Rosacea, here's what to do for your skin's health

By Cristiano Antonino Last updated Jun 16, 2023

Rosacea is a rather common chronic skin disorder that mainly affects adults, particularly people with fair complexion and hair

It is a form of benign chronic dermatitis characterised by the presence of dilated capillaries that in most cases mainly affects the central area of the face, such as the cheeks, nose, forehead and chin; due to the predisposition of fair-skinned individuals to manifest this disorder, it is also known as the curse of the Celts.

The inflammation is generally benign and rosacea does not pose any serious risks or complications for the patient.

Acne rosacea is characterised by a progressive course within which four phases can be distinguished: a pre-rosacea phase, a vascular phase, an inflammatory phase and finally an advanced phase.

The main symptoms include redness, inflammation, the appearance of small pimples and dilation of superficial blood vessels, which together give the ‘red cheeks’ appearance typical of this disorder.

What is rosacea?

Rosacea is a chronic inflammatory skin disease characterised by reddening of the central area of the face, rashes and pathological dilation of superficial blood vessels.

The symptoms can be quite variable from patient to patient, in fact this disorder can often be confused with other dermatological conditions such as skin allergies or dermatitis.

Acne rosacea generally has a progressive course, with a gradual worsening of symptoms over time; in other cases it may be cyclical, with phases during which symptoms are more acute, interspersed with periods when the disorder is less noticeable.

Four different stages of the disease can be identified:

Pre-rosacea phase: in its early stages, rosacea manifests itself with mild symptoms, such as a sensation of heat and congestion of the face accompanied by reddening of the skin.
Vascular phase: as the disease worsens, the redness becomes persistent and the face may present erythema and oedema; in addition, telangiectasia may occur, i.e. capillaries and blood vessels dilate and become more prominent on the surface (couperose).
Inflammatory phase (acne rosacea): the third stage involves the onset of skin eruptions, which may be small pimples and papules or actual pustules with accumulation of pus due to bacterial superinfection or the presence of Demodex follicolorum.
Advanced stage: in the most advanced stage of the disease, lesions become persistent and more evident, and in some cases tissue hyperplasia with thickening of the skin and swelling of the nose (rhinophyma) and cheeks may occur.

Although there is no definitive cure for this disease, it is possible to undergo some targeted treatments and therapies to alleviate the symptoms and control the degeneration.

If not treated properly, rosacea can give rise to permanent skin lesions and also extend to the region around the eyes (ocular rosacea).

The symptoms of ocular rosacea include inflammation of the eyelids, which can sometimes extend to the conjunctiva, iris, sclera and cornea; the patient may also experience itching, the sensation of a foreign body in the eye, redness and swelling of the eye. In both forms, however, rosacea is not a particularly serious disorder and is not contagious.

What are the symptoms?

As already mentioned, the manifestations of acne rosacea can vary from individual to individual and patients may present with symptoms of varying severity and extent depending on the specific case.

Although there is no cure that can definitively eradicate this disease, its signs can be counteracted by undergoing targeted therapies, which is why it is essential to recognise it early and intervene promptly to treat the disorder.

The main symptoms of rosacea include

Reddening of the skin: the redness may be sudden and temporary or persistent, and is mainly concentrated in the centre of the face;
Flushing or burning;
Appearance of lesions and rashes such as papules or pustules;
Rhinophyma, i.e. swelling and enlargement of the nose;
Teleangiectasias, i.e. the appearance of visible capillaries on the nose and cheeks;
Thickening of the skin;
Oedema.

In many cases, patients with acne rosacea may also develop ocular rosacea, the symptoms of which extend to the eye area and involve:

Eye irritation and burning
Conjunctivitis
Dry eyes
Swelling of the eyelids
Increased sensitivity to light
Tearing

In severe cases rosacea can also develop on the neck, chest, scalp and ears.

Main causes of rosacea

The exact causes of the onset of rosacea are still unknown, but experts believe it is a combination of different factors, including a genetic predisposition, environmental factors and immunological reasons; certain habits and lifestyles may also influence the appearance of acne rosacea.

Causes that may contribute to the onset of this disorder are:

Intake of hot, spicy or spicy foods and drinks;
Consumption of alcohol and caffeine;
Smoking;
Temperature swings and climates that are too cold or too hot;
Excessive exposure to sunlight;
States of stress, anxiety, anger or embarrassment;
Intense physical activity;
Menopause;
Vascular diseases and microcirculation disorders;
Drug therapies based on corticosteroids and other vasodilating substances.

A correlation between acne rosacea and Helicobacter pylori infections has also been hypothesised, as well as an involvement of the skin mites Demodex follicolorum, which proliferate on the face of rosacea patients.

Diagnosis

As already pointed out, due to the degenerative nature of rosacea, an early diagnosis from the earliest stages of the disease is of paramount importance in order to avoid aggravation of symptoms that could otherwise lead to permanent lesions on the skin.

Unfortunately, there are no specific tests for diagnosing acne rosacea, but an experienced dermatologist will be able to identify the typical symptoms of this disorder and discriminate it from other skin diseases with similar manifestations.

Diagnosis of rosacea is therefore based solely on clinical evaluation of the symptoms and analysis of the skin lesions.

Although in some cases it may present with symptoms similar to other disorders, such as acne vulgaris, the higher incidence in adults and the absence of comedones (i.e. blackheads and whiteheads) make it easy to distinguish.

In order to accurately identify the condition and prescribe the most appropriate treatment, a differential diagnosis must also be made with respect to dermatitis and eczema, seborrhoea, lupus and psoriasis.

Cures and treatments

Although, as mentioned above, there is no real cure for rosacea, there are several treatment options and specific therapies available that can alleviate the obvious signs of the disease and keep the symptoms under control.

First of all, in order not to incur a worsening of symptoms, it is best to avoid the triggers described in the previous paragraphs, and to take proper care of one’s skin through the use of moisturisers, gentle cleansers and protective sunscreens.

There are several alternatives for treating rosacea, which may include topical application of medication, taking specific drugs, or using more invasive techniques such as surgery and laser therapy to combat the blemishes resulting from the disease.

The duration of treatment depends on the symptoms and their severity, but long-term therapy is often necessary to avoid recurrences.

To combat rosacea in its acne-pustular phase, the most indicated treatment is the daily application of anti-inflammatory and antibacterial creams and lotions based on azelaic acid, while some specific types of laser may be indicated to treat telangiectasias in the second stage of the disease.

In the case of ocular rosacea, antibiotics and the use of steroid eye drops may be useful to treat the inflammation.

In more advanced forms, surgery such as electrosurgery and ablative laser therapy can be used to remove more pronounced lesions and tissue build-up around the nose.

How to prevent rosacea?

For patients with rosacea or those who are predisposed to this disease, there are some simple steps that can be taken to avoid or reduce the symptoms caused by the disorder.

Based on the above, it is important to identify the risk factors that can trigger rosacea; some preventive measures can therefore be

limit consumption of very spicy or spicy foods;
avoid hot drinks, alcohol and caffeinated beverages;
pay attention to changes in temperature, particularly in winter it may be useful to cover the face with a scarf to avoid excessive exposure to cold or wind;
avoid excessive exposure to sunlight and take care to apply broad-spectrum protective creams;
limit exertion and strenuous physical activity;
although difficult, try to keep emotional stress levels under control as much as possible.

Other useful tips to follow include

scrupulously follow the treatment plan and if necessary apply the lotions indicated by the doctor on a daily basis, even after the symptoms disappear (rosacea is a relapsing disease)
use specific cleansers and neutral products for facial cleansing, particularly aggressive chemical agents and cosmetics containing perfumes should be avoided;
avoid touching or rubbing the skin of the face too much.

Pendulous Fibroids: What Are They And How Do They Appear?

Nevi: What They Are And How To Recognise Melanocytic Moles

Dermatological Examination For Checking Moles: When To Do It

Dysplastic Nevus: Definition And Treatment. Should We Be Concerned?

Rare Diseases: New Hope For Erdheim-Chester Disease

How To Recognise And Treat Melanoma

Moles: Knowing Them To Recognise Melanoma

Skin Melanoma: Types, Symptoms, Diagnosis And The Latest Treatments

Melanoma: Prevention And Dermatological Examinations Are Essential Against Skin Cancer

Symptoms And Causes Of Spitz Nevus

What Is A Dysplastic Nevus And What Does It Look Like?

Nail Fungus: What Are They?