Rosacea

Rosacea most commonly affects adults between the ages of 30 and 60, with a higher prevalence in individuals with fair skin, especially those of Northern European descent. However, it can also occur in individuals with darker skin tones, although it may be underdiagnosed in these populations due to less visible redness.

Both men and women can develop rosacea, but certain forms, such as rhinophyma (a thickening of the skin on the nose), are more frequently seen in men. Women, particularly during perimenopause or menopause, are more likely to experience rosacea-related flushing and persistent redness.

There is also a genetic component to rosacea. Individuals with a family history of the condition may be more likely to develop it. In addition, people who have other inflammatory skin conditions, such as seborrheic dermatitis or acne, may also be more prone to developing rosacea or may experience overlapping symptoms.

Rosacea can vary significantly in how it appears from person to person. It often develops in stages, beginning with episodic flushing or facial redness that becomes more persistent over time. The primary symptoms include:

• Facial redness and flushing: This is typically the earliest and most common sign of rosacea. The redness usually occurs in the center of the face and may resemble a sunburn or blush that does not fade.
• Visible blood vessels: Tiny blood vessels, called telangiectasias, may become visible on the surface of the skin, especially on the cheeks and nose.
• Bumps and pimples: Some patients develop acne-like lesions that can be confused with common acne. However, these are typically not associated with blackheads and may be accompanied by burning or stinging sensations.
• Eye involvement (ocular rosacea): Rosacea can affect the eyes, leading to symptoms such as dryness, irritation, redness, and swollen eyelids. In some cases, ocular rosacea can cause more serious complications if left untreated.
• Skin thickening: In more advanced cases, especially in men, rosacea can lead to thickened skin on the nose (rhinophyma), giving it a bulbous appearance.

Rosacea is generally categorized into four subtypes, though symptoms can overlap:

• Erythematotelangiectatic rosacea: Characterized by persistent redness and visible blood vessels.
• Papulopustular rosacea: Includes redness with acne-like bumps.
• Phymatous rosacea: Involves thickened skin and irregular surface texture, often on the nose.
• Ocular rosacea: Affects the eyes and eyelids.

Although the precise cause of rosacea is unknown, researchers believe it involves a combination of genetic predisposition, immune system overactivity, and environmental influences. Several factors are thought to contribute to the onset and worsening of symptoms, including:

• Abnormal blood vessel function, which may contribute to flushing and persistent redness.
• An overactive immune response, including increased levels of certain inflammatory proteins in the skin.
• A skin mite called Demodex folliculorum, which is found in higher numbers on the skin of people with rosacea.
• Certain bacteria, such as Helicobacter pylori, have also been studied for a possible connection.

In addition, many patients find that specific lifestyle or environmental factors can trigger or worsen their symptoms. Common triggers include sun exposure, hot or cold weather, wind, stress, spicy foods, alcohol, hot beverages, exercise, and certain skin care products.

Rosacea is typically diagnosed through a clinical evaluation by Dr. Neely. There are no specific laboratory tests for rosacea, so diagnosis is usually based on a patient’s history and physical examination. She will assess the pattern and location of symptoms and rule out other skin conditions such as acne, lupus, or seborrheic dermatitis, which may present with similar signs.

In some cases, especially when ocular symptoms are present or when diagnosis is uncertain, additional consultation with an ophthalmologist or testing for underlying infections or inflammatory conditions may be necessary.