Rosacea on the face
What is Rosacea?
Rosacea is a chronic skin disorder characterized by redness of the cheeks, nose, chin and forehead that may come and go (flare-ups and remissions).
People with fair skin who tend to flush or blush easily tend to be at greatest risk of developing rosacea. It is more frequently diagnosed in women, but more severe symptoms tend to be seen in men. Rosacea, usually experienced by people over 30 years old, often starts with mild symptoms which become more persistent over time.
The cause of rosacea remains unknown and there is presently no cure. However, there are a variety of safe and effective treatment options to reduce the inflammation, redness and other symptoms.
Left untreated, rosacea can worsen. What might first appear as areas of redness (erythema) and flushing, may evolve over time into bumps and pimples. These can further worsen and, and in severe cases, the nose may grow swollen and bumpy from excess tissue.
There are four subtypes of rosacea. Rosacea patients may have more than one subtype at the same time.
Four Rosacea Subtypes
Rosace types
Rosacea subtype 1 (facial redness or “ erythematotelangeiotectic rosacea”) is the mildest form of rosacea. Its main symptom are:
- Flushing
- Persistent facial redness in the central face
- Burning sensation of the facial skin
- Small visible blood vessels called “telangiectasias”
Rosacea subtype 2 (bumps and pimples or “papulopustular rosacea”) is a more advanced stage of rosacea than subtype 1. Its symptoms include papules or pustules that may resemble acne, but there are no whitheads or blackheads. The bumps are also accompanied by persistent facial redness.
Rosacea subtype 3 (skin thickening redness or “phymatous rosacea”) is an often-severe form of rosacea that can cause enlargement of the nose and other skin irregularities. There is skin thickening, especially nodules and lumps around the nose. This is called “rhinophyma”. There may also be thickened skin around the chin, ears and forehead, and visiable blood vessels (telangiectasias).
Rosacea subytpe 4 (eye irritation or “ocular rosacea”) results in a variety of eye symptoms, including burning, stinging, watery, and itching eyes. There can be a sensation of a “foreign body” in the eye, light sensitivity, and blurred vision. Some cases may require examination by an eye specialist (ophthalmologist).
Those afflicted with rosacea may first notice a tendency to flush or blush easily. The condition progresses to persistent redness, pimples, and visible, threadlike blood vessels (telangiectasias) in the center of the face. These skin changes can eventually spread to the cheeks, forehead, chin, and nose.
Rosacea occurs most commonly in people 30 to 50 years of age. Although women have rosacea more commonly than men, men tend to suffer more severe forms.
The cause of rosacea remains unknown, though it appears to involve a combination of genetics and environmental factors. It is not contagious.
Rosacea Treatment
Although there is no cure for rosacea, a variety of safe and effective rosacea treatments are available to reduce its appearance and prevent further progression. If allowed to worsen over a long period, rosacea becomes more difficult to treat.
Rosacea treatments include oral and topical medications, lifestyle modifications, laser and light therapies, and surgical procedures (used mostly for advanced cases).
Your doctor will recommend a treatment plan based on the following:
- The rosacea subtype(s) you have developed
- The severity of rosacea
- Your skin type (light vs. dark, oily vs. dry)
- Results from previous treatments
- Your personal preferences
Rosacea Classification & Grading
The National Rosacea Society (NRS) convened a committee of dermatology thought leaders to develop a standard classification system for rosacea. Based on the primary and secondary characteristics of this disorder, the NRS Expert Committee identified 4 types of rosacea: erythematotelangiectatic, papulopustular, phymatous, and ocular; one variant, granulomatous, also was recognized. The NRS Expert Committee also developed a grading system for rosacea signs and symptoms that will complement this classification system.
Standard grading system for rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. From the Journal of the American Academy of Dermatology. 2004; 50:907-912. Available on the National Rosacea Society Website.
Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. From the Journal of the American Academy of Dermatology. 2002; 46:584-587. Available on the National Rosacea Society Website.
