Rosacea is a incurable condition of the skin that is defined by a chronic redness of the face, affecting the nose, cheeks 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. In later stages, rosacea patients frequently suffer from 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. The condition is made worse by trigger factors such as heat, cold, sun exposure, stress and foods high in histamine. 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. Although symptoms can be kept under control for long periods of time, inflammation of the skin frequently flares up due to a variety of trigger factors.
An official classification system of rosacea was developed in 2002 and defines four subtypes of rosacea, which cover 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 4 subtypes of rosacea are:
Erythematotelangiectatic rosacea: A chronic redness (erythema) of the face 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 frequently experience painful, itchy skin.
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.
Ocular rosacea: Ocular rosacea is characterized by the 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. Some patients may develop loss of vision due to corneal complications. Since ocular rosacea is such a serious condition, patients are encouraged to have their eyes checked regularly.
Phymatous rosacea: Commonly associated with an enlargement of the nose (rhinophyma). This sub-type is predominantly found 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 cheeks, chin, forehead, ears and eyelids. Telangiectasias may be present as well.
Because of the way in which rosacea develops, patients only seek help when their condition is in a later stage. While the symptoms can be controlled with the proper treatment, the skin of these patients will have a significant number of telangiectasias (permanently dilated blood vessels) that results in 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.