Rosacea Skin Condition – Subtypes, Causes And Treatment

Rosacea is a common chronic skin condition that is characterized by redness or erythema in the face and sometimes pimples. This skin condition mainly affects Caucasian descendents of northwestern Europe. Though rosacea affects both men and women, it is more common among women by almost three times. The peak onset age for this skin condition is 30 to 60 years. If the rosacea skin condition is not treated, it can worsen over time. There are four subtypes for this skin condition that affects adults. Whereas three of the subtypes affect the skin, the fourth subtype affects the eyes.

Find out the Different Rosacea Skin Condition Subtypes

Erythematotelangiectatic Rosacea

This subtype is characterized by permanent redness and a tendency to easily blush and flush. Small and widened blood vessels may be commonly visible near the skin’s surface (telangiectasias). Patients who are suffering from this subtype often have sensitive skin which may become dry and flaky. They may experience intense stinging, burning as well as itching sensations. Symptoms may also be present on the neck, chest, ears, scalp as well as upper back.

Papulopustular Rosacea

People affected with Papulopustular rosacea can have papules and pustules which may last for one to four days or even longer. The symptom may be extremely varied and this subtype may be mistakenly diagnosed as acne.

Phymatous Rosacea

This subtype is commonly linked to rhinophyma, nose enlargement. People suffering from this rosacea skin condition may have symptoms such as skin thickening, surface nodularities as well as enlargement. Phymatous rosacea may also affect the forehead, cheeks, chin, eyelids and ears. Telangiectasias may also be present.

Ocular Rosacea

Ocular rosacea is characterized by red, dry, irritated eyes and eyelids. Eyes may be watery and cysts may often appear on eyelids. Other symptoms include a sensation of having a foreign body in the eye, burning, sensitivity to light and itching. Eyes of the patients suffering from this subtype may become susceptible to infections. About 50% of the people affected with rosacea subtypes one to three have eye symptoms. Blurry vision and sometimes loss of vision can also occur.

There are different variants of rosacea such as rosacea conglobata, rosacea fulminans, phymatous rosacea, etc., and patients affected by rosacea may have one or more subtype present. Rosacea patients may experience periodic flares and remissions.

Rosacea Causes

The exact reason for the cause of rosacea skin condition has not been clearly understood even now. Though the cause continues to remain a mystery, the basic process involves dilation of small facial blood vessels. Genetic factors, exposure to sun, a mite (demodex folliculorum) that is found in hair follicles sometimes, medications and gastrointestinal disease which may lead to widening of small blood vessels are some of the suspected causes of rosacea. Heredity is also seen to play a part.

In addition to the above, there are a variety of factors that can contribute to a flare up of rosacea. Some of the factors that trigger rosacea are as follows:

Emotional factors: stress, anxiety, fear, embarrassment, emotional upsets, etc.

Weather conditions: strong winds, changes in humidity levels, exposure to sun, etc.

Other factors: exercise, consumption of alcohol, spicy food, etc.

Studies conducted by Richard L. Gallo and his colleagues revealed that the patients with rosacea had elevated levels of the peptide cathelicidins and stratum corneum tryptic enzymes. Studies have also shown that intestinal bacteria play a role in causing the rosacea skin condition. Further, research has shown that some people suffering from rosacea, especially rosacea induced by steroid, had increased numbers of demodex mites on them.

Rosacea Treatment

Most people suffering from rosacea have only a mild redness of the skin. Therefore, they are never formally diagnosed and treated. Further, there is no specific test for diagnosing rosacea. Often, the rosacea skin condition is diagnosed through visual examination by a trained physician or doctor.

Rosacea is treated based on its severity and subtype. Cases of mild rosacea are seldom treated. Rosacea cannot be cured, but can be managed to reduce erythema as well as inflammatory lesions; bring down the intensity, number and duration of flares; and relieve the symptoms of burning, itching and tenderness.

Rosacea is primarily treated with topical creams and oral antibiotic medications. Patients may experience a temporary remission in a matter of weeks, but the redness returns when the treatment is stopped. Some patients treated with medication for a period of one to two years may experience permanent control of the skin condition. However, lifelong treatment may be essential for some others.

The first line of medications prescribed by doctors is tetracycline antibiotics such as tetracycline, doxycycline and minocycline and topical antibiotics such as metronidazole. They relieve pustules, papules, inflammation and redness to some extent. Topical azelaic acid like Skinoren or Finacea is helpful in reducing inflammatory lesions, papules and bumps. Use of peels containing alpha-hydroxy acid may relieve redness due to irritation and pustules and papules associated with rosacea skin condition.

Oral antibiotics may be helpful in relieving symptoms associated with ocular rosacea. If pustules and papules continue to persist, isotretinoin may be prescribed by doctors. Though it has a number of side effects, it is found to be effective against phymatous rosacea and papulopustular in low dosages.

People who are suffering from underlying allergies that respond strongly to food containing histamines in high levels may benefit from oral antihistamines especially form a reduction in flushing symptoms. Mirtazapine is another medication that may be prescribed by doctors to people with facial burning and flushing.

Laser treatments for rosacea skin condition include the use of dermatological vascular laser and intense pulsed light machines. They are particularly effective in treating skin erythema. Redness may altogether be eliminated with sufficient number of treatment sessions. Additional periodic treatments may be required in order to remove nee capillaries that may be formed in the course of time. CO2 lasers are used to get rid of excess tissue that phymatous rosacea causes to form. Low level light therapies are used in the treatment of rosacea.

In conclusion, avoidance of triggers can help a great deal in the onset of rosacea. However, avoidance alone will not be sufficient to cause remission. It may be very helpful for mild cases of rosacea. As sunlight often triggers rosacea, it is better to avoid excessive exposure to sun. Some people with rosacea may benefit from using a sunscreen on a daily basis. Emotional stress is also seen to trigger rosacea. People who frequently get eyelid infections must cleanse the eyelid using an over-the-counter cleaner or diluted baby shampoo every day and apply warm compress several times a day. It has also been observed that some people respond positively to topical application of sandalwood oil, especially in terms of reduction in erythema and pustules.