Rosacea

There are many medical conditions that are fairly common, but oftentimes go unrecognized by both the patient and the physician.  This can be due to the mildness of the disease’s symptoms, making it difficult to identify as a treatable condition.  Acne rosacea is one of these conditions.    

Acne rosacea or simply “Rosacea” is an inflammatory skin condition that affects the face, mostly the area of the cheeks and nose.  Initially the inflammation may be very mild, almost undetectable.   A blush or redness of the cheeks or nose can be seen.  Some individuals may notice small blood vessels in the skin across the affected areas.  In more moderate cases of rosacea, red pimples or pustules may appear.  

Sufferers with severe rosacea will experience increasingly red, thickened, and bumpy skin on the cheeks and nose.  When the nose becomes thick, red and enlarged, the condition is called rhinophyma (rhino- meaning “nose” and phyma- “congestion”).  Rhinophyma is usually seen with long-standing inflammation.

About half of individuals with rosacea will also have eye symptoms.  These include itchy, burning, red, and irritated eyes, similar to the symptoms of pink eye.

The cause of rosacea is unknown.  Since certain antibiotic treatments seem to improve the symptoms of rosacea, skin bacteria may be involved in causing the inflammation.  It tends to occur more often in fair-skinned individuals of northern European heritage.  Symptoms are usually first seen between the ages of 30 and 50 years of age. 

Women are affected two to three times more frequently than men.  However, men tend to have more severe symptoms.

Most individuals with rosacea will experience a waxing and waning of their symptoms.  Certain foods and environmental exposures can trigger a flare-up or worsening of the condition.  Common triggers of rosacea include sun exposure, emotional stress, hot weather, alcohol, spicy foods, hot drinks, and exercise.  

Treatment of rosacea will not cure the condition.  Treatment is aimed at controlling the symptoms and improving the appearance of the skin.  The obvious first step in managing the disease is avoiding potential triggers: protecting yourself from excess sun exposure and heat, avoiding spicy foods and alcohol, and managing life stressors. 

Medical treatment of rosacea is with antibiotics.  Topical prescription antibiotics such as metronidazole gel may be all that are needed to control mild rosacea.  More severe cases or sudden flares of rosacea may necessitate antibiotic pills.  Some individuals require both topical and oral preparations to control their condition.  

When starting treatment, it’s important to remember that it may take up to two months of continuous treatment to see a significant change in the skin.  Once symptoms have been under good control, medicines can often be cut back to lower daily doses.  Some individuals may experience remissions and can sometimes stop their medications for periods of time under their physician’s care.  

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.

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