Rosacea is a chronic inflammatory skin condition that primarily impacts the
central area of the face, commonly occurring between the ages of 30 and 60. It
is characterized by persistent redness on the face and tends to have periods of
flare-ups and improvement. Managing symptoms involves a combination of
lifestyle adjustments, general skincare, medications, and procedural treatments.
Rosacea is estimated to impact approximately 5% of adults globally. While it
is often believed to affect women more than men, research has shown that the
distribution between genders is nearly equal.
Typically, rosacea appears after the age of 30 and becomes more prevalent
as individuals age. However, it can develop at any age and occasionally appears in children. Although rosacea can affect individuals of any background, it is more commonly observed in those with fair skin, blue eyes, and of Celtic or North European ancestry. Recognizing and diagnosing rosacea may be more challenging in individuals with darker skin tones.
Rosacea has been linked to various health conditions, including depression,
hypertension, cardiovascular diseases, anxiety disorders, dyslipidemia,
diabetes mellitus, migraines, rheumatoid arthritis, Helicobacter pylori
infection, ulcerative colitis, and dementia.
There are multiple factors that are known to cause rosacea. Mainly, genetic,
environmental, vascular, and inflammatory agents result in rosacea’s outburst.
Moreover, chronic exposure to ultraviolet (UV) radiation is associated with
skin damage.
The skin’s innate immune response is directly linked with rosacea due to the
presence of antimicrobial peptides, especially cathelicidins, in high
concentrations. Cathelicidins play an important role in the skin’s normal
defence against microbes. Cathelicidins are essential in promoting the infiltration
of neutrophils in the dermis as well as dilating blood vessels. Neutrophils
release nitric acid which also promotes vasodilation. If the fluid leaks from
these dilated blood vessels, swelling occurs. As a result, pro-inflammatory
cytokines leak into the dermis which in return increases inflammation.
Matrix metalloproteinases (MMPs) like elastase and collagenase are also
closely linked with rosacea. These enzymes are essential in remodelling
normal tissue, aiding the healing process in wounds, and promoting the
production of blood vessels. In patients with rosacea, these enzymes are found
in high concentrations which leads to cutaneous inflammation. Moreover, the
skin gets thickened and hardened. MMPs can also activate cathelicidins which
causes inflammation.
Hair follicle mites (Demodex folliculorum) and rosacea are also
closely linked; however, the actual cause has not been determined yet.
Besides the factors mentioned above, rosacea can be triggered by different
facial creams and/oils as well as topical steroids.
Usually, rosacea appears in the form of red spots (papules) and in rare
cases, as pustules. These spots have a dome-shaped form. Unlike acne,
rosacea does not present any nodules, whiteheads, and/or blackheads. Depending
on the type of rosacea, it can burst in red areas (erythemato-telangiectatic
rosacea), swelling (phymatous rosacea), and scaling (rosacea dermatitis).
Patients diagnosed with rosacea experience frequent blushing or
flushing. A red face may be due to constant redness and/or prominent
blood vessels. Red papules and pustules tend to appear mostly on the forehead,
nose, cheeks, and chin. In rare cases, trunk and upper limbs can also be
affected. The facial skin may feel dry and flaky. Sun exposure, hot and spicy
food or drinks can trigger even more redness. Individuals with sensitive skin
may experience burning and stinging sensations as a reaction to makeup, facial
creams, and/or sunscreens. As a result, due to affected eye areas, ocular
rosacea can be diagnosed. It is usually characterized by having red, sore, and
gritty eyelid margins with papules and styes.
Usually, rosacea is diagnosed through a regular clinical assessment
performed by the dermatologist. A skin biopsy may be performed in order to
observe any additional chronic inflammations and vascular changes. The Global
ROSacea COnsensus (ROSCO) Panel recommends assessing rosacea based on
diagnostic, major, and minor phenotypes. The diagnostic phenotype includes
accessing the fixed centrofacial erythema in a characteristic pattern and
phymatous changes. The major phenotypes include accessing papules and pustules,
flushing, and ocular rosacea. Lastly, the minor phenotypes include assessing
burning and/or stinging sensations, edema (swelling), and dry appearance.
There are numerous treatment methods available for treating rosacea that are
unique for every patient. For instance, different variations of oral
antibiotics or topical treatments can be prescribed for the course treatment.
Moreover, persistent blood vessels that cause rosacea can be successfully
reduced with the non-invasive and non-ablative treatment method of Intense pulsed
light (IPL).
Centre for Medical and Surgical Dermatology offers various treatment options
for rosacea which are unique for every patient. For more information on
this condition, visit the following link:
Centre for Medical and Surgical Dermatology offers IPL therapy as a
treatment option for rosacea. For more information about this treatment option,
visit the following link:
Laser Treatment
