What is Rosacea?
Rosacea is a common chronic, mainly centrofacial dermatosis, initially characterized by episodic reddening and later by persistent redness and inflammatory lesions. Based on present knowledge, it is considered to be a syndrome, or typology, encompassing single or combinations of various cutaneous signs such as flushing, erythema, telangiectasia, edema, papules, pustules, ocular lesions, and rhinophyma. [1]
The disease commonly starts in the fourth decade of life, peaking at the age of 40 to 50 years. In some cases, rosacea will occur before the age of 20. Rosacea leads to facial disfigurement—with related emotional suffering—and may cause serious ocular complications if left untreated. [2] The causes are still not identified; a multifactorial etiology is assumed.
In many cases, those suffering from rosacea are unaware of the condition and do not seek medical treatment in its early stages. While rosacea can affect anyone, fair-skinned individuals are more susceptible to the disease. People who have a family history of rosacea or a tendency to flush or blush easily are also more at risk. The clinical appearance of rosacea can be similar to acne—it is thus sometimes erroneously referred as to acne rosacea, but rosacea is not a primary follicular disease.
Prevalence
Rosacea appears to be quite common, and in an epidemiologic study in Sweden its prevalence was 10%. [3] It has been most frequently observed in patients with fair skin, especially among Celtic types of northern Europeans, and is therefore popularly known as “The curse of the Celts”. In the United States, it is estimated that approximately 5% of the population—corresponding to 13 to 14 million people—suffer from rosacea. [4]
Both women and men are equally prone to the disease , but experience has shown that women are more likely to ask for medical help because of concern for their appearance. However, the course of the disease is in general less severe in women, and tissue and sebaceous gland hyperplasia resulting in rhinophyma—the most obvious stigma of rosacea—almost exclusively affect men. Unfortunately, rhinophyma is often misinterpreted as being associated with alcohol abuse, which can lead to adversely affected professional and social image and loss of self-esteem.
The etiology and pathogenesis of rosacea are unknown, and no histologic or serologic markers have been identified.
Etiology and pathogenesis
The exact cause of rosacea is still largely unknown. As in many other diseases, a multifactorial etiology of rosacea is assumed. Over the years, a variety of suspected but unconfirmed causes have been studied (See: rosacea.dermis.net).
Genetic predisposition
As 30-40% of patients with rosacea have a relative suffering from the disease, there is growing evidence for a genetic predisposition. However, genetic markers for rosacea—such as HLA—have not yet been identified.
Small vessel dilatation
Rosacea patients are prone to flushing and blushing as well as developing telangiectasia due to a microcirculatory disturbance of the facial angular veins. The affected face tissue is weakened, and later damaged, by the pressure from the accumulation of blood, which eventually leads to individual vessels being constantly widened. The increase of migraine headaches in rosacea patients could also be explained by a vascular dysfunction.
Gastrointestinal disturbances
Although there is no strong evidence for any correlation, an association between gastrointestinal disturbances—such as dyspepsia with gastric hypochlorhydria and inflammatory bowel disease—with rosacea has been discussed.
Helicobacter pylori
An association between the infection with Helicobacter pylori (Hp) of the gastric mucosa and rosacea has been the subject of much controversy. It is doubtful that an eradication of Hp influences the long-term course of rosacea, even though it might relieve rosacea symptoms over the short term.
Seborrhea
Experimental studies have not proved an association between rosacea and seborrhea—indeed sebum production is not usually increased in rosacea patients.
Demodex folliculorum
The face mite Demodex folliculorum is not the cause of rosacea, yet it is much more frequently found in rosacea patients than in control groups. This might represent an effect secondary to the changes in rosacea or might represent a cofactor in the development of the disease.
Endocrine changes
There seems to be a relation between endocrine changes and rosacea, since increases of rosacea symptoms during pregnancy, menses or perimenopause have been observed.
Ultraviolet and infrared light
Ultraviolet and infrared radiation is thought to play a major role in the pathogenesis of rosacea, since it affects the dermal connective tissue as well as lymphatic and blood vessels. Ultraviolet light could therefore contribute to passive vasodilatation.
Lymphedema
A disturbance of the lymphatic drain, such as lymphedema, is thought to be a factor in the development of rosacea, especially in the severe form of rhinophyma.
Drugs
Amiodarone or nitroglycerine-like drugs inducing vasodilatation and flushing may intensify an existing case of rosacea.
Trigger factors
The flushing episodes that form a predominant symptom among patients with rosacea can be attributed to different trigger factors (see rosacea.dermis.net):
- Extreme temperatures
- Heat
- Sauna
- Hot baths
- Cold
- Exposure to the sun
- Physical exertion
- Exercise and "lift and load" jobs
- Emotional factors
- Stress
- Anxiety
- Embarrassment
- Alcoholic beverages
- Hot drinks
- Spicy food
- Skin care products containing
- Hydro-alcohol
- Acetone
For further information see
References
- [1] Wilkin J, Dahl M, Detmar M, Drake L, Feinstein A, Odom R, Powell F. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol 2002 ;46:584-7.
- [2] Kligman AM, Jansen T, Plewig G : Acne and Rosacea; Springer Verlag, Heidelberg 2000
- [3] Berg M, Liden S. An epidemiological study of rosacea. Acta Derm Venereol. 1989;69:419-23
- [4] See www.rosacea.org