What is Rosacea?
Rosacea is a chronic skin disease that manifests as an outbreak whose etiology has not been fully elucidated. It usually begins in middle adulthood and mainly affects the face. The characteristic signs of rosacea are erythema (redness), nodules, pustules and superficial vascular dilatations.
One complication that occasionally arises associated with rosacea is the involvement of the eyes with inflammation of the eyelid, the conjunctiva. Another additional symptom that occurs almost exclusively in men is the hyperplasia of the sebaceous glands, especially in the nose. As a result, a bulbous nose appears (rhinophyma) which can be remodeled by surgery.
Sunlight and extreme temperatures are factors that intensify rosacea, so it is recommended that those affected avoid them. Depending on the manifestation of this pathology, a topical or oral treatment with antibiotics is prescribed. Persistent redness or erythema and (red venites) can be removed by laser. Rosacea is a chronic disease that usually responds well to treatment consisting of adequate pharmacological therapy and periodic visits to the doctor.
What is the definition of rosacea?
Rosacea (Latin rosaceus = pink in color) is a chronic inflammatory cutaneous condition that manifests itself as an outbreak and occurs mainly between 40 and 50 years in most cases. It is usually chronic course for which definitive treatment is not yet found, so it can only be controlled. For this reason, it is common for patients to have a considerable aesthetic problem.
In order to facilitate diagnosis and treatment, rosacea is divided into stages:
Stage I, erythematous rosacea: In the first phase of the disease, the facial skin is inflamed and reddened (erythema).
Stage II, papulopustular rosacea: After a certain time the erythema becomes chronic. Rosacea is called papulopustular when isolated or clustered, inflamed and erythematous papules and pustules are added to the blush and remain for days or weeks.
Stage III, rosacea conglobata: In the third stage of the disease the skin is thickened and shows large pores with confluent and hemorrhagic inflammatory nodules in some cases.
What causes to rosacea?
The causes of rosacea has not been sufficiently clarified. It is possible that causes are from an extreme sensitivity of the parasympathetic nervous system until a dysfunctional regulation of the sanguineous irrigation in the zone of the face.
Some people are likely to have a genetic predisposition which they are more prone to rosacea. It is also discussed that Demodex folliculorum mite may be the causes. Some findings suggest that the composition of the secretion of the sebaceous glands of the face plays a role in rosacea and its causes. It is also suspected that there is a relationship with certain gastrointestinal disorders.
Intense and prolonged sun exposure, certain medications, heat, cold, hot or spicy foods, as well as the consumption of coffee, tea and alcohol may favor the appearance and intensification of rosacea symptoms. It seems that psychological factors can also trigger acute outbreaks of this ailment. Situations of stress and conflict can lead to the manifestation of the disease or contribute to determine the severity of its evolution.
The triggers of rosacea are very diverse, and have to be identified and avoided individually.
What are the symptoms of rosacea?
The first symptom of rosacea is erythema of the skin of the face. Burning or stabbing pain in the skin may also occur. Then the pink spots on the face usually extend from the nose sideways to the cheeks and up and down to the forehead and chin.
Rosacea courses are usually in a chronic and phased manner. It is common for the skin erythema to be accompanied by a slight desquamation and the dilation of the superficial blood vessels permanently. Sprouts, papules (nodules) and swelling from fluid build-up (edema) may appear later on, and the skin becomes thicker and coarser.
In severe cases the disease can spread to the ears, neck and chest. Unlike acne, rosacea does not have pimples. If they appear, it may be a mixed form of both conditions.
In some cases, rosacea also affects the eyes. Patients experience a foreign body sensation in the eye, burning, dilation of blood vessels and inflammation of the upper eyelid and conjunctiva.
How is rosacea diagnosed?
The diagnosis of rosacea is established based on the clinical picture with the typical symptomatology, such as cutaneous erythema, visible vascular dilatations, ocular alterations or pustules and papules. The collection of information about the life habits of the patient (anamnesis) allows to identify the factors that worsen the disease.
In severe or unclear cases, it may be advisable to take a skin sample (biopsy) and corroborate the diagnosis by means of a histological study. As far as the differential diagnosis is concerned, rosacea has to be distinguished mainly from acne and perioral dermatitis. It is also complex to diagnose rosacea in mixed diseases.
How is rocacea treated?
The treatment of rosacea aims to control signs and symptoms. Treatment is established based on the stage in which it is.
General therapeutic measures include frequent but gentle skin hygiene. Soaps and gels with alcohol should be dispensed with. In addition patients have to bypass the factors that trigger and worsen rosacea such as intense sunlight. When using sunscreens, it is advisable to choose those that have a high sun protection factor. Creams with color allow covering the affected skin regions. Whenever possible, it is advisable to avoid raising the temperature of the face, avoiding very hot and spicy foods, and rooms, bathrooms, showers and saunas at high temperatures. Likewise, each patient should try to identify and avoid the specific factors that trigger the disease in their specific case.
In the light forms of rosacea, it may be helpful to perform a circular massage of the affected areas for five or ten minutes twice a day.
In rare cases, local treatment with antibiotics or other anti-inflammatory creams are useful. Antibiotic ointments with metronidazole or erythromycin have been shown to work well.
When rosacea is more severe or complications arise, oral antibiotic treatment with active substances such as tetracycline, erythromycin or minocycline is prescribed. In very difficult cases, the administration of isotretinoin may be used under certain circumstances.
Permanent redness and red veins can be removed by laser treatment. Depending on the size of the surface to be treated, several sessions may be required. After treatment, inflammation and irritation usually appear which recur quickly. The bulbous nose (rhinophyma) can also be surgically or laser-resolved. The eye problems must receive an additional adequate treatment to the symptomatology.
What is the process of rosacea?
Rosacea is usually chronic and outbreaks. Adequate treatment allows for a very favorable outcome in which there are hardly any symptoms and the occurrence of infrequent episodes.
The manifestation of the disease can vary considerably. It includes from slight erythema in the area of the cheeks until the appearance of multiple pustules similar to those of acne. Sometimes the pustules also appear on the rest of the body, especially in the chest and back. This ailment can progress at high speed, but also stop at each stage.
One of the complications associated with rosacea in the third stage (rosacea conglobata), seen mainly in men is the hyperplasia of the sebaceous glands, especially in the nose (bulbous nose or rhinophyx). Sometimes it also occurs on the forehead, chin and ear lobes.
This disorder of the sebaceous glands sometimes appears in isolation, without other symptoms of rosacea. In exceptional cases from a rhinophyma may develop a basiloma, a type of skin cancer.
Another possible complication of rosacea is the involvement of the eye. Patients suffer from dry eye, conjunctivitis and blepharitis to keratitis and iritis. In very rare cases this can lead to blindness.
In the first two stages of rosacea evolution is favorable. In the third stage the evolution is chronic and no treatment has been found with complete effectiveness.
How to prevernt rosacea
There are no measures to actively prevent rosacea. However, it is desirable that patients know and avoid as far as possible all the factors that intensify the disease or cause outbreaks. These include mainly exposure to intense solar radiation and other stimuli with a vasodilatory effect such as heat, alcohol, hot or spicy foods and beverages.
In general, the skin should be thoroughly cleaned and irritations derived from creams or make-up must be avoided. In order to prevent possible complications arising from possible ocular involvement, periodic examinations by the ophthalmologist are required.