Acne rosacea or simply rosacea is a chronic inflammation of the skin of the face and the scalp. It is characterized by facial reddening, focal red lesions, skin rashes, pimples and in severe cases, an enlarged ruddy nose. Ance rosacea is far more common in fair-complexioned, adults aged 30 to 50 years. There is no cure for rosacea and the condition tends to worsen over time. It usually has no significant complications apart from the psychological impact on sufferers.
Flushing of the skin on the face is not unusual. It may occur with excess alcohol consumption, sun exposure and emotions (blushing). The increased blood flow through the suddenly widened blood vessels in the skin gives the face the typical red appearance. However, this is short lived, not associated with any other skin symptoms and resolves shortly thereafter. Rosacea is different. The reddening of the skin is severe. It persists for long periods of time and there are other skin lesions that may be present.
The causes of acne rosacea are unclear. The condition is associated with :
- abnormal widening of blood vessels
- impairment in venous drainage of the face
- excessive mites on the skin (Demodex folliculorum)
- increased number of microbial organisms on the skin surface and bacteria like H. pylori
There are no specific tests to diagnose acne rosacea. The characteristic appearance is taken into account. Acne rosacea can be distinguished from acne vulgaris in two aspects – (1) different ages of onset, and (2) presence of blackheads and whiteheads in acne vulgaris. It is important to understand that rosacea and acne vulgaris are two separate skin conditions.
Acne rosacea manifests itself in four different stages:
- Pre-rosacea phase: Excessive flushing and abnormal stinging in the face is the first symptom noted in the patients. Harsh sunlight, emotional stress, extreme temperatures, alcohol consumption, physical exercise, hot bath, intake of spicy foods, use of cosmetics, or hot beverages are some of the most common triggers. Redness and blushing result from an increased blood flow to the facial blood vessels coupled with an increased number of blood vessels on the facial surface.
- Vascular phase: Apart from the aforementioned symptoms, facial reddening, swelling and presence of small, focal red lesions are seen in this phase. The symptoms result from uncontrolled dilation and constriction of blood vessels. A permanently flushed skin is reported with progression of the condition.
- Inflammatory phase: Inflammation starts and uninfected bumps start to appear in this stage. These skin bumps give the condition its name of ‘adult acne’.
- Late stage: This stage is not found in all the patients. Only a few people develop inflammation and an abnormal growth of cheeks and nose.
There is no cure for acne rosacea and the treatment is directed at controlling the symptoms.
Initial treatment of acne rosacea involves avoiding the triggers. Use of sunscreen lotions, managing physical and emotional stress, avoiding cosmetics, and dietary modifications can prevent the onset of symptoms of the pre-rosacea phase.
Antibiotics are used to control inflammation of the tissue. Topical application of azelaic acid cream and metronidazole in the form of cream, lotion, or gel is very effective. Addition of benzoyl peroxide to the regime improves the control. Other alternatives include clindamycin, erythromycin sodium sulfacetamide and sulfur solutions. The treatment can be prolonged and strict adherence is required to avoid relapses.
Carefully regulated doses of oral antibiotics like tetracycline, doxycycline, minocycline, and erythromycin are effective in patients with multiple pus-filled cysts. Treatment-resistant cases may respond to oral administration of isotretinoin.
Controlled removal of upper layers of skin and resection of abnormal tissue growth is recommended for late stage patients.