Rosacea, also known as acne rosacea or copper acne, is a skin disease that occurs primarily in the mid-facial area. It usually begins between the ages of 30 and 40 and often worsens between 40 and 50. Rosacea has similarities to acne but is accompanied by other problems. Rosacea is a chronic and progressive inflammatory skin condition that typically affects the face. It can lead to redness, swelling, blisters, nodules, and tissue formation. Those affected suffer from itching and pain, as well as cosmetic disfigurement.
What is Rosacea?
Rosacea (formerly also known as "copper nose") is a non-contagious, chronically inflammatory skin disease (dermatosis). It primarily affects the face, especially the nose and cheeks, but can also affect the forehead and chin. In rare cases, adjacent regions such as the scalp, neck, or décolletage may also be affected.
The severity of rosacea may initially only manifest as temporary redness (rosacea diathesis) but can become much more severe in advanced stages, even leading to permanent changes in connective tissue.
This skin condition affects people of all ages, although it primarily affects individuals in their middle and later years. According to current knowledge, men and women are equally affected.
Since rosacea exhibits inflammatory skin changes that resemble acne, the disease is sometimes referred to as "acne rosacea." However, unlike acne patients, people with rosacea do not develop blackheads. If you experience symptoms of both conditions simultaneously (blackheads and redness), it is likely that you suffer from a mixed form of the two diseases.
Triggers of Rosacea?
The exact causes of rosacea are still unknown. It is believed that rosacea is related to hereditary factors. Many people who suffer from rosacea have family members who also have it. Since light-skinned people of Western and Northern European descent are more likely to develop rosacea, the term "curse of the Celts" has become common in Anglo-American literature.
Sun-induced damage to the facial skin is likely a factor in the development of rosacea. It affects both connective tissue and blood and lymphatic vessels, leading to vasodilation and inflammation. According to current studies, a faulty innate immune response leads to skin inflammation. Demodex mites, which are an integral part of the disease, seem to play a role in the inflammation. Cathelicidin, a natural antimicrobial protein particle (peptide) that is part of the innate immune system, appears to be involved in the inflammation, at least in part. Elevated levels of cathelicidin, a type of antimicrobial peptide produced by skin cells as part of the innate immune system, can contribute to rosacea symptoms.
The immune cells in the affected areas release substances that dilate blood vessels and cause inflammation. This excessive division of connective tissue and sebaceous glands leads to thickening of the skin in some places and makes pores appear larger.
How can Rosacea worsen?
It is important to avoid typical triggers for rosacea flare-ups. These are some of them:
- Heat, hot baths and showers,
- Sauna visits
- Washing lotions and soaps with an alkaline pH (7)
- Certain cosmetics
- Certain medications
- Stress
- Alcohol
- Spicy dishes
- Warm drinks
- Sun exposure
Rosacea can be triggered by events you may not even notice. Events that cause a rosacea flare-up can be imperceptible. Remember that your skin cannot distinguish what is real and what is not.
A flare-up of the disease can be caused by hormonal changes, e.g., during pregnancy. Be sure to discuss this possibility with your doctor.
Since everyone reacts differently to potential triggers, you should carefully observe which stimuli your skin reacts to and adjust your lifestyle accordingly.
Rosacea Diagnosis
The dermatologist (skin doctor) will examine the skin carefully and ask the person about their medical history and aggravating factors to diagnose rosacea.
Sometimes it makes sense to take a skin sample (biopsy) from the facial area and examine it under magnification. This way, similar-looking diseases such as lupus erythematosus (also called red wolf) or perioral dermatitis can be definitively ruled out. Blood tests may also be necessary for the diagnosis of rosacea. If the dermatologist suspects that rosacea is affecting the eyes, they will refer the patient to an ophthalmologist for further tests.
Rosacea Symptoms
Rosacea is characterized by three main symptoms: redness, erythema, and telangiectasias. Flushing refers to sudden redness and warmth on the skin, erythema is persistent redness of the skin, and telangiectasia is a visible dilation of blood vessels.
Later, papules (skin thickenings) and pus-filled blisters (pustules) as well as lymphatic vessel swellings (lymphedema) may appear.
Other changes in your skin may include dullness, dry patches, plaques, inflammation (edema), and excessive sebum and connective tissue overgrowth (phymas).
The most common symptoms are burning, stinging or aching skin and a feeling of heat. In some cases, the eyes are also affected. This manifests as dilated blood vessels in the eyes and recurrent dry and inflamed eyes.
Severity Levels in Rosacea
Rosacea is a skin condition that worsens in flare-ups and has different severity levels. The disease is accompanied by the following symptoms:
- Pre-stage – Rosacea Diathesis: The first symptom of rosacea is typically redness. This only occurs on the face, but can also appear on the neck, chest, scalp, or eyes.
- Severity I – Rosacea erythematosa-teleangiectatica: Telangiectasias are dilated blood vessels that often appear on the facial skin. In addition to redness, those affected often suffer from dry and itchy skin, as well as burning or stinging pain.
- Severity II – Rosacea papulopustulosa: In this stage of rosacea, more red and inflamed blisters or pustules (colloquially referred to as pimples) and nodules (papules) appear. They can sometimes last for several weeks. In addition, swelling (lymphedema) in the facial tissue may occur.
- Severity III – Glandular-hyperplastic Rosacea: This is the most severe form of rosacea. The connective tissue and sebaceous glands increase in size, leading to bulbous growths (phyma), such as a "bulbous nose" or "potato nose" (rhinophyma). These changes often have a significant impact on the appearance of those affected.
The symptoms of rosacea often differ from patient to patient, making it difficult to assign a severity level. Therefore, more and more experts use ROSCO, a modular system for measuring the severity of the disease. Primary and secondary symptoms are categorized by how frequently, how severely, and how long they occur in patients. This allows doctors to better treat their patients depending on the severity of the symptoms.
Treating Rosacea Yourself
Treatment for rosacea begins with avoiding things that trigger the disease or promote its progression. This includes food and environmental factors to which the skin is exposed, such as e.g., extreme sun exposure or temperature fluctuations.
Home remedies for treating rosacea, such as apple cider vinegar, chamomile tea, green tea, honey and other things can be found online. Due to the extremely sensitive skin of people with rosacea, you should definitely consult a dermatologist before using these remedies. The doctor will tell you if the application is fine and safe for you. If your skin reacts in a way you don't like after application, the doctor can also address the consequences and suggest other solutions.
What helps with Rosacea?
Rosacea is a chronic condition that always requires long-term treatment and regular check-ups with a dermatologist. However, medication should only be seen as part of the overall strategy.
Avoid Aggravating Factors
Anyone suffering from rosacea should avoid worsening the symptoms. These are some of the things that should be avoided:
- Sunlight
- Spicy foods
- Warm drinks
- Alcohol
- Stress
Medications like calcium antagonists can cause facial redness. If you believe your medication is having this effect, talk to your doctor about it. Do not stop taking the medication without talking to your doctor first!
Reduce Stress
Dealing with stress can be difficult, but there are a number of ways to manage it. In addition to individual strategies, relaxation methods such as progressive muscle relaxation and autogenic training can also be helpful.
Skincare Products and Cosmetics
People suffering from rosacea can take steps to alleviate the signs and symptoms of their condition. Even with appropriate skincare, people with rosacea can do a lot to relieve symptoms. For the face, only mild, soap-free, pH-neutral washing lotions or syndets should be used, as sensitive skin can be irritated.
When choosing cosmetics, you should pay careful attention to the ingredients. It is important to carefully check the components. Menthol and camphor are two examples of ingredients that people with rosacea should avoid. Preparations based on glycerin or silicone oil are generally well tolerated.
The skin changes associated with rosacea are a cosmetic problem for many sufferers. Covering the redness with special products (camouflage) is very effective. Products containing green pigments are particularly helpful, as they visually reduce redness on the face.
Day Care with Sun Protection
Many people report that their symptoms worsen when exposed to intense sunlight. Therefore, patients are advised to avoid extended sunbathing and to use sunscreens effective against UV-A and UV-B rays. Since chronic sun exposure plays an important role in the development and maintenance of the disease, year-round use of a sunscreen suitable for one's skin type is recommended.
Cold Drink or Ice Cubes
Sudden facial redness can be remedied by consuming cold drinks or sucking on ice cubes.
Facial Massages
Facial massages can help reduce swelling caused by rosacea. Inflammation causes swelling that is not improved by muscle activity. They are found on the face and are not affected by muscle tension.
Nutrition
In most cases, symptoms can be relatively easily brought under control. By eliminating the causes of the disease, one can prevent its recurrence. Alcohol, especially hot beverages and spicy foods, have a vasodilating effect and should primarily be avoided. Obesity and chronic inflammation are linked in multiple ways. Obesity, like other inflammatory diseases, is associated with the consumption of pro-inflammatory foods. The disease can be improved by weight reduction. Intermittent fasting helps detoxify the liver - our body's natural cleanser - while also reducing weight. Bitter plants, such as chicory and arugula, promote liver function. For a stronger immune system, it is best to take probiotics and maintain an anti-inflammatory diet, avoiding sugar, fatty meats, wheat - and, if possible, dairy products.
Facial Cream, Lotion, or Ointment for Rosacea
Ointments consist entirely of fat and contain no water, while creams contain a certain amount of water. Lotions even contain more water than fat and are therefore called oil-in-water emulsions.
Since creams and lotions have a high water content, they are ideal for rosacea patients. They do not form a greasy film on the skin that clogs pores, like other products. Instead, they allow the skin to breathe without drying it out.
Products with added fragrances or dyes can cause skin irritation and should be avoided for sensitive skin. Talk to a pharmacist before buying new skincare products for personalized advice.
Rosacea Medication
Most cases of rosacea are treated with medication, both externally and internally.
External Therapy
Metronidazole is most commonly used as a cream, gel, or lotion. The mechanism of action of metronidazole is currently unknown; it likely has an anti-inflammatory effect. Azelaic acid is another common rosacea therapy in the form of a gel. In addition, this active ingredient inhibits inflammation. Recently, ivermectin has become available in cream form for the treatment of rosacea, by reducing the Demodex mite and associated inflammation. Another way to alleviate redness is with active ingredients such as bromonidine, which constricts blood vessels.
However, it must be noted that rosacea should never be treated with corticosteroid-containing medications for an extended period, as this would worsen the skin condition.
Internal Therapy
If symptoms do not improve with external treatments such as creams or ointments, or if the inflammation is severe, a doctor may prescribe antibiotics. Tetracyclines - such as minocycline or doxycycline - have proven effective in treating rosacea. Doxycycline is generally preferred because it is available in a special preparation and in low doses that do not affect bacterial growth. Therefore, it works exclusively against inflammation and is well tolerated.
Isotretinoin (a vitamin A derivative) is administered in capsule form. However, this is an off-label use that the doctor and patient must discuss and agree upon in detail. If tetracyclines are ineffective or undesirable, isotretinoin has proven successful. Isotretinoin may be prescribed to treat mild rhinophyma, as it reduces volume. However, if this is the chosen form of treatment, pregnant women and women of childbearing potential are not allowed to take it, as it can cause birth defects in the unborn child. In addition, all patients taking isotretinoin must use a reliable method of contraception. Regular blood tests (liver values, blood lipids) are also required during therapy. If a Demodex infection is confirmed, permethrin, an active ingredient against the parasite, can be used to reduce the number of mites. However, since this is an off-label use, the doctor and patient must go through and agree upon this in detail. Permethrin is not a long-term therapy for rosacea.
