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Rosacea rO-!zA-shE-u

by Karen McKoy, MD, MPH

Rosacea (acne rosacea) is a persistent skin disorder that causes redness, tiny pimples, and noticeable blood vessels, usually on the central area of the face.

  • The cause is unknown.

  • Typical symptoms include redness, small visible blood vessels, and sometimes small pimples that appear on the cheeks and nose.

  • The diagnosis is based on the typical appearance of the rash and on the person's age when symptoms first appear.

  • Worsening of rosacea may be prevented by avoiding certain foods, alcohol, caffeine, and exposure to sunlight, extremes of temperature, wind, and cosmetics.

  • Treatment includes antibiotics applied to the skin or, for some people, taken by mouth.

The cause of rosacea is not known.

Rosacea typically affects people aged 30 to 50. The disorder is most common among people of Irish and Northern European descent who have fair complexions but it does affect and is probably under-recognized in darker-skinned people. Although usually easy for doctors to recognize, rosacea sometimes looks like acne and certain other skin disorders. It is often called adult acne.

Symptoms

Rosacea affects only the face and scalp. The skin over the cheeks and nose becomes flushed, red, and may sting. The skin may appear red and swollen, with small blood vessels visible just below the surface. Often small pimples develop, sometimes with some pus (called pustules). The skin around the nose occasionally thickens, making it look red and bulbous (called rhinophyma).

Rosacea that affects the eyes (ocular rosacea) often accompanies rosacea that affects the face. Symptoms may include inflammation of the eyelids, conjunctiva, iris, sclera, cornea, or a combination that causes itching, a feeling as though something is in the eye (foreign body sensation), redness, and swelling of the eye.

Diagnosis

Doctors base the diagnosis on the typical appearance of the rash. There are no specific tests. The person's age when the symptoms first appear and a lack of blackheads and whiteheads help distinguish rosacea from acne.

Treatment

People with rosacea should avoid foods that cause the blood vessels in the skin to dilate (flushing) —for example, spicy foods, alcohol, coffee, and other caffeinated beverages. Other triggers may include sunlight, emotional stress, cold or hot weather, exercise, wind, cosmetics, and hot baths or hot drinks.

Antibiotics that are applied to the skin, such as metronidazole, benzoyl peroxide, clindamycin, and erythromycin, may be effective. Azelaic acid cream may also be effective.

Certain antibiotics taken by mouth are given to people who have many pustules or ocular rosacea. Tetracycline, doxycycline, minocycline, or erythromycin is usually used. Isotretinoin may be effective when taken by mouth but, because of possibly severe side effects, is not used unless other treatments are ineffective. Corticosteroids applied to the skin tend to make rosacea worse. Severe rhinophyma is unlikely to improve completely with drugs. Therefore, a person with this disorder may need dermabrasion, a procedure in which the skin surface is rubbed with an abrasive metal instrument to remove the top layer, or surgery or laser treatment to remove the excess tissue (see Using Lasers to Treat Skin Problems).

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • CLEOCIN
  • ACHROMYCIN V
  • FLAGYL
  • ERY-TAB, ERYTHROCIN
  • PERIOSTAT, VIBRAMYCIN
  • MINOCIN
  • SOTRET