While rosacea today is well-recognized as a skin disorder affecting millions of people worldwide, it was not until the end of the past millennium that it came to be understood as a distinct disease, and only recently have advances in therapy allowed for its effective treatment.
Early literature, from Chaucer's Canterbury Tales to Shakespeare's Henry V, included various descriptions of men with red faces and enlarged noses. Artists through the ages have also depicted rosacea, and a painting in the Louvre, "The Old Man and His Grandson" by Ghirlandiao in 1480, is a well-known example.
To the best of our knowledge, the first medical description of rosacea was by Dr. Guy de Chauliac, a French surgeon living in the 14th century.
Dr. de Chauliac wrote about "red lesions in the face, particularly on the nose and cheeks." He called the condition "goutterose" (French for "pink droplet") or "couperose" (now a common French term for rosacea).
Whatever the name, the condition was then commonly "attributed to the excessive consumption of alcoholic drinks," according to Dr. Jean de Bersaques in the European Journal of Dermatology.1
However, while alcohol may exacerbate the condition, it is now known that the symptoms can be just as severe in a teetotaler.
Early treatments for rosacea ran the gamut from blood-letting in the arm, forehead and nose, to applying leeches on affected areas. The use of salves containing such ingredients as mercury, sulphur and bull's blood as treatment was first referred to in the 16th century.
A written reference to "acne rosacea" appeared in an English medical text by Dr. Thomas Bateman in 1812, who noted, "The perfect cure of acne rosacea is, in fact, never accomplished." Other 19th century references commonly listed rosacea among the different forms of acne.
During the 20th century, rosacea became increasingly recognized as a separate disease, requiring different therapy than acne. Effective medical treatment became available with the development of antibiotics after World War II, and in 1989 metronidazole was approved as the first topical therapy specifically for rosacea.
Although the cause of rosacea is still unknown, today it can usually be treated effectively with oral and/or topical antibiotics, followed by long-term therapy with topical medication alone and avoidance of environmental and lifestyle factors that aggravate the condition in various individuals.
The National Rosacea Society provides a Patient Diary Checklist to help rosacea sufferers identify and avoid environmental and lifestyle factors that cause rosacea flare-ups in their individual cases, as well as "Coping with Rosacea," a booklet that offers tips on avoiding common rosacea tripwires.
de Bersaques J: Historical notes on rosacea. European Journal of Dermatology. 1995;5:16-22.