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Rosacea - Causes, Symptoms and Treatment


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Rosacea is an inflammatory skin disease. The cause of rosacea is unknown. There are several theories regarding the origin of overactive facial blood vessels and inflammation, including genetic, environmental, vascular, inflammatory factors. It begins as erythema on the central face and across the cheeks, nose, or forehead but can also less commonly affect the neck and chest. As rosacea progresses, other symptoms can develop such as semi-permanent erythema, telangiectasia, red domed papules and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red lobulated nose. Rosacea is most common in women and people with fair skin. Rosacea may be aggravated by facial creams or oils, and especially by topical steroids. There are also some foods and drinks that can trigger flushing, these include alcohol, foods and beverages containing caffeine, foods high in histamines and spicy food. Certain medications and topical irritants can quickly progress rosacea. If redness persists after using a treatment then it should be stopped immediately. Steroid induced rosacea is the term given to rosacea caused by the use of topical or nasal steroids. These steroids are often prescribed for seborrheic dermatitis.

Treating rosacea varies from patient to patient depending on severity and subtypes. People with rosacea often find that certain lifestyle and environmental factors trigger a flare-up or aggravate their individual conditions. Rosacea is not caused by alcohol abuse, as people once thought. But in people who have rosacea, drinking alcohol may cause symptoms to get worse. Trigger avoidance can help reduce the onset of rosacea but alone will not normally cause remission for all but mild cases. Rosacea can affect the eyes. How severely rosacea affects the eye is not related to how severe the facial rosacea is. Left untreated, rosacea tends to be progressive, which means it gets worse over time. Oral tetracycline antibiotics and topical antibiotics such as metronidazole are usually the first line of defence prescribed by doctors to relieve papules, pustules, inflammation and some redness. The treatment of flushing and blushing has been attempted by means of the centrally acting a-2 agonist clonidine, but there is no evidence whatsoever that this is of any benefit.

Causes of Rosacea

The exect cause of rosacea is unknown. Triggers that cause episodes of flushing and blushing play a part in the development of rosacea. Exposure to temperature extremes can cause the face to become flushed as well as strenuous exercise, heat from sunlight, stress, anxiety, cold wind, moving to a warm or hot environment from a cold one such as heated shops and offices during the winter. Certain medications and topical irritants can quickly progress rosacea. If redness persists after using a treatment then it should be stopped immediately. Some acne and wrinkle treatments that have been reported to cause rosacea include microdermabrasion, chemical peels, high dosages of isotretinoin, benzoyl peroxide and tretinoin.

Common causes and risk factors of Rosacea:

  • Sun and wind exposure.
  • Hereditary and environmental factors.
  • Abnormal immune reactions in the skin which leads to inflammation.
  • Long-term use of steroid creams on the face.
  • A steady diet of hot beverages.

Signs and Symptoms of Rosacea

Rosacea may begin as a tendency to flush or blush easily. There are red spots and sometimes pustules in both conditions. A rare symptom is rhinophyma, a thick, leathery texture of the nose skin. The eyes can be affected with irritation and increased light sensitivity. Rosacea may also result in reddened skin, scaling and swelling of affected areas. When the eyes are affected, symptoms may include burning and tearing or the feeling that there is a piece of grit in the eye. The eyelids may swell due to infection. Usually this condition does not impair vision.

Sign and symptoms may include the following :

  • Tendency to flush or blush easily.
  • Red, bulbous nose.
  • Thick skin, usually on the forehead, chin and cheeks.
  • Dry and flaky facial skin.
  • Frequent redness of the face, or flushing.

Treatment for Rosacea

There is no permanent cure for rosacea. There is nothing you can do to prevent rosacea from starting. However, treatments can ease symptoms. The treatments used may vary, depending on what symptoms develop. Oral tetracycline antibiotics and topical antibiotics such as metronidazole are usually the first line of defence prescribed by doctors to relieve papules, pustules, inflammation and some redness. People who develop infections of the eyelids must practice frequent eyelid hygiene. Daily scrubbing the eyelids gently with diluted baby shampoo or an over-the-counter eyelid cleaner and applying warm compresses several times a day is recommended.

Treatment may include:

  • Calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream are reported to help some patients with rosacea.
  • Tetracycline antibiotics including doxycycline and minocycline reduce inflammation. They reduce the redness, papules, pustules and eye symptoms of rosacea.
  • Sometimes other oral antibiotics such as cotrimoxasole or metronidazole are prescribed for resistant cases.
  • Surgery or other treatments may help your skin look better if you have advanced rosacea.
  • Rhinophyma can be treated successfully by reshaping the nose surgically or with carbon dioxide laser by a dermatologic or plastic surgeon.