Rosacea ... More Than a Red Face

Last Editorial Review: 1/31/2005

Rosacea affects 14 million adults in the U.S., but only 1 in 4 people have even heard of it.

By Daniel DeNoon
WebMD Feature

Reviewed By Charlotte Grayson

It's pronounced row-ZAY-shuh. A National Rosacea Society poll shows that three out of four Americans never heard about this common skin problem. Yet it affects 14 million U.S. men and women. Left untreated, rosacea can become disfiguring. W.C. Fields' bulbous nose was due to severe rosacea.

The Problem

Rosacea is not something you catch. People inherit rosacea, although it usually doesn't appear before age 30. It's most common in people who blush or flush easily. People tend not to recognize rosacea because it develops gradually. After a while, they begin to think they just flush easily, or that they're having periodic acne attacks.

Rosacea starts as redness on the cheeks, nose, chin, or forehead (and less often on the neck, scalp, chest, or ears). At first, rosacea comes and goes. After a while, the redness deepens and lasts longer. Visible blood vessels appear in the skin. If not treated, pimples and bumps develop. The nose may become large and bumpy as tissue builds up. And rosacea sometimes affects the eyes, making them irritated, watery, and bloodshot.

"Rosacea tends to be more frequent in certain ethnic groups," dermatologist Julie Anne Winfield of Mill Valley, Calif., tells WebMD. One survey by the National Rosacea Society found that 33% of respondents reported having at least one parent of Irish heritage, and 27% had a parent of English descent. Other ethnic groups with higher rates of rosacea included people of Scandinavian, Scottish, Welsh, or eastern European descent.

There's no cure for rosacea. But treatment -- especially when begun in the early stages -- can work wonders.

"Fortunately, there are some very good treatment options," Winfield says. "The bottom-line message is this: There is real hope out there for people with rosacea."

The Solution

The first step in treating rosacea is lifestyle change. Though rosacea is genetic in nature, there are lots of "triggers" that make it worse. Avoid common triggers listed here.

  • Sun exposure: Everyone should avoid too much sun, but people with rosacea are particularly sensitive. They should be sure to apply sun block to the face when going outdoors. But take care! Skin affected by rosacea is very sensitive to chemicals. Use a quality sun block that doesn't irritate the skin.
  • Stress: Flushing increases when you're under stress. Learn relaxation techniques such as deep breathing.
  • Alcohol: Alcohol doesn't cause rosacea, but it does dilate blood vessels in the face. That makes rosacea worse.
  • Spicy foods: Heavily spiced foods cause flushing and worsen rosacea.
  • Cosmetics: Makeup, cleansers, lotions, and even some moisturizers can irritate the skin. Use only products that are non-irritating, hypoallergenic, and noncomedogenic.

The first-line medical treatment is antibiotics. That may sound wrong because rosacea isn't caused by germs. But antibiotics keep blood vessels from dilating. Doctors usually start by prescribing topical metronidazole in cream or gel form. Other topical antibiotics may be used as well. Oral antibiotics also work. Doctors usually start with tetracycline or minocycline.

Other topical treatments include azelaic acid, retinoic acid, and even vitamin C preparations.

In more advanced cases -- or if antibiotics don't do the job -- doctors often prescribe the acne treatments Accutane or Sotret. These can work very well. But they can cause birth defects, so women who take them must be prepared to use effective birth control.

Doctors can use lasers, pulsed light, and other surgical devices to remove visible blood vessels and reduce redness. Cosmetic surgery can correct a disfigured nose.

Published August 2003.

SOURCES: Julie Anne Winfield, MD, dermatologist, Mill Valley, Calif. Journal of the American Board of Family Practitioners, May-June 2002. National Rosacea Society. The American Academy of Dermatology.

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