While protective face masks may both hide and exacerbate the signs and symptoms of rosacea, the 16 million Americans who suffer from this red-face disorder now have access to more treatment options and sophisticated medical care than ever before. The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month to educate the public on this common and potentially serious facial condition, and to urge those who suspect they may have it to see a dermatologist for diagnosis and the most up-to-date therapy.
“The heat and abrasion from prolonged use of face masks often leads to irritation of facial skin and a worsening of rosacea signs and symptoms, calling for more intense medical treatment and special care,” said Dr. Linda Stein Gold, director of dermatology clinical research at the Henry Ford Health System. “Because of rosacea’s conspicuous impact on facial appearance, these aftereffects may become increasingly apparent as mask mandates are eased when COVID-19 is brought under control.”
She noted that, even during rosacea flare-ups, it is important to follow public health directives and wear masks when and where they are required.
In a recent study of mask-related rosacea symptoms, after wearing protective masks for six weeks the average severity score for flushing rose 58% in rosacea patients with persistent facial redness and 52% in patients with bumps and pimples.1 Scores for persistent facial redness increased 56% in patients with bumps and pimples, and 44% in those with facial redness alone. During the same period, quality of life scores declined 69% in patients with facial redness and 45% in those with bumps and pimples.
“Rosacea is now understood as a single disease with a wide variety of potential signs and symptoms, and fortunately there is a growing range of medical therapies that can be tailored for each individual case to achieve substantially improved outcomes,” said Dr. Stein Gold.2 “When the signs and symptoms of rosacea are virtually eliminated, the positive effect on patients’ lives is often dramatic.”
In an NRS survey of more than 800 rosacea patients, 83% 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% reported improvement in their occupational well-being.3
“Through habit or lack of knowledge, however, many patients may unknowingly continue with therapy that is not as effective as it could be,” Dr. Stein Gold said. “In these cases, there may be newer medications that produce more successful results as well as therapy combinations that offer excellent synergistic effects.”
New Therapies Offer Opportunities for Improvement
Although the onset of rosacea often occurs between the ages of 30 and 60, rosacea is a chronic condition where the incidence is cumulative and therefore increasingly prevalent among older individuals. Yet a recent NRS survey found that rosacea sufferers aged 60 and over were especially more likely to use older treatments.4 In the survey of 1,714 rosacea patients, 54% of those 60 and over reported they still use the first prescription therapy ever developed and approved for rosacea, compared to 41% of those under 60. Furthermore, 42% of those 60 and over had never changed their treatment regimen, compared to only 19% of those under 60.
Dr. Stein Gold noted that developing an individualized treatment plan with one or more targeted therapies tailored to a patient’s specific signs and symptoms will achieve the best overall outcome, both objectively in terms of clear skin and subjectively in terms of quality of life. “As dermatologists, we want patients to be healthy and happy in their skin,” she said. “If a therapy is not doing its job, it may be time to try a different approach.”
She noted that for many patients persistent facial redness, the most common diagnostic sign of rosacea, is the most damaging to quality of life.5 However, there are now new medical therapies specifically for redness that are not only effective but may even modify the long-term course of disease. Of equal importance, new advances in topical and oral therapy for bumps and pimples have been introduced to help achieve clear skin.
Lasers and other light therapies are often used to remove visible blood vessels, and more aggressive lasers or surgery is used to correct any thickening of the skin, especially on the nose. Extra-gentle skin care products have also been developed to avoid irritation and soothe sensitive skin.
A New Understanding of 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 (erythema) or, less commonly, phymatous changes where the facial skin thickens are considered diagnostic of the disorder.6 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, a watery or bloodshot appearance and potential loss of visual acuity. 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.
Rosacea was recently estimated to affect 415 million individuals 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 Lena Dunham and Naomi Watts, singer Sam Smith and comedian Amy Schumer.
While 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.
Although causal relationships have not been determined, recent research has found associations between rosacea and increased risk of a growing number of potentially serious systemic disorders. These have included cardiovascular diseases, gastrointestinal disorders, psychiatric and neurological conditions, autoimmune diseases and certain types of cancer.
“As scientific and medical knowledge of rosacea continues to increase, the good news is that it is now possible to tailor a personal treatment plan to address the individual signs and symptoms of each patient to substantially improve the quality of their lives,” Dr. Stein Gold said.
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 rosacea.org.
About the National Rosacea Society
The National Rosacea Society is the world's largest organization dedicated to improving the lives of the estimated 16 million Americans who suffer from this widespread but poorly understood disorder. Its mission is to raise awareness of rosacea, provide public health information on the disorder and support medical research that may lead to improvements in its management, prevention and potential cure.
In addition to the NRS website at rosacea.org, the NRS may be followed on Facebook, Twitter, Instagram and Pinterest for up-to-date information and tips on rosacea. Further information may be obtained by writing the National Rosacea Society, 111 Lions Dr., Suite 216, Barrington, Illinois 60010; via email at email@example.com; or by calling its toll-free number at 1-888-NO-BLUSH.
1. Damiani G, Gironi LC, Grada A, et al. COVID-19 related masks increase severity of both acne (maskne) and rosacea (mask rosacea): multi-center, real-life, telemedical, observational prospective study. Dermatol Ther 2021 Feb 3:e14848. doi: 10.1111/dth.14848. Epub ahead of print.
2. Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2020;82(6):1501–1510. doi:10.1016/j.jaad.2020.01.077
3. National Rosacea Society. Rosacea Awareness Month highlights new treatment options. Rosacea Review 2020 Spring.
4. National Rosacea Society. Survey shows most patients are satisfied with therapy, but more awareness of treatment options is needed. Rosacea Review 2020 Fall.
5. National Rosacea Society. Experts urge greater focus on facial redness at rosacea roundtable. Rosacea Review 2020 Summer.
6. Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2018 Jan;78(1):148-155. doi: 10.1016/j.jaad.2017.08.037. Epub 2017 Oct 28.