Rosacea

Rosacea, also known as acne rosacea or simply rosacea, is a chronic skin condition that primarily affects the central part of the face, including the nose, chin, forehead, and cheeks. It typically begins with episodes of flushing and burning, followed by the development of pimples, persistent redness, increased visibility of blood vessels, swelling, and a thickened appearance of the skin. Rosacea is often referred to as “rose disease” or “curse of the Celts.”

WHAT ARE THE CAUSES OF ROSACEA?

The exact cause of rosacea is not fully understood. Suspected factors include:

1. Genetic predisposition: Family history is found in approximately 30-40% of cases, although there is still no clear evidence of genetic transmission.
2. Infectious agents: The most commonly implicated infectious agents are the Helicobacter pylori bacteria found in the stomach and demodex mites found on the skin.
3. Environmental factors: Various environmental factors such as ultraviolet light and changes in temperature play a role in the onset or exacerbation of rosacea lesions.
4. Psychogenic factors: Intermittent episodes of burning and flushing, which are often observed, can be influenced by changes in the patient’s emotional state and psychological stress.
5. Natural immune system: Recent studies suggest an imbalance in the skin’s natural defense system.

WHAT ARE THE CLINICAL FEATURES OF ROSACEA AND HOW IS IT DIAGNOSED?

Rosacea is most commonly seen in fair-skinned adults aged 30 to 60. Although more prevalent in women, it tends to be more severe in men.

There are four clinical stages:

Stage 1: Recurrent episodes of burning and flushing on the face.

Stage 2: Persistent redness in the central part of the face, with visible small blood vessels developing on the nose and cheeks.

Stage 3: Darker and more persistent redness on the face, accompanied by small, red bumps or inflamed pimples on the nose, cheeks, forehead, and chin (different from whiteheads or blackheads).

Stage 4: Burning sensations in the eyes or constant sensitivity (ocular rosacea), and/or a red, swollen nose (rhinophyma).

Diagnosis is usually based on clinical findings, although a biopsy may be necessary to differentiate it from other conditions. There is no specific laboratory finding for rosacea.

DOES ROSACEA AFFECT THE EYES?

Approximately one-third of patients with rosacea experience eye involvement. In 20% of cases, eye involvement may occur without skin symptoms. Eye involvement is not necessarily correlated with the presence or severity of skin symptoms. Symptoms may include blepharitis, conjunctivitis, keratitis, photophobia, watering, burning, chronic periorbital edema, widespread eye pain, and blurred vision.

WHAT FACTORS AGGRAVATE THE CLINICAL SYMPTOMS OF ROSACEA?

1. Foods and beverages (hot and cold drinks, soups, tea, coffee, spicy foods, hot sauce, pickles, chocolate, alcohol…)
2. Weather conditions (sunlight, hot weather, cold weather, humidity, wind)
3. Psychological stress and excessive exercise
4. Bathing, cleaning, and personal care products (hot baths and facial irritants, cologne, toner, rose water, wet wipes)
5. Medications (prolonged topical corticosteroid use on the face)
6. Systemic conditions (premenstrual, pregnancy, menopause, severe coughing, and constipation)

HOW IS ROSACEA TREATED?

While rosacea may not be completely curable, it can be managed with treatment.

General measures: The most important step is to avoid factors that exacerbate clinical symptoms.

Sun protection: Sun exposure is one of the most important triggers of the condition. Therefore, it’s crucial to protect yourself from the sun throughout your life. Apply a suitable sunscreen recommended by your dermatologist every 2-4 hours. Additionally, wear a sun-protective hat and sunglasses, dress appropriately, and avoid sun exposure during peak hours.

Topical treatment: Mild cases are often treated with creams and gels. The most commonly used agents include metronidazole (cream, gel, lotion), azelaic acid (cream, gel), and sodium sulfacetamide with sulfur. Other medications include tretinoin, benzoyl peroxide, erythromycin, clindamycin, tetracycline, 5% permethrin cream, tacrolimus, and pimecrolimus.

Systemic treatment: In severe cases, systemic treatment alone or in combination with topical agents may be used. The most commonly preferred systemic agents are systemic antibiotics (minocycline, doxycycline, tetracycline, metronidazole, and azithromycin) and isotretinoin, a vitamin A derivative.

Laser treatment: Various laser treatments and intense pulsed light (IPL) systems can be effective in treating increased redness and blood vessel formation, especially on the face.

Surgical treatment: Surgery, cryotherapy, electrocautery, or dermabrasion may be used in severe cases that cause disfigurement, especially on the nose and cheeks.

IS THERE A SPECIFIC DIET FOR ROSACEA?

While there is no specific diet for rosacea, you should avoid foods and beverages that increase facial redness. Although publications regarding gluten, dairy, caffeine, theine, and polyphenols do not definitively incriminate these products, some patients have found relief through personalized elimination diets.