Many rosacea sufferers grow up with a complexion that initially is very fine. But when rosacea strikes, being accustomed to compliments on a "peaches and cream" complexion can make the relentless march of unsightly redness, pimples and excess tissue growth especially shocking.
"The healthy-looking rosy glow that appears in many rosacea sufferers in their teens and early 20s can actually be an early sign of rosacea," said Dr. Larry Millikan, chief, department of dermatology, Tulane Medical Center. "But it's extremely important for those whose complexions are being eroded by rosacea symptoms to understand that all is not lost -- they can regain their former appearance through compliance with long-term medical therapy and lifestyle changes.
Rosacea is a chronic and progressive disorder that may first be noticed as a redness on the cheeks, nose, chin or forehead that comes and goes. A susceptibility to rosacea, called prerosacea, can be detected in some individuals in their teens or early 20s.1 Rosacea has even been reported in children. It is characterized by frequent blushes or flushes that last a little longer than normal, a strong family history of rosacea and facial skin that may become irritated in reaction to topical creams and lotions, especially anti-acne medications, over-the-counter skin-care products or sunscreens with irritating ingredients.
Left untreated, rosacea progresses to the second stage, where the redness tends to become ruddier and more permanent. Dilated blood vessels known as telangiectasia may appear, and bumps and pimples called papules and pustules often develop. In some cases, the skin of the eyelids as well as the cheeks, below the eyes and the nasolabial folds -- the folds of skin from the nose to the lips -- may take on a "baggy" appearance from swelling.
Signs of the third stage of rosacea include persistent deep redness and many dilated veins, especially around the nose. An early sign of the third stage is fibroplasia -- growth of excess tissue -- which can produce enlarged pores. In rare cases, this can result in an"orange-peel" facial appearance.
At its worst, especially in men, the nose may grow swollen and bumpy from excess tissue, a condition called rhinophyma that gave comedian W. C. Fields his trademark bulbous nose. When the entire face is involved, swelling may produce painful nodules and, along with fibroplasia, may result in lion-like facial features.
"Certainly, the onset of an incurable disorder that can dramatically alter one's appearance can be devastating," said Dr. Millikan. "But the good news is that rosacea's symptoms can be effectively controlled and the sufferer's complexion restored, especially if the condition is treated early."
Compliance with medical therapy and lifestyle changes is key to managing rosacea, he said. Dermatologists usually prescribe both oral and topical antibiotics to bring rosacea under control rapidly. Clinical studies have demonstrated high rates of general effectiveness with various antibiotics and dosages, and these may be tailored by the dermatologist for each individual case.
Long-term therapy is usually conducted with a topical therapy alone to maintain remission while avoiding side effects from prolonged use of antibiotic tablets, such as gastrointestinal problems, phototoxicity and genital infection. Because blood levels of topical antibiotics are minuscule, such systemic side effects have not been reported with these products.
In some rosacea patients, the eyes also may be affected. Those with ocular rosacea may notice their eyes feel gritty and/or appear bloodshot. However, symptoms of ocular rosacea also may be controlled with medical therapy. Though telangiectasia and rhinophyma cannot be reversed with medications, lasers have been successfully used to remove excess tissue and visible blood vessels -- which also may be effectively concealed with makeup.
Faria DT, Krull EA: Recognizing and managing rosacea. Hospital Medicine. 1996;February:35-40.
The National Rosacea Society is a 501(c)(3) nonprofit organization whose mission is to improve the lives of people with rosacea by raising awareness, providing public health information and supporting medical research on this widespread but little-known disorder. The information the Society provides should not be considered medical advice, nor is it intended to replace
consultation with a qualified physician. The Society does not evaluate, endorse or recommend any particular medications, products, equipment or treatments. Rosacea may vary substantially from one patient to another, and treatment must be tailored by a physician for each individual case. For more information, visit About Us.