Rosacea, also known as rosacea disease, is a chronic, multifactorial skin condition of unknown cause, characterized by periods of remission and flare-ups. The condition primarily affects the central area of the face (cheeks, nose, forehead, and chin).
The pathogenesis of rosacea is not fully understood; however, it is believed to result from a combination of several exogenous and endogenous factors. The potential contributing factors include the following:
Activity of microorganisms such as Demodex folliculorum and Bacillus oleronius
Vascular disorders (abnormal vasomotor response)
Gastrointestinal issues, often associated with Helicobacter pylori
Genetic predisposition
Ultraviolet radiation
Environmental aggravating factors
Topical treatments that cause vasodilation
Clinically, rosacea presents with erythema, inflammatory papules, pustules, telangiectasias, and, more rarely, hypertrophy of the sebaceous glands (which may lead to the development of rhinophyma and fibrosis) in the facial area, and less commonly on the neck, chest, and scalp. In less than 50% of cases, ocular involvement may occur, presenting as blepharitis, conjunctivitis, or severe eye irritation accompanied by swelling. The most common age of onset is between 30 and 50 years. It is more frequently observed in women (with a ratio of 2–3:1). Over time, the redness tends to become more intense, with visible superficial capillaries, especially in cases where no treatment is administered.
Depending on the main characteristics presented in each case, the following subtypes of rosacea are identified:
Erythematotelangiectatic Rosacea: Features include erythema and persistent redness in the central area of the face, with or without the presence of telangiectasias.
Papulopustular Rosacea: Characterized by persistent erythema in the central face, with the presence of transient papules or pustules.
Phymatous Rosacea: The main characteristic is thickening of the skin, primarily located on the nose (rhinophyma), forehead (metophyma), ears (otophyma), and chin (gnathophyma). This type is more common in men and occurs due to the hyperplasia and fibrosis of sebaceous glands.
- Ocular Rosacea: This type can often coexist with another form of rosacea in the patient and is frequently undiagnosed. Its main characteristics include hyperemia and erythema of the conjunctiva (and the adjacent eyelid area), lacrimation, a sensation of a foreign body, burning, itching, sensitivity to sunlight, and blurred vision. Chalazia or styes often develop. This type of rosacea is caused by dysfunction and inflammation of the meibomian glands, which are specialized sebaceous glands located in the eyelids. Additionally, it is often associated with dry eye syndrome. In rarer cases, patients may experience vision loss due to corneal damage.
The therapeutic agents and methods used to treat the disease are:
- Oral antibiotics
- Oral isotretinoin
- Topical metronidazole gel
- Topical benzoyl peroxide
- 15% Azelaic acid gel or cream
- Topical moisturizing creams
- PDL laser
- CO2 LASER – Dermabrasion, for rhinophyma
- Photodynamic therapy, Light treatments
Along with the treatment prescribed by your dermatologist, patients are advised to follow a series of tips to help reduce flare-ups, such as:
Avoid sun exposure as much as possible throughout the year, as UV rays can worsen flare-ups.
Avoid causing irritation to your face and refrain from vigorous rubbing.
Do not use facial exfoliating products with beads or products containing alcohol or other substances that may irritate the skin.
Prefer products labeled as “non-comedogenic.”
Avoid hot water, as well as very cold water, when bathing.
Avoid intense stress.
Avoid spicy foods and alcohol.
On hot days, avoid strenuous physical activity.
Rosacea is not an infectious disease, and there is no evidence to suggest that it is transmitted through skin contact or inhalation of airborne bacteria. The effectiveness of antibiotics in treating rosacea symptoms is believed to be due to their anti-inflammatory action, rather than their ability to destroy bacteria.
The flare-ups of the condition, which are related to menopause, can trigger an exacerbation or even the initial onset of rosacea.