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osacea is a chronic skin disorder, affecting more than 14 million people in the United States, that is distinguished by flushing of the face, by acne-like pimples and pustules, and by small thin veins that course over the skin of the cheeks and nose. It can be most embarrassing to those who suffer from this disorder, as it is frequently associated with alcohol consumption.
It is typically a problem of middle-aged women around the time of menopause, but when men blossom forth with rosacea, cosmetically disagreeable complications can arise (see below). Light complexion and blue eyes seem to predispose to rosacea. Many of those affected come from the Celtic regions - Ireland, Scotland, England, as well as northern Germany.
Many well-know people have been and are afflicted with rosacea: the late Princess Diana, President Clinton, Rembrandt, J.P. Morgan and, of course, W.C. Fields, the one with the bulbous nose attributed to his constant drinking.
The rash of rosacea, resembling the acne pimples of teenagers, is usually symmetrically distributed over the forehead, cheeks, nose, chin, rims of ears, and can involve the eyelids.
Beginning as a flushing or a stinging, it gradually evolves into pimples, knobby lumps on the nose (in men), and thin red lines over the nose and cheeks as a result of enlarged blood vessels.
While the cause of rosacea is an enigma, we do know that various stimuli – hot and spicy foods, alcoholic beverages, coffee, increased environmental temperature, and even emotional tension – can lead to a dilatation, a widening, of the blood vessels of the face, resulting in exaggeration of the normal flush response. This repeated flushing and blushing is followed by permanent redness, and, in advanced cases, unsightly pimples, pustules, and fine veins will materialize.
Certain medications are also known to bring about rosacea: ACE-Inhibitors, Vasotec, Capoten, Prinivil, Zestril, Accupril, Altase, niacin and others.
Rosacea is occasionally associated with gastrointestinal disturbances, and often there is thought to be a small mite (Demodex folliculorum) that thrives and multiplies in the oil glands of the skin that seems to be implicated in many of these pustular infections. In long-standing, severe cases, a cosmetic disfigurement of the nose – rhinophyma – can develop. This condition is especially pronounced in elderly males. The nose becomes enlarged, the tissue becomes soft, and the openings of the oil glands become widened and plugged with a cheese-like material.
Rosacea-like inflammation can be a result of using strong cortisone-like topical creams and lotions on the facial skin for extended periods of time. Helicobacter pylori was thought at one time to play a role in causing rosacea, but this has been effectively disproven.
The treatment of rosacea aims at eliminating all stimuli – the so-called “tripwires” – that encourage the widening of the superficial blood vessels of the face:
While there is no cure for rosacea, it can be controlled. Dermatologists usually treat rosacea with oral antibiotics, such as tetracycline, doxycycline, minocycline or erythromycin, as well as with various types of surface remedies containing metronidazole. Some of the topical preparations containing metronidazole are MetroGel, MetroCream, and MetroLotion, all prescription products. Applied twice daily – even without oral antibiotics – a marked improvement can be expected from these topical medications in a matter of a few weeks for all degrees of rosacea.
When exposed to the sun, always use a sunscreen with an SPF of at least 15 (see Chapter on Sun).
If left untreated, rosacea may gradually increase in severity, infect the eyelids and eyes – ocular rosacea – and can last for years.
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For further information concerning rosacea write to or phone: The National Rosacea Society 800 South Northwest Highway – Suite 200 Barrington, IL 60010 1-800-NO-BLUSH www.rosacea.org or www.aad.org 1-888-462-DERM x22 |
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