Rosacea is a chronic skin condition that is characterized by a persistent redness of the face, affecting the cheeks, nose and forehead. Initially, rosacea exhibits frequent flushing or blushing of the face that becomes more permanent as rosacea progresses into a more chronic inflammation of the face. Later stages of rosacea are often accompanied by pastules (red bumps that look like acne), papules (pus-filled bumps) and permanently dilated blood vessels that become visible through the skin (telangiectasias).
Rosacea is estimated to affect 45 million people worldwide and primarily affects fair-skinned people between the ages of 20 and 50. Rosacea symptoms often get worse by trigger factors such as sun exposure, extreme heat or cold, foods containing high levels of histamine and stress. Many rosacea patients seek help when the condition has progressed to a later stage. Rosacea symptoms can be treated with topical rosacea treatments (over-the counter and by prescription) and by an oral regimen of antibiotics. While symptoms can be controlled for long periods of time, inflammation of the skin frequently flares up due to a variety of trigger factors.
A standard classification system of rosacea was established in 2002 and describes four subtypes of rosacea, which include the various primary and secondary signs and symptoms of rosacea. Rosacea patients can have more than one subtype at any given time. In 2004, a standard grading system was added to the classification system. Symptoms are graded as mild, moderate or severe. The four subtypes of rosacea are:
Papulopustular rosacea: This subtype often exists before a diagnosis of rosacea is made. It has some permanent redness (erythema) with red bumps (papules), some of which are filled with pus (pustules). Burning and stinging sensations of the skin usually are present as well. The papules and pustules often retreat with the right treatment. This subtype resembles regular acne.
Erythematotelangiectatic rosacea: A persistent redness of the face (erythema) with the possibility of visible (enlarged) blood vessels near the surface of the skin (telangiectasias). Sometimes, the redness of the face covers up the telangiectasias, which become more visible when the redness of the face clears up. A rosacea diagnosis is not dependent on the presence of telangiectasias. Patients with this subtype often blush easily and often experience painful, itchy skin.
Phymatous rosacea: Commonly associated with an enlargement of the nose (rhinophyma). This sub-type is more prevalent in men. The main symptom of phymatous rosacea is thickening of the skin with unevenly shaped nodules and the associated enlarged nose, but the thickening of the skin can also affect the chin, forehead, cheeks, eyelids and ears. Telangiectasias may be present as well.
Ocular rosacea: Symptoms of ocular rosacea include a burning and itching sensation of the eyes. The eyes appear red and inflamed (with associated multiplication of small blood vessels) and patients often complain of a “foreign body” sensation in the eyes. Eyes can be dry and sensitive to light and some patients may experience blurred vision. Eyelids and tear glands are frequently inflamed. In some patients, corneal complications could result in loss of vision. Since ocular rosacea is such a serious condition, patients are encouraged to have their eyes checked regularly.
Because of the progression of this skin disorder, most rosacea patients only seek help when their condition is in a later stage. While the symptoms can be kept under control with the proper treatment, the skin of these patients will have a significant number of telangiectasias (permanently dilated blood vessels) that leads to a residual redness. The rosacea classification and grading system allows more patients to receive the proper care quicker and will prevent the condition from becoming worse.
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