Questions and Answers About
Rosacea
This booklet contains
general information about rosacea (ro-ZAY-she-ah). It defines rosacea and
describes its symptoms, possible causes, and treatments. If you have further
questions after reading this booklet, you may wish to discuss them with your
doctor.
What Is Rosacea?
Rosacea is a chronic
(long-term) disease that affects the skin and sometimes the eyes. The disorder
is characterized by redness, pimples, and, in advanced stages, thickened skin.
Rosacea usually affects the face; other parts of the upper body are only rarely
involved.
Who Gets Rosacea?
Approximately 14 million
people in the United States have rosacea. It most often affects adults between
the ages of 30 and 60. Rosacea is more common in women (particularly during
menopause) than men. Although rosacea can develop in people of any skin color,
it tends to occur most frequently and is most apparent in people with fair
skin.
What Does Rosacea Look Like?
There are several
symptoms and conditions associated with rosacea. These include frequent
flushing, vascular rosacea, inflammatory rosacea, and several other conditions
involving the skin, eyes, and nose.
Frequent flushing of the
center of the face--which may include the forehead, nose, cheeks, and
chin--occurs in the earliest stage of rosacea. The flushing often is
accompanied by a burning sensation, particularly when creams or cosmetics are
applied to the face. Sometimes the face is swollen slightly.
A condition called
vascular rosacea causes persistent flushing and redness. Blood vessels under
the skin of the face may dilate (enlarge), showing through the skin as small
red lines. This is called telangiectasia (tel-AN-je-ek-tay-ze-ah). The affected
skin may be swollen slightly and feel warm.
A condition called
inflammatory rosacea causes persistent redness and papules (pink bumps) and
pustules (bumps containing pus) on the skin. Eye inflammation and sensitivity
as well as telangiectasia also may occur.
In the most advanced
stage of rosacea, the skin becomes a deep shade of red and inflammation of the
eye is more apparent. Numerous telangiectases are often present, and nodules in
the skin may become painful. A condition called rhinophyma also may develop in
some men; it is rare in women. Rhinophyma is characterized by an enlarged,
bulbous, and red nose resulting from enlargement of the sebaceous
(oil-producing) glands beneath the surface of the skin on the nose. People who
have rosacea also may develop a thickening of the skin on the forehead, chin,
cheeks, or other areas.
How Is the Eye Affected?
In addition to skin
problems, up to 50 percent of people who have rosacea have eye problems caused
by the condition. Typical symptoms include redness, dryness, itching, burning,
tearing, and the sensation of having sand in the eye. The eyelids may become
inflamed and swollen. Some people say their eyes are sensitive to light and
their vision is blurred or otherwise impaired.
What Causes Rosacea?
Doctors do not know the
exact cause of rosacea but believe that some people may inherit a tendency to
develop the disorder. People who blush frequently may be more likely to develop
rosacea. Some researchers believe that rosacea is a disorder where blood
vessels dilate too easily, resulting in flushing and redness.
Factors that cause
rosacea to flare up in one person may have no effect on another person.
Although the following factors have not been well-researched, some people claim
that one or more of them have aggravated their rosacea: heat (including hot
baths), strenuous exercise, sunlight, wind, very cold temperatures, hot or
spicy foods and drinks, alcohol consumption, menopause, emotional stress, and
long-term use of topical steroids on the face. Patients affected by pustules
may assume they are caused by bacteria, but researchers have not established a
link between rosacea and bacteria or other organisms on the skin, in the hair
follicles, or elsewhere in the body.
Can Rosacea Be Cured?
Although there is no cure
for rosacea, it can be treated and controlled. A dermatologist (a medical
doctor who specializes in diseases of the skin) usually treats rosacea. The
goals of treatment are to control the condition and improve the appearance of
the patient's skin. It may take several weeks or months of treatment before a
person notices an improvement of the skin.
Some doctors will
prescribe a topical antibiotic, such as metronidazole, which is applied
directly to the affected skin. For people with more severe cases, doctors often
prescribe an oral (taken by mouth) antibiotic. Tetracycline, minocycline,
erythromycin, and doxycycline are the most common antibiotics used to treat
rosacea. The papules and pustules symptomatic of rosacea may respond quickly to
treatment, but the redness and flushing are less likely to improve.
Some people who have
rosacea become depressed by the changes in the appearance of their skin.
Information provided by the National Rosacea Society indicates that people who
have rosacea often experience low self-esteem, feel embarrassed by their
appearance, and claim their social and professional interactions with others
are adversely affected. (See "Where Can
People Get More Information About Rosacea?" below.) A doctor should be
consulted if a person feels unusually sad or has other symptoms of depression,
such as loss of appetite or trouble concentrating.
Doctors usually treat the
eye problems of rosacea with oral antibiotics, particularly tetracycline or
doxycycline. People who develop infections of the eyelids must practice
frequent eyelid hygiene. The doctor may recommend scrubbing the eyelids gently
with diluted baby shampoo or an over-the-counter eyelid cleaner and applying
warm (but not hot) compresses several times a day. When eyes are severely
affected, doctors may prescribe steroid eye drops.
Electrosurgery and laser
surgery are treatment options if red lines caused by dilated blood vessels
appear in the skin or if rhinophyma develops. For some patients, laser surgery
may improve the skin's appearance with little scarring or damage. For patients
with rhinophyma, surgical removal of the excess tissue to reduce the size of
the nose usually will improve the patient's appearance.
Working With Your Doctor To Manage Rosacea
The role you play
in managing your rosacea is important. You can take several steps to keep
rosacea under control:
- Keeping a written record of
when flareups occur may provide clues regarding what is irritating the
skin.
- Most people should use a
sunscreen every day that protects against UVA and UVB rays (ultraviolet rays)
and has a sun-protecting factor (SPF) of 15 or higher, but sunscreen is
particularly important for people whose skin is irritated by exposure to the
sun.
- Using a mild moisturizer may
be helpful, but avoid applying any irritating products to the face. Some people
find that a green-tinted makeup effectively conceals skin
redness.
- If your eyes are affected,
faithfully follow your doctor's treatment plan and clean your eyelids as
instructed.
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What Research Is Being Conducted To Help People With
Rosacea?
Researchers are studying
the eyes of people who have rosacea to find ways to prevent dry eyes and other
eye problems related to rosacea. Scientists also are evaluating the most
effective ways to use medications to treat rosacea and the best methods to
minimize scarring of the sebaceous glands when removing excess nasal tissue in
rhinophyma.
Where Can People Get More Information About
Rosacea?
National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National
Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone:
301-495-4484 or 877-22-NIAMS (226-4267) (free of charge)
TTY:
301-565-2966
Fax: 301-718-6366
E-mail:
NIAMSInfo@mail.nih.gov
www.niams.nih.gov
NIAMS provides
information about skin diseases, arthritis and rheumatic diseases, and bone,
muscle, and joint diseases. It distributes patient and professional education
materials and refers people to other sources of information. Additional
information and updates can be found on the NIAMS Web site.
American Academy of
Dermatology
P.O. Box 4014
Schaumburg, IL 60168-4014
Phone:
847-330-0230 or 888-462-3376 (free of charge)
Fax: 847-330-0050
www.aad.org
This national
organization can provide referrals to dermatologists. It also publishes a
brochure on rosacea. These are available on the organization's Web site or can
be obtained by calling or writing the academy.
National Rosacea
Society
800 South Northwest Highway, Suite 200
Barrington, IL
60010
Phone: 888-NO-BLUSH (662-5874) (free of charge)
Fax:
847-382-5567
E-mail: rosacea@aol.com
www.rosacea.org
This nonprofit
organization provides fact sheets, booklets, and a newsletter on rosacea. It
also provides a patient diary checklist for identifying lifestyle and
environmental factors that may trigger flareups or aggravate individual
conditions.
Acknowledgments
The NIAMS
gratefully acknowledges the assistance of Mark Dahl, M.D., Mayo Clinic,
Scottsdale, AZ; Sam Huff, National Rosacea Society, Barrington, IL; Robert
Katz, M.D., Rockville, MD; M. Carol McNeely, M.D., University Dermatology
Associates, Washington, DC; Larry Miller, M.D., Chevy Chase, MD; Alan Moshell,
M.D., NIAMS, NIH; and Gary Peck, M.D., Washington Hospital Center, Washington,
DC, in the review of this fact sheet.
The mission of
the National Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS), a part of the National Institutes of Health (NIH), is to support
research into the causes, treatment, and prevention of arthritis and
musculoskeletal and skin diseases, the training of basic and clinical
scientists to carry out this research, and the dissemination of information on
research progress in these diseases. The National Institute of Arthritis and
Musculoskeletal and Skin Diseases Information Clearinghouse is a public service
sponsored by the NIAMS that provides health information and information
sources. Additional information can be found on the NIAMS Web site at
www.niams.nih.gov.
This booklet is
not copyrighted. Readers are encouraged to duplicate and distribute as many
copies as needed.
Additional
copies of this booklet are available from
National
Institute of Arthritis and Musculoskeletal and Skin Diseases
NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD
208923675
NIH Publication No. 025038
Publication Date: June
2002