Are My Rosy Cheeks Rosacea?
Rosy cheeks are often associated with a radiant glow and youthful beauty, but for those who suffer from rosacea, they can be an irritating or embarrassing symptom. Rosacea affects millions of Americans, yet we are still learning about the causes of this condition and searching for better treatment methods. Here we’ll take a closer look at rosacea to better understand our options for finding relief.
What is Rosacea?
Rosacea is a common skin disorder that affects over 14 million people in the United States. It is widely recognized by its characteristic redness and blushing, known as “vascular hyperactivity,” across the central face. This redness can also be accompanied by additional symptoms, such as telangiectasias (or spider veins) and rhinophyma (nose enlargement), which are also characteristic features of rosacea.
Rosacea tends to develop gradually and its estimated that up to 25% of people afflicted with rosacea aren’t even aware they have it. When people do seek treatment it tends to be long after the condition’s initial stages, once the symptoms have progressed and are more visibily or physically discomforting.
Who gets Rosacea?
Rosacea is mostly seen in adults, and onset begins anywhere from one’s 20s to 50s. Furthermore, people with fair skin, or who are of Irish or Scandinavian descent, are more likely to develop rosacea. While it more often occurs in women, it is men who are more likely to seek out care as the side effects are often more severe in men.
The Subtypes and Severity of Rosacea
There are four different subtypes of rosacea:
- Flushing and redness of the central face.
- Pustular rosacea, with bumps and pimples in addition to redness.
- Rhinophyma, or nose enlargement.
- Ocular rosacea, affecting the eyes.
Rosacea is also graded based on severity, a few of the grading methods include:
- IGA score (Investigator Global Assessment of Rosacea Severity)
- Papule/pustule count
- Presence of telangiectasias
- RosaQOL (quality of life rating based on self-assessment of symptoms)
What Causes Rosacea?
As mentioned above, the main symptom of rosacea is redness and flushing across the central face.Though the underlying cause of this blushing is unknown, it could be related to genetics, an individual’s unique composition of skin microflora, or high levels of inflammation in the body. While it has since been disproven, many years ago a prominent myth was that rosacea was related to alcoholism. Though we know now that it is not a cause, alcohol can often be a trigger that can exacerbate symptoms of rosacea.
Triggers of Rosacea
While the causes of rosacea are still unknown, there are known triggers that can make rosacea worse or bring on an episode of flushing:
- Spicy food
- Hot (temperature) food
- Cold weather
- Sun exposure
- Topical products
- Any substance to which a person is sensitive
Rosacea has an interesting correlation with the presence of Demodex mites on the face, which are normal “parasites” that live in and around our hair follicles. These mites feed on dead skin cells and other debris and typically do not cause a problem. However, research shows that people with rosacea have four times as many Demodex mites on their skin than those who do not. Studies are still exploring the link between the presence of the mites, the bacteria in their waste products, and the development of rosacea.
Bumps and Redness: Is that Rosacea?
Because rosacea presents mostly as redness and bumps, it is often misdiagnosed as other skin conditions. The most common misdiagnosis is acne, especially when the rosacea presents with pustules.
But acne and rosacea actually present quite differently when we take a closer look. Here are some of the significant differences between the two conditions:
- Rosacea occurs mostly on the central face, while acne can occur across a broader range of locations such as on the face, back, and chest.
- Acne pustules are comedones caused by overactive sebaceous glands and hormone imbalances, while rosacea pustules are related to blood vessel reactivity.
- Acne develops mostly in the teenage years with reoccurrences in perimenopause, while rosacea’s onset is in adulthood.
How Can We Help Rosacea?
The chosen treatment(s) for rosacea will vary with each individual and their severity of symptoms. A few of the most common conventional treatment methods are:
No matter what kind of rosacea you have, avoiding triggers is always key to reducing redness and pustules. Sometimes this may impact your lifestyle, like avoiding certain favorite foods or even some types of exercise. Speak with your skin care professional to determine a lifestyle plan that works for you while keeping rosacea at bay.
Treating rosacea can follow a similar plan to acne, as they share goals of reducing both inflammation and bacterial growth. Common topical treatments include prescribed antibiotics like metronidazole (Flagyl) and clindamycin (Cleocin-T), and topical azelaic acid which has antimicrobial and anti-inflammatory effects.
Topical tretinoin (Retin-A) can help reduce rosacea by increasing desquamation and cell turnover. However, tretinoin may be drying, which can increase inflammation and irritation.
In some cases, broad-spectrum oral antibiotics are prescribed to reduce rosacea symptoms. Commonly used ones are doxycycline and erythromycin. Other choices, like oral clindamycin, are used less frequently.
While prescription treatments like topical or oral antibiotics can be effective, they may also have unwanted side effects. Some people cannot tolerate these drugs, or they may be poorly successful in individual cases.
Surgery can be helpful for those with severe rhinophyma, characterized by a large, red, bulbous nose. Laser therapy has been shown to help reduce telangiectasias, more commonly known as spider veins.
Relief for Rosacea
Rosacea can be difficult to manage both physically and emotionally. Clear and holistic care from a skin care professional will help put your best face forward. In the next article, we will discuss the cosmeceutical options for managing rosacea.