When the National Rosacea Society (NRS) was founded in 1992, rosacea was considered a rare disease and there was only one FDA-approved treatment. Thanks to more than three decades of celebrating Rosacea Awareness Month every April, rosacea is now a frequent topic in health and beauty publications, and the estimated 16 million Americans who suffer from this chronic facial skin disorder have access to a broad range of medications, procedures and sensitive skin care products to address their unique set of signs and symptoms.
“Every case of rosacea is a little different, with a complex of signs and symptoms that vary in severity,” said Dr. Julie Harper, president and owner of Dermatology and Skin Care Center of Birmingham. “Fortunately, both medical therapy and consumer skin care products have advanced alongside awareness, and we can now create a custom therapeutic regimen aimed at a patient’s particular features.”
What Is Rosacea?
Rosacea is a chronic disorder of the facial skin that is often characterized by flare-ups and remissions. Although it can develop in many ways and at different stages in life, rosacea typically first appears after age 30 as a redness on the cheeks, nose, chin or forehead that comes and goes, and might be mistaken for a sunburn. Unfortunately, the redness tends to worsen and grow more persistent over time, and small visible blood vessels may appear. Without treatment, bumps and pimples often develop, and burning and stinging are common. In severe cases, the nose may become enlarged from excess tissue, and in many rosacea patients the eyes are also affected, feeling irritated and appearing watery or bloodshot.
Because rosacea’s signs and symptoms can vary so widely, the chronic disorder was initially classified into four subtypes – clusters of observable manifestations that often appeared together. However, researchers have a clearer picture of how the disease develops and the processes involved in and under the skin. Rosacea’s often fluctuating and seemingly unrelated signs and symptoms are now understood to be part of a single underlying inflammatory continuum.
Today rosacea is identified according to its individual characteristics, or phenotypes – the major elements that may result from this disease process, which may appear in different combinations and at different times.1 This new targeted focus encourages consideration of the full range of potential signs and symptoms, better assessment of their severity, and selection of treatment that is more precisely tailored for each individual case.
Diagnosis and Treatment
Rosacea may be diagnosed in several ways: when either persistent redness of the facial skin (erythema) or skin thickening (phymatous changes) are present; or when two or more other major signs appear together, including bumps and pimples (papules and pustules), flushing, small visible blood vessels (telangiectasia), or eye irritation such as burning, stinging or redness.
“Fortunately, whereas we once had a limited number of treatments to offer patients, there are now multiple therapeutic options for virtually every aspect of the disease, including oral and topical medications to treat persistent redness, bumps and pimples, and eye irritation,” Dr. Harper said. “Light-based therapies, including lasers and intense pulsed light, may help relieve or eliminate redness and telangiectasia. Lasers and surgical techniques may be used to remove thickened skin on the nose, known as rhinophyma, and other areas of the face.”
Therapy for ocular rosacea may involve eyelid hygiene, artificial tears, and oral or topical antibiotics or other medications, depending on severity. Rosacea patients with significant eye involvement should see an ophthalmologist for specialized treatment, Dr. Harper noted.
“What’s more, research and clinical experience have shown us that medications used in combination may have a synergistic effect that is more successful than using a single therapy alone, helping patients achieve clear or almost clear skin,” she said.
Well-tailored therapy can help reduce the appearance of rosacea, but it may also keep the disease from progressing. Some medications appear to improve baseline redness over time, while others have been shown to help maintain remission of inflammatory bumps and pimples.2
Skin Care Matters
In addition to medical care, effective skin care is an important part of successful rosacea therapy. Prior to diagnosis, many rosacea sufferers may turn to skin care products and cosmetics as a way to treat or cover up these signs and symptoms, mistaking them for sunburn or acne. However, harsh cleansers, acne medications and even bar soap may make matters worse by irritating or drying out the skin and damaging the moisture barrier. Even many gentle skin care and cosmetic products may contain ingredients that could cause a rosacea flare-up.
In NRS surveys, 82% of rosacea patients reported that certain skin care products and cosmetics aggravated their condition, 70% said there were specific ingredients that irritated their skin and 84% were interested in more guidance on skin care. The most common irritants were astringent alcohol (63%), perfumes or fragrances (57%), witch hazel (31%) and menthol (30%). Around a quarter of respondents were affected by peppermint or eucalyptus oil, dyes and pigments, sulfates, and parabens or other preservatives.
To help patients overcome these obstacles and make appropriate choices, the NRS recently launched a Seal of Acceptance program to identify skin care and cosmetic products that may be suitable for people who suffer from rosacea. To be considered for the Seal, skin care and cosmetic products must be free of ingredients that cause skin barrier dysfunction, flushing (vasomotor instability) or unwanted neurosensory stimulation such as burning or itching. Each product earning the NRS Seal of Acceptance must undergo clinical testing to demonstrate safety and low risk for irritation and sensitization in people with rosacea.
To date, more than 50 products have received the Seal of Acceptance, including cleansers, moisturizers, sunscreens, foundations and other gentle products. More information about the Seal and a directory of accepted products may be found online at rosacea.org/seal-of-acceptance.
About Rosacea Awareness Month
During Rosacea Awareness Month in April and throughout the year, the NRS conducts public education activities to reach the many millions of rosacea sufferers who may not realize they have a treatable medical condition, emphasizing the warning signs and urging those who suspect they may have rosacea to see a dermatologist. Those who experience any of the following signs 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
Bulk quantities of educational materials are available to health professionals for their patients through the NRS website at rosacea.org or by writing the National Rosacea Society, 4619 N. Ravenswood Ave., Suite 103, Chicago, IL 60640; calling the NRS toll free at 1-888-NO BLUSH; or via email at info@rosacea.org. Those interested in spreading awareness during April are encouraged to visit the official Rosacea Awareness Month landing page at rosacea.org/ram for ways in which they can participate.
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. More information can be found at rosacea.org.
References:
1. 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;78(1):148-155. doi:10.1016/j.jaad.2017.08.037.
2. Gallo RL, Baldwin HE, Stein Gold L, Harper JC. Update on facial erythema in rosacea. J Drugs Dermatol 2021 Aug 1;20(8):861-864. Published online July 19, 2021. DOI:10.36849/JDD.6062.