Much to their chagrin, millions of American adults are now walking around red-faced, and many of them don’t know why. They may assume it’s just a temporary complexion problem, and like teenage acne it will eventually go away by itself. What they don’t realize is that they are likely to be unknowing victims of rosacea – “The Great Impostor” – a complex and potentially serious facial disorder that can lead to significant disruption and untold anguish in their personal lives if left untreated.
“To many people, the flushing or redness of rosacea may resemble a sunburn, and the bumps and pimples may be mistaken for a typical case of acne,” said Dr. Richard Odom, professor of dermatology at the University of California-San Francisco. “Adding to the confusion, even fewer are likely to associate the eye problems of ocular rosacea with a skin disorder.” He noted that this lack of understanding causes many rosacea sufferers to delay seeing a dermatologist because they assume they have a temporary condition that will ultimately disappear on its own. Without medical help, however, the effects of rosacea usually persist and may grow increasingly severe.
Unfortunately, this widespread ignorance about the disease has made it the subject of numerous myths. One common misconception is that rosacea sufferers, who often have a red face and nose, are alcoholic. In fact, while alcohol consumption may aggravate the disorder, the symptoms can be just as severe in a teetotaler.
Another false assumption is that a person's skin problem is due to poor hygiene, and many sufferers do not realize they have a medical condition that can be successfully controlled with proper diagnosis and treatment.
"Because rosacea affects the way we look, its consequences often go far deeper than its physical impact alone," said Dr. Ted Grossbart, a psychologist at Harvard Medical School and author on the emotional impact of skin diseases. "Nobody likes feeling unattractive, and the effect of rosacea on appearance makes a person emotionally vulnerable. Especially because this condition is not well understood, rosacea can leave its victims feeling isolated and even alienated from society."
In National Rosacea Society surveys of more than 1,200 rosacea patients, 76 percent said rosacea had lowered their self-confidence and self-esteem, and 69 percent said they had experienced embarrassment as a result of the disorder. Nearly 63 percent reported difficulty in establishing new relationships, and 41 percent said they had avoided or canceled face-to-face contact because of their condition.
For most people, rosacea starts innocently enough. Suddenly, without warning, a flush comes to their cheeks, nose, chin or forehead. Then just when they start to feel concern, the redness disappears. Unfortunately, it happens again and again, becoming ruddier and lasting longer and longer each time. Eventually, visible blood vessels may appear, and bumps and pimples often develop, growing more extensive over time. In many rosacea sufferers, the eyes are also affected, appearing watery or bloodshot and feeling gritty or irritated. Without treatment and proper care, severe cases of this condition, known as ocular rosacea, can potentially lead to corneal damage and reduced vision. In severe cases, especially in men, the nose may also become enlarged from excess tissue. This is the condition that gave comedian W.C. Fields his trademark red bulbous nose.
In addition to these basic signs and symptoms, many rosacea sufferers may experience facial burning, stinging or itching, as well as a dry appearance. Other potential signs of rosacea include raised red patches, facial swelling and skin thickening. In some people, rosacea may also develop on the neck, chest, scalp, ears or elsewhere beyond the face.
While the cause of rosacea remains a mystery, there are various factors that may put people at greater risk for acquiring the disorder or that trigger its eruptions. These factors fall into such diverse categories as genetic heritage, skin type, weather, emotional influences, physical exertion, certain foods and beverages, adverse reactions to drugs and cosmetics, and underlying medical conditions. But a thread that generally runs through them all is that each may relate to flushing. In surveys of rosacea sufferers by the National Rosacea Society, 40 percent of the respondents indicated they had a family member who also suffered from rosacea or similar symptoms. More than 72 percent of the respondents said they had fair skin, while 27 percent said their complexion was medium and less than 1 percent reported dark complexions.
Sometimes referred to as the "Curse of the Celts," rosacea was found especially common among individuals of Irish descent. While the disorder can occur in all ethnic groups, rosacea was also found unusually prevalent among people of English, Scottish, Scandinavian and northern or eastern European ancestry. Rosacea is more frequently diagnosed in women, but is often more severe in men. However, this perception may arise in part because women are more likely to see a physician, while men are more likely to seek medical attention only after the condition reaches advanced stages.
Once rosacea appears, an astonishing array of lifestyle and environmental factors has been found to aggravate the condition or trigger flare-ups of symptoms in various individuals. Some of the more common rosacea triggers include sun exposure, emotional stress, hot weather, alcohol, spicy foods, strenuous exercise, wind, hot baths, cold weather, heated beverages and certain skin-care products.
"The single most important action a person who suspects he or she may have rosacea can take is to see a dermatologist for diagnosis and treatment," Dr. Odom said. "Although rosacea cannot be cured, effective medical therapy is available that can halt its progression and minimize or reverse its effects."
Dermatologists usually prescribe oral and topical therapy to bring symptoms under immediate control, and then continue long-term therapy to maintain remission. When appropriate, lasers or other devices may be used to remove visible blood vessels, reduce extensive redness or recontour an enlarged nose. A gentle skin-care regimen is recommended, and cosmetics may also be used to minimize the appearance of redness. Another important step is to identify and avoid those factors that seem to trigger rosacea flare-ups in individual cases. Just as with allergies, minimizing the things that aggravate the condition can go a long way toward reducing its effects.
To help rosacea sufferers identify and avoid their individual triggers, the National Rosacea Society offers a rosacea diary booklet, as well as a range of other materials with detailed information on the disorder.