Increased medical understanding has led to significant advances in the control of rosacea, allowing many of those who suffer from this chronic red-faced disorder to live free of its conspicuous and embarrassing symptoms for the first time. April has been designated Rosacea Awareness Month by the National Rosacea Society (NRS) to educate the public on this potentially serious condition estimated to affect more than 16 million Americans, and to urge those with the warning signs to see a dermatologist for diagnosis and appropriate therapy.
“Although the occurrence of rosacea has been well documented over the centuries, virtually everything we now understand about the disorder in medical science has been discovered in the last 20 years,” said Dr. Julie Harper, clinical associate professor of dermatology at the University of Alabama-Birmingham. “As a result of these advances, dermatologists are now able to identify and prescribe specific therapies for the various signs and symptoms based on a thorough understanding of the underlying disease process.”
Perhaps no one could have invented a more embarrassing disorder. First it tends to initially strike people at an age when they are already self-conscious about their appearance — those in their 30’s, 40’s or older. Then it afflicts the one part of the body that cannot be hidden — the face. Adding insult to misery, its diagnostic symptoms, a red face and in some cases a red bulbous nose, are often associated with heavy drinking — even though rosacea can be just as severe in a teetotaler. And the most common major symptoms, bumps and pimples, are often mistaken for poor hygiene or an inexplicable case of teenage acne.
In many patients, rosacea can also affect the eyes, causing them to feel irritated and appear bloodshot. Without treatment this condition, known as ocular rosacea, can lead to loss of visual acuity.
“Because of its effect on personal appearance, studies have demonstrated just how profoundly rosacea can damage the quality of people’s lives, as well as the positive impact of successful treatment,” Dr. Harper said. “Thanks to new approaches and important advances in medical therapy, it is increasingly possible to achieve clear or almost clear skin.”
In an NRS survey of 1,675 rosacea patients, 90 percent said the disorder had lowered their self-esteem and self-confidence, and 52 percent said they had avoided face-to-face contact because of the disorder. In another survey, 51 percent of those with severe symptoms said they had even missed work because of their condition.
When the signs and symptoms of rosacea are virtually eliminated, however, the improvement in patients’ lives is often dramatic. In an NRS survey of more than 800 rosacea patients, 83 percent of those who had achieved clear or almost clear skin said their psychological well-being had improved. Seventy-three percent said it had also improved their social lives, and 63 percent reported improvement in their occupational well-being.
In contrast, among those whose rosacea had only slightly or moderately improved, just 26 percent reported improvement in psychological well-being, 22 percent in social well-being and 21 percent in occupational well-being.
Although causal relationships have not been determined, recent research has also found associations between rosacea and increased risk of a growing number of potentially serious systemic disorders. These have included cardiovascular diseases, gastrointestinal disorders, neurological conditions, autoimmune diseases and certain types of cancer.
Rosacea was recently estimated to affect 415 million worldwide. Among the most famous rosacea sufferers is former President Bill Clinton, whose doctors disclosed he has this condition in the New York Times. Others reported to have suffered from rosacea include Princess Diana, actresses Renee Zellweger and Naomi Watts, singer Sam Smith and comedian Amy Schumer.
During Rosacea Awareness Month and throughout the year, the NRS will conduct public education activities to reach the many millions of rosacea sufferers who may not realize they have a medical condition that can be treated, emphasizing the warning signs and urging those who suspect they may have rosacea to see a dermatologist. Comprehensive information and materials are available on the NRS website at rosacea.org.
Help us spread awareness during the month of April! Visit the official Rosacea Awareness Month landing page at rosacea.org/ram for resources and ways to participate, and follow the conversation on social media using the hashtag #RosaceaAwareness. You can also follow the NRS on Facebook, Twitter and Pinterest for up-to-date information and tips on rosacea.
What Is Rosacea?
Rosacea is a chronic disorder of the facial skin that is often characterized by flare-ups and remissions. According to the recently updated standard classification of rosacea, the presence of persistent facial redness or, less commonly, phymatous changes where the facial skin thickens, are considered diagnostic of the disorder. Additional major signs include bumps (papules) and pimples (pustules), flushing, visible blood vessels (telangiectasia) and certain ocular manifestations. The presence of two or more major features independent of the diagnostic signs is also considered diagnostic of rosacea, and secondary signs and symptoms include burning or stinging, swelling and dry appearance.
In around half of rosacea patients, the eyes are also affected, including visible blood vessels on the eyelid margin and a watery or bloodshot appearance. In some patients, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose.
“Today’s approach to rosacea treatment is different than in the past, when there was a tendency to view the disorder in terms of common presentations of signs and symptoms,” Dr. Harper said. “Because the disease can manifest in so many ways, however, we are now finding it is much more effective to address the individual signs and symptoms of each patient.”
For example, advances in topical and oral therapy are now available for treating the inflammatory bumps and pimples, and topical therapies have now also been developed for persistent facial redness. Lasers and other light therapies are often used to remove visible blood vessels, while more aggressive lasers or surgery are used to correct phymatous changes.
Although the ultimate cause of rosacea remains unknown, flare-ups of signs and symptoms may be triggered by a vast array of lifestyle and environmental factors that can differ in each individual case, and patients are urged to identify and avoid those factors that aggravate their individual conditions. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin-care products and potentially an overabundance of Demodex mites.
“Fortunately today, rosacea can be controlled very effectively with a combination of medical therapies and lifestyle changes,” Dr. Harper said. “A growing number of treatments are now available that can be tailored to each individual case, substantially reducing the impact of rosacea on people’s lives.”
Individuals with any of the following warning signs of rosacea are urged to see a dermatologist for diagnosis and appropriate treatment:
- Redness on the cheeks, nose, chin or forehead
- Small visible blood vessels on the face
- Bumps or pimples on the face
- Watery or irritated eyes
During April and throughout the year, people who suspect they may have rosacea can contact the NRS for more information, or visit the Patients section of rosacea.org.