Rosacea, also known as red pimples or copper acne, is a skin disease that mainly affects the mid-face area. It usually begins between the ages of 30 and 40 and often worsens between the ages of 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 impairments.
What is rosacea?
Rosacea (formerly also known as "copper rose") is a non-contagious, chronic inflammatory skin disease (dermatosis). It mainly 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 décolleté can also be affected.
The severity of rosacea can initially only be noticeable through a temporary reddening (rosacea diathesis), but in advanced stages it can become much more serious and even lead to permanent changes in the connective tissue.
This skin disease affects people of all ages, although it mainly affects people in their middle and later years. According to current findings, men and women are equally affected.
As rosacea has inflammatory skin changes that are similar to acne, the disease is sometimes referred to as "acne rosacea". However, unlike acne sufferers, people with rosacea do not develop blackheads . If you experience the symptoms of both conditions at the same time (blackheads and redness), it is likely that you are suffering from a mixed form of the two conditions.
Rosacea triggers?
The exact causes of rosacea are still unknown. It is suspected that rosacea is linked to hereditary factors. Many people who suffer from rosacea have family members who also have the condition. As fair-skinned people of Western and Northern European descent are more likely to suffer from rosacea, the term "curse of the Celts" has become established in Anglo-American literature.
The damage to the facial skin caused by sun exposure is probably a factor in the development of rosacea. It affects both the connective tissue and the blood and lymph vessels, leading to vasodilation and inflammation. According to recent studies, an incorrect innate immune response leads to skin inflammation. Demodex mites, which are an integral part of the disease, appear 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 at least partially involved in the inflammation. Elevated levels of cathelicidin, a type of antimicrobial peptide produced by skin cells as part of the innate immune system, may contribute to rosacea symptoms.
The immune cells in the affected areas release substances that dilate the blood vessels and cause inflammation. This excessive division of the connective tissue and sebaceous glands leads to a thickening of the skin in some areas and makes the pores appear larger.
How can rosacea worsen?
It is important to avoid the 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 value (7)
- Certain cosmetics
- Certain medications
- Stress
- Alcohol
- Spicy dishes
- Hot drinks
- Solar radiation
Rosacea can be triggered by events that you may not even be aware of. Events that cause rosacea flare-ups can be imperceptible. Remember that your skin cannot tell the difference between 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 talk to your doctor about this possibility.
As everyone reacts differently to possible triggers, you should closely observe which stimuli your skin reacts to and adjust your lifestyle if necessary.
Rosacea diagnosis
The dermatologist (skin doctor) will examine the skin closely 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. In this way, similar-looking diseases such as lupus erythematosus (also known as red wolf) or perioral dermatitis can be definitively ruled out. Blood tests may also be required to diagnose rosacea. If the dermatologist suspects that rosacea affects the eyes, he or she will refer the patient to an ophthalmologist for further tests.
Rosacea symptoms
Rosacea is characterized by three main symptoms: Flushing, erythema and telangiectasia. Flushing refers to sudden redness and warmth on the skin, erythema is a persistent reddening of the skin and telangiectasia is a visible dilation of the blood vessels.
Later, papules (thickening of the skin) and pus-filled blisters (pustules) as well as swelling of the lymph vessels (lymphoedema) may occur.
Other changes to your skin may include dullness, dry patches, plaques, inflammation (edema) and excessive sebum and connective tissue growths (phyma).
The most common symptoms are burning, stinging or painful skin and a feeling of heat. In some cases, the eyes are also affected. This manifests itself in dilated blood vessels in the eyes and recurring dry and inflamed eyes.
Severity of rosacea
Rosacea is a skin disease that worsens in episodes and has varying degrees of severity. 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 frequently occur on the facial skin. In addition to the 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, red and inflamed blisters or pustules (colloquially known as spots) and nodules (papules) appear more frequently. They can sometimes last for several weeks. Swelling (lymphoedema) can also occur in the facial tissue.
- Severity III - Glandular hyperplastic rosacea: This is the most severe form of rosacea. The connective tissue and sebaceous glands increase in size, resulting in bulging 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, so it can be difficult to assign a severity level to them. This is why more and more experts are using ROSCO, a modular system for measuring the severity of the disease. The primary and secondary symptoms are categorized according to how often, how severe and how long they occur in patients. This allows doctors to better treat their patients according to the severity of their symptoms.
Treat rosacea yourself
The treatment of rosacea begins with avoiding things that trigger the disease or promote its progression. These include foods and environmental factors to which the skin is exposed, such as extreme sunlight or temperature fluctuations.
Home remedies for treating rosacea, such as apple cider vinegar, chamomile tea, green tea, honey and other things can be found on the internet. Due to the extremely sensitive skin of people with rosacea, be sure to consult a dermatologist before using these remedies. The doctor will let you know if it is okay and safe for you to use. If your skin reacts in a way you don't like after using it, the doctor can also take care of the consequences and suggest other solutions.
What helps against rosacea?
Rosacea is a chronic disease 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 amplifiers
Anyone suffering from rosacea should avoid aggravating the symptoms. These are some of the things that should be avoided:
- Sunlight
- spicy food
- warm drinks
- Alcohol
- Stress
Medications such as calcium antagonists can cause redness of the face. If you believe that your medication has 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 cope with it. In addition to individual strategies , relaxation methods such as progressive muscle relaxation and autogenic training can also be helpful.
Skin care products and cosmetics
People who suffer from rosacea can take steps to alleviate the signs and symptoms of their condition. People with rosacea can also do a lot to alleviate the symptoms with appropriate skin care. For the face, only mild, soap-free, pH-neutral wash lotions or syndets should be used, as the sensitive skin can become irritated.
When choosing cosmetics, you should pay careful attention to the ingredients. It is important to check the ingredients carefully. Menthol and camphor are two examples of ingredients that people with rosacea should avoid. Products based on glycerine 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 in visually reducing the redness on the face.
Day care with sun protection
Many people report that their symptoms worsen when they are exposed to intense sunlight. Therefore, patients are advised to avoid prolonged sunbathingand to use sunscreens that are effective against UV-A and UV-B rays. As chronic sun exposure plays an important role in the development and maintenance of the disease, the year-round use of a sunscreen suitable for the skin type is recommended.
Cold drink or ice cubes
Sudden reddening of the face can be relieved by drinking cold drinks or sucking ice cubes.
Massages for the face
Facial massages can help to reduce the 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, the symptoms can be brought under control relatively easily. By eliminating the causes of the disease, a recurrence of the disease can be prevented. Alcohol, especially hot drinks and spicy foods, have a vasodilating effect and should be avoided in the first instance. Obesity and chronic inflammation are linked in several ways. Obesity, like other inflammatory diseases, is associated with the consumption of pro-inflammatory foods. The disease can be improved by reducing weight. Intermittent fasting helps detoxify the liver - our body's natural cleansing power - while reducing weight. Bitter plants, such as chicory and rocket, promote liver function. For a stronger immune system, it is best to take probiotics and follow an anti-inflammatory diet in which you avoid sugar, fatty meat, wheat - and dairy products if possible.
Face cream, lotion or ointment for rosacea
Ointments consist entirely of fat and contain no water, whereas creams contain a certain amount of water. Lotions contain even more water than fat and are therefore referred to as oil-in-water emulsions.
As creams and lotions have a high water content, they areideal for rosacea patients. They do not form a greasy film on the skin that closes the pores like other products. Instead, they allow the skin to breathe without drying it out.
Products with added fragrances or colorants can cause skin irritation and should be avoided if you have sensitive skin. Talk to a pharmacist for personal advice before buying new skin care products.
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 probably has an anti-inflammatory effect. Azelaic acid is another common rosacea treatment in the form of a gel. This active ingredient also inhibits inflammation. Ivermectin has recently become available in cream form to treat rosacea by reducing the Demodex mite and the associated inflammation. Another way to alleviate the redness is to use active ingredients such as bromonidine, which constricts the blood vessels.
However, it should be noted that rosacea should never be treated with cortisone-containing medication over a longer period of time, as this would aggravate the skin condition.
Internal therapy
If the symptoms do not improve with topical 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 the treatment of rosacea. Doxycycline is usually preferred because it is available in a special preparation and in low doses that do not interfere with bacterial growth. It is therefore only effective against inflammation and is well tolerated.
Isoretinoin (a vitamin A derivative) is administered in capsule form. However, this is an off-label application that the doctor and patient must discuss and agree upon in detail. When tetracyclines are ineffective or undesirable, isotretinoin has been shown to be successful. Isoretinoin can be prescribed to treat mild rhinophyma as it reduces the volume. However, if this is the chosen form of treatment, pregnant women and women of childbearing age must not take it, as it can lead to malformations in the unborn child. In addition, all patients taking isoretinoin must use a safe method of contraception. Regular blood tests (liver values, blood lipids) are also required during therapy. If a Demodex infection is confirmed, permethrin, an active substance against the parasite, can be used to reduce the number of mites. However, as this is an application that goes beyond the scope of the approval, the doctor and patient must go through and agree this in detail. Permethrin is not a long-term therapy for rosacea.
