Rosacea

Rosacea is a persistent inflammatory disorder that can cause several different kinds of rashes, most noticeably on the central part of the face. This disorder is also called acne rosacea, although it is unrelated to acne, which affects mostly adolescents and young adults.

Rosacea usually begins in middle age or later. Fair-skinned people are affected most often. Rosacea varies in severity. Once it develops, it usually persists indefinitely.

Occasionally, rosacea can irritate the eyes or cause gradual but permanent enlargement of the nose (rhinophyma), as it did for comedy actor W.C. Fields. Rhinophyma usually affects men.

Causes and Symptoms

The cause of rosacea is unknown. However, the disorder can run in families. Folk wisdom sometimes associates rosacea with alcohol use, but the cause is probably something else. Hormones, psychologic factors, infections of the digestive tract, or mite infestations may be involved. Sun exposure can worsen the symptoms.

In people with rosacea, the skin of the nose and cheeks becomes chronically red. Blood vessels in the skin expand (dilate) so that more blood flows through them. These blood vessels often become twisted and visible. Acnelike bumps that may contain pus or small solid bumps often appear. The redness may temporarily worsen after drinking alcohol or hot beverages, eating spicy foods, using certain cosmetics, or being exposed to excessive heat or sunlight.

Rosacea can cause the eyes to burn, water, or feel sore or gritty. Commonly, the hair follicles at the base of the eyelashes become red and irritated. The whites of the eyes may become bloodshot.

Treatment and Outlook

Treatment can usually control symptoms and improve the skin's appearance. But the redness of the face often persists even when the acnelike bumps and eye irritation clear up.

Avoiding things that make the redness worse can help. Examples are alcohol, hot beverages, or spicy foods. Using a sunscreen with a high sun protection factor (SPF) and staying out of the sun can help. Exposure to excessive heat should be avoided. For example, showers or baths should not be too hot. People should not use cosmetics that irritate the skin. Scrubbing or rubbing the face can also irritate the skin.

Applying an antibiotic lotion or gel (a topical antibiotic) to the affected skin can help clear the acnelike bumps. Topical antibiotics that may help include metronidazole, erythromycin, clindamycin, and sulfacetamide. Ketoconazole, an antifungal drug, may also help. If topical antibiotics do not help, azelaic acid, a topical drug also used to treat acne, may be tried.

If the acnelike bumps are severe or if the eyes are affected, antibiotics are taken by mouth, usually for at least a month. Tetracycline, doxycycline, and minocycline are effective. If these drugs are ineffective or if a person cannot tolerate them, erythromycin or metronidazole may be used. Some people need to take antibiotics frequently or continuously. If no other treatment is effective, isotretinoin (a drug used to treat severe acne) may help.

Treatment with lasers (pulsed dye laser therapy) or electric current (electrocautery) may be used to destroy blood vessels that remain dilated. This treatment can be very effective. If rhinophyma develops, treatment with another type of laser may reduce the size of the nose. Certain kinds of makeup can hide redness that persists.

Rosacea is usually chronic. For some people, redness of the face is the only symptom. Often, symptoms are mild for long stretches of time, with periodic flare-ups. For a few people, symptoms worsen steadily and progressively despite treatment.