The More You Know : Rosacea and “Redness”

First off - what’s rosacea?

Rosacea is a skin condition characterized by flushing and redness primarily on the central portion of the face (though it can also present on ears, neck, and chest). Causes of the condition are not well understood, and it may present in a widely varied way depending on subtype, severity, and an individual’s skin condition.

Rosacea is distinct from other inflammatory skin conditions in that it is not related to skin oil production that clogs pores and causes blackheads or whiteheads. Flushing episodes from rosacea may be related to the vascular system and overly/easily dilated capillaries near the surface of the skin. Redness associated with rosacea also differs from PIE or PIH, as rosacea is a condition that is often transient (the majority of redness will disappear at the end of a flushing episode) or more permanent. While PIE may present similar to rosacea, it is directly related to the presence of acne. Rosacea is present with or without other inflammatory conditions and is considered separate by dermatologists!

Here's an album explaining some of the differences between PIH, PIE, and rosacea.

What causes it?

Little is known about the cause of rosacea. Because of the great variance in the condition (this is something I will say frequently, unfortunately) a definitive cause - or even a definitive classification - is not always easy.

Some of the theories on rosacea causes include:

• facial blood vessels dilate too easily, leading to flushing
• skin bacteria;
• skin mites, e.g. demodex
• sun damage, environmental factors
• abnormal immune system response (autoimmune issues)
• hereditary conditions

How can I tell if I have rosacea? Only a dermatologist can diagnose you with rosacea.

It is difficult to classify and diagnose rosacea due to the variety it presents with, however The National Rosacea Society has recently published a classification of the skin condition based on an expert panel.

Rosacea is classified by the presence of one of it’s 4 primary features:

• Flushing (transient erythema) - a history of frequent blushing, flushing episodes which last longer than expected (a blush can last hours after a trigger)

• Nontransient erythema - a persistent redness of the face

• Papules and pustules - typically cystic

• Telangiectasia - small, widened blood vessels on the skin [1]

A number of secondary features may present along with the primary features mentioned above. Dry skin, plaque (elevated red patches), itching, burning, irritated skin, edema, and eye problems (blurry or itchy eyes, styes, or other eye conditions) may occur on people with rosacea. These alone aren't indicative of the condition, but may be related in some way.

In addition to the classification of rosacea, the condition has varied subtypes. These include more “mild” manifestations that include flushing, blushing, and persistent redness. Others may present more severe with transient papules and nodules under the skin, changes in skin texture and appearance, etc. [2]

Management and Treatment Rosacea treatment can (but of of course!) vary as much as the condition. Treatment for rosacea will be prescribed to you by your diagnosing dermatologist based on the severity of the condition, how it impacts your life, and the main features you exhibit. It is not always a lifetime condition, and can clear with time.

Some management options for rosacea include steroidal application, antibiotics, topical treatments, and surgical or laser procedures (for visible blood vessels). Avoiding or minimizing rosacea triggers is a crucial part of treatment of the condition. Triggers of flushing episodes can include certain food and drink - including hot or spicy foods/drinks and alcohol - stress, sun exposure, allergies, astringent skincare… and triggers can vary person to person.

Skincare for people with rosacea is, just like the condition, highly specialized. In surveys of people with rosacea, there was no specific skin condition that the majority had - those with rosacea reported dry, oily, or combo skin. It is important to understand your skintype, possible ingredient triggers, dermatologist recommendations, and skin needs when choosing a skincare routine. It is crucial to understand that a treatment that works one person may not (a likely will not) work for another.

Again, it is important if you fear you exhibit the features of rosacea, or have concerns about your skin, you should visit a dermatologist. Only a dermatologist medical professional can diagnose you with rosacea. Edit: u/Firefox7275 commented with some great additional information for those of you in the UK - specifically, your GP can diagnose and prescribe for rosacea, so do not hesitate to see them regarding your skin concerns!

More Information This information, and much more (including a list of rosacea specialists), can find be found from the National Rosacea Society website!

There are some great rosacea subreddits:

r/rosacea

r/rosaceahelp

Some Sources:

[1] Telangiectasia. U.S. National Library of Medicine - National Institutes of Health. MedicinePlus. http://www.nlm.nih.gov/medlineplus/ency/article/003284.htm. Accessed 9/24/2014.

[2] Wilkin J, Dahl M, Detmar M, Drake L, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. Journal of the American Academy of Dermatology.2002; 46:584-587.