea

Even though the cause of rosacea is yet unknown, and there is no cure or medical treatments available, you can take steps to mitigate or reverse its effects.

Talking About Your Rosacea: What to Tell Your Physician

On your first visit, it’s important to tell your doctor about any facial signs not visible at that time. If these include significant periods of redness or flushing, identify how frequently they occur and how long they remain. Explain lengthy periods of exposure to the sun and if they are due to your lifestyle or vocation. Photo-damage, rather than rosacea might cause the redness or visible blood vessels.

physicianYour physician should also know about any facial burning, stinging, itching, tightening, swelling or any other unusual feelings related to your face.

Since rosacea’s effect on the eyes can be mild, patients may omit mention of eye problems. But it’s important to let your doctor know about any itching, burning, tightening or swelling or if they tend to be watery or bloodshot. The possibility of extreme cases leading to corneal damage and reduced vision makes this important information to give your doctor before he has to refer you to an eye specialist.

Finally, be honest with your physician about the effects of rosacea on your appearance as it relates to your personal and professional life. Don’t feel embarrassed to let them know its emotional impact. Not because you need reassurance but because your doctor needs this information to tailor a medical regimen designed for you. Remember that rosacea takes many forms. Because of that each patient requires a discrete medical therapy.

Medical Therapies You Can Try

Though the complexities of rosacea have resulted in its classification into subgroups – see “The Four Faces of Rosacea” above – patients may have symptoms of more than one subgroup at once. It follows that, as physicians tailor medical therapies for individual patients, they may prescribe therapies that overlap one or more subgroups.

lasersTreatment for subtype one, facial redness or erythematotelangiectatic rosacea includes antibiotic therapy to relieve redness, though the Centers for Disease Control and Prevention (CDC) recommends caution in the overuse of antibiotics. Visible blood vessels and background redness may be reduced by lasers or intense pulsed light therapy. Several sessions are usually necessary at first with occasional touch-up sessions later.

Makeup may be used to conceal the redness.

The bumps and pimples of subgroup two or papulopustular rosacea often occurs with the symptoms of subgroup one. Fortunately, a lot of medications are available for its treatment. Many can be used to prevent reoccurrence of symptoms for the long term.

In mild to moderate cases, doctors have available several oral and topical prescriptions to bring immediate relief. These can be followed by topical medications to maintain remission. Higher doses of antibiotics may be prescribed for patients unresponsive to conventional medication. However, see the CDC warning above.

dermabrasionMen primarily suffer from subgroup three, the thickening of skin about the nose and its enlargement. Although medications may successfully treat mild cases, moderate to extreme varieties normally require surgery.

Many surgery options are available including removal of excess flesh and re-contouring the nose by means of a bloodless scalpel. Finishing touches by a process called dermabrasion often follows this procedure.

Any one or several of the symptoms of subgroup four or ocular rosacea may manifest. These can include watery or bloodshot appearance, the sensation of the presence of a foreign body, burning, stinging, itching, dryness, sensitivity to light and blurred vision. Many patients have previously suffered from sties and “dry eye” or blepharitis.

In addition to all of the above therapies, patients should review their lifestyles and make changes as necessary. They should also become more aware of the importance of skin care.

Skin Care for Rosacea Relief

skin care productsThe most important rule: Be kind to your skin. By the use of gentle skin care products, you cannot only help manage rosacea but improve the look of your skin. That leads to self-assurance in your social life and at the work place. A quick guide to follow: use products appropriate for sensitive skin or skin with rosacea. Avoid those that sting, burn, irritate or otherwise harm the skin.

As many as 41 percent of 1,066 patients in a National Rosacea Society survey claimed that certain skin-care products exacerbated their condition, and 27 percent said the same of some cosmetics.

Here are some tips to follow to avoid irritation:

Know the common rosacea irritants.

Witch HazelPatients responding to National Rosacea surveys blamed the following ingredients for causing skin irritation:

  • Alcohol: 66 percent
  • Witch Hazel: 30 percent
  • Fragrance: 30 percent
  • Menthol: 21 percent
  • Peppermint: 14 percent
  • Eucalyptus Oil: 13 percent

Most respondents reported that they avoided astringents, exfoliating ingredients and other products that are known to be harsh for sensitive skin.

Look for fragrance-free skin-care products and makeup.

You should choose these types of products to protect your skin. The American Academy of Dermatology claims that, “Fragrances cause more allergic contact dermatitis than any other ingredient.” Skin forms a freeway for allergies to enter the body. The irritations accompanying allergies weaken the skin dramatically. Use fragrance-free and allergy-tested products.

TestCaution: “Hypoallergenic,” a term not clearly defined by the cosmetic industry, does not mean “allergy tested.” Here are some additional tips for finding the right skin products for you:

  • Test products before using: Before using an item on your face try it out on a patch of nearby skin, say on the neck. If it causes a reaction, you’ll know not to use it. Note the ingredients and avoid products containing them. Remember that rosacea symptoms vary from person to person. What works for you may not work for a fellow sufferer.
  • Reduce the number of products you use: To limit the number of products you use choose those with multiple functions.

The Many Causes of Rosacea

So, to return to the question we started with: Is rosacea on the rise, or are we simply becoming more aware of it? Let’s first look at its underlying causes and then the specific conditions from which victims of the disorder suffer. Problems with the following bodily processes may contribute, or even cause rosacea, such as:

1. The Innate Immune System

CathelicidinsYour body relies on its innate immune system for its first line of defense against infection. The latest scientific research, though, suggests that this protective system may be malfunctioning in rosacea patients. Cathelicidins are anti-microbial molecules within the innate immune system that fight malignant bacteria and activate other parts of complex immune systems.

In National Rosacea Society-funded research, Dr. Richard Gallo and his colleagues at the University of California-San Diego found that cathelicidins seem to cause bumps and pimples, along with flushing and the appearance of small blood vessels. They exist more abundantly in rosacea patients than in rosacea-free people, though in a different form. Dr. Gallo published the research results in the prestigious scientific journal, Nature Medicine.

2. The Neurovascular System

Dr. Martin Steinhoff of the Charles Institute of Dermatology at University College Dublin and researchers at the University of California-San Francisco, have carried out National Rosacea Society-funded research. They found close links between the nervous system and vascular system that produce signs and symptoms of rosacea. This suggests that the flushing and inflammation of the condition share the same continuum.

alcoholic beveragesSome of the most common rosacea triggers show involvement of the sensory nervous system. These include exposure to ultraviolet radiation or skin irritants, extremes of temperature, strong emotions, alcoholic beverages and spicy foods. The researchers also noted that certain sensory nerves around blood vessels that may be related to stinging increase during rosacea’s rise.

In addition, they found that rosacea skin disrupts neuropeptides, the protein-like molecules nerve cells use for communication, their corresponding receptors and other related substances.

Research continues in an effort to determine if this imbalance affects the flushing and inflammation of rosacea. Neuropeptides affect the lymphatic system as well. The group found that lymphatic vessels may also influence swelling in the initial stages of rosacea.

3. The Vascular System

Dr. Mina Yaar and colleagues of the Boston University School of Medicine, funded by the National Rosacea Society, studied the effects of ultraviolet radiation exposure. They found that the ultraviolet radiation from sunlight led to the production of vascular endothelial growth factor, which has been linked to the development of visible blood vessels.

Observation showed that the pigmentation of darker skin increased protection of the deeper skin levels from ultraviolet radiation. In those subjects the pigmentation tended to stop penetration of vascular endothelial growth factor in the upper skin levels, safely out of reach of blood vessels.

On the other hand, ultraviolet rays penetrated more deeply into the less protected skin of fair-skinned people, inducing vascular endothelial growth factor production in deeper skin layers which led to the creation of visible blood vessels more often than in darker skin.

The aforementioned Dr. Gallo of the University of California-San Diego and his group found that ultraviolet-B radiation exposure increases vascular endothelial growth factor. It seems to cause production of new blood vessels in mice.

That links the effects of ultraviolet radiation to the innate immune system. Future studies should increase knowledge of links between ultraviolet radiation and skin inflammation.

Read on to learn about other rosacea causes scientists are considering.

4. Demodex Mites and Microbes

The human microbiome, the ecological community existing within and on our bodies, hosts two microscopic species of Demodex mites. Demodex folliculorum live in hair follicles, mostly on the face, and in glands of the eyelid. Demodex brevis lives in the skin’s sebaceous glands.

Though Demodex folliculorum live in the skin of all humans they inhabit those with rosacea in greater numbers. Researchers have debated whether their increased presence indicates the cause of rosacea or the result. Evidence seems to be mounting, though, that a large population of Demodex might trigger an immune response in people with rosacea or that certain bacteria associated with the mites might cause the inflammation.

Research by Dr. Martin Schaller, assistant professor of dermatology at Ludwig-Maximilians University in Munich, Germany, has shown that a severe infestation of Demodex mites, known as demodiciosis, may mimic rosacea but fails to respond to treatment for rosacea.

5. Genetics

geneticWorking under a NRS grant, Dr. Anne Chang, assistant professor of dermatology at the Stanford University School of medicine, and colleagues have identified two genetic varieties of rosacea located in areas of the genome associated with autoimmune disease. If genetic coding specific to rosacea is found in the human genome blood tests it may identify people at risk. That would make possible early intervention.

6. Longevity

Dr. Jonathan Wilkin, quoted frequently above, has stated that steady population growth and its aging over the past few decades has significantly raised the incidence of rosacea. Widespread but poorly understood, it now affects massive numbers of the baby boom generation.

Rosacea: The List of Causes and Triggers Grows

Exposure to the sunThe list below gives the types of conditions that are causes of the rosacea subgroups given above. Many victims suffer from conditions of two or more subgroups. They are listed in order of the most common to least common according to a National Rosacea Society survey of 1,066 rosacea patients.

  • Exposure to the sun
  • Emotional stress
  • Extremes in weather
  • Wind
  • Heavy exercise
  • Consumption of alcohol
  • Hot baths
  • Spicy foods
  • Indoor heat
  • Some skin-care products
  • Heated beverages
  • Some types of makeup
  • Medications
  • Medical conditions
  • Certain foods
  • Longer lifespans

As the list continues to grow, more people are beginning to pay attention to their rosacea and how to avoid flare-ups.

You Are Not Alone: The Famous Faces of Rosacea

President ClintonWith so many people dealing with rosacea, there is no need for you to feel alone with this condition. They include:

  • President Clinton
  • Prince William
  • Princess Diana
  • W.C. Fields
  • Santa Claus

Santa Claus? Really? Yes. In 2012 rumors circulated after members of a literary society noticed his “cheeks were like roses, his nose like a cherry.” Could these symptoms have stemmed from consumption of too much spiked eggnog, or from rosacea?

Not according to Dr. Jerome Litt, assistant clinical professor of dermatology at Case Western University as quoted in a National Rosacea Society weblog. He reportedly succinctly laid the rumors to rest by stating, “It looks like a clear-cut case of rosacea to me.”

Is medical science great or what? The best news of all is that scientific research is underway right now to find out more about this growing skin condition. If you think you may have it, don’t hesitate to enlist the help of your doctor. You don’t have to be embarrassed by a red face any longer, as long as you can avoid the triggers in the first place.


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