The disease has a wide range of symptoms and signs, but rarely do patients go through each stage of rosacea. Variable erythema and telangiectasia is seen on cheeks and forehead. Inflammatory papules and pustules are seen mainly on the nose, the forehead, and the cheeks. Rarely, the neck and the upper part of the chest are involved.

In severe cases, thickened and disfigured noses (rhinophyma) are seen due to prominent sebaceous glands. Patients may complain of drying and peeling of the skin. Ocular lymphedema may be outstanding but is not seen commonly. Usually, rosacea does not cause any scarring.

Sometimes rhinophyma is the only presenting symptom and no other signs of rosacea are seen. Lymphedema can be predominant in periorbital area and sometimes be the only presenting symptom.

Ocular rosacea can be associated with conjunctival infection, and, rarely ever with chalazion and episcleritis.

Rosacea fulminans (pyoderma faciale) is a rare complication which is identified by the formation of nodules and abscesses with development of a sinus tract along with systemic signs.

A rare granulomatous type of rosacea (acne agminata/lupus miliaris disseminatus faciei) can present with inflammatory erythematous or flesh-colored papules spread symmetrically on the upper part of the face, especially around the eyes and nose. This type of rosacea may be associated with scarring and sometimes do not respond to regular treatment.

• Asymptomatic

  […] severity and by the sites of involvement.20 Similar to rosacea, seborrheic dermatitis is a chronic and relapsing erythematous rash with well-demarcated erythematous patches, papules, or plaques; however, unlike rosacea, the distribution varies from minimal asymptomatic [mdedge.com]

  They are generally asymptomatic unless they become irritated by frictional forces or their blood supply becomes compromised. They are very common and need not be removed or destroyed unless they become irritated. [onhealth.com]

  Accounting for uncertainty in the steps used to convert rotavirus-positive proportions into rotavirus-attributable fractions The frequent asymptomatic carriage of many pathogens in the stools of healthy controls necessitates the calculation of attributable [ncbi.nlm.nih.gov]

• Malaise

  She was otherwise healthy, with no history of fever, malaise, or weight loss. Physical examination revealed multiple symmetrically distributed discrete and coalescing red plaques, papules and nodules scattered over the face, neck and extremities. [ncbi.nlm.nih.gov]

• Flushing

  Scientists consider the condition something of a mystery, but most believe a mix of genetics and sun damage kick-start this tendency to flush easily and often, at almost everything—and sometimes nothing at all. [allure.com]

  At first, telangiectasias may be hidden by the redness of flushing or blushing, but they usually reappear after this redness fades. [drugs.com]

  If you have severe, persistent flushing, there are other possible causes of flushing requiring laboratory tests; see your doctor. [skinsight.com]

  General measures: Avoid the triggers of flushing, as discussed above. [dermcoll.edu.au]

• Skin Disease

  From Wikidata Jump to navigation Jump to search long-term human skin disease characterized by ruddy reddening of the skin acne rosacea (disorder) acne roscea acne, erythematosa rosacea (disorder) rosacea NOS (disorder) Acne Rosacea edit English rosacea [wikidata.org]

  Definition (CHV) an acne like skin disease occurring mostly in middle aged adults Definition (CHV) an acne like skin disease occurring mostly in middle aged adults Definition (CHV) an acne like skin disease occurring mostly in middle aged adults Definition [fpnotebook.com]

  […] occurring mostly in middle aged adults Rosacea is a long-term disease that affects your skin and sometimes your eyes. [icd9data.com]

  Limited data have suggested that disease management by a primary care physician (PCP) may be less costly than seeing a specialist, though it is not clear if the same is true for the management of skin disease. [ncbi.nlm.nih.gov]

  Learn about the diseases and conditions that may cause scaly skin. [skincarephysicians.com]

• Dermatitis

  No RB were found in the perioral areas of other types of facial dermatitis, including atopic dermatitis and seboerrheic dermatitis or in 16 healthy controls. [ncbi.nlm.nih.gov]

  Eczema Resource Center - Caring for a child with eczema Atopic dermatitis Contact dermatitis Dry, scaly, and painful hands could be hand eczema Dyshidrotic eczema Neurodermatitis Nummular dermatitis Stasis dermatitis Hair and scalp problems Many people [skincarephysicians.com]

  Convert to ICD-10-CM : 695.3 converts approximately to: 2015/16 ICD-10-CM L71.0 Perioral dermatitis Or: 2015/16 ICD-10-CM L71.1 Rhinophyma Or: 2015/16 ICD-10-CM L71.8 Other rosacea Approximate Synonyms Dermatitis perioral Dermatitis perioral (around the [icd9data.com]

  Acne vulgaris Steroid rosacea Periorificial dermatitis or periocular dermatitis Demodicosis Flushing due to other causes Keratosis pilaris rubra faciei Skin ageing Rosacea fulminans Seborrhoeic dermatitis Irritant contact dermatitis Systemic ( acute ) [dermnetnz.org]

• Acne Vulgaris

  Unlike acne vulgaris, rosacea is typically localized commonly over the central face (i.e. medial cheek, nose, forehead, and chin). Acne Vulgaris vs. [stanfordmedicine25.stanford.edu]

  The affected child may be predisposed to more severe acne in adolescence. acne papulo´sa acne vulgaris with the formation of papules. acne rosa´cea a form of acne in which the skin around each pustule is a rosy red; it is usually seen in persons over [medical-dictionary.thefreedictionary.com]

  Rosacea, also referred to as acne rosacea, is different from acne vulgaris, which normally affects younger people. [acne.org]

  Acne Vulgaris Acne vulgaris is the most common skin disease in the United States.21 It is characterized by noninflammatory; open or closed comedones; and inflammatory papules, pustules, and nodules. [mdedge.com]

  They are easily irritated if you apply harsh acne medicines to them, thus behaving more like a rash than acne. Also, unlike regular acne vulgaris, adult acne rosacea does not cause blackheads. [drbaileyskincare.com]

• Eczema

  Eczema Resource Center - Caring for a child with eczema Atopic dermatitis Contact dermatitis Dry, scaly, and painful hands could be hand eczema Dyshidrotic eczema Neurodermatitis Nummular dermatitis Stasis dermatitis Hair and scalp problems Many people [skincarephysicians.com]

  — Sarah Jacoby, SELF, "Why So Many People Swear By Azelaic Acid to Combat Acne and Redness," 5 Mar. 2019 This is the case with conditions like eczema, psoriasis, and rosacea, as well as generally sensitive skin. — Carolyn L. [merriam-webster.com]

  Types of Eczema There are many types of eczema, and many types include the word "dermatitis" (in dermatology, dermatitis is another word for eczema). For instance, eczema types include stasis dermatitis and dyshidrotic eczema. [onhealth.com]

  Types & treatments Childhood eczema Adult eczema Insider secrets Types of hair loss Treatment for hair loss Causes of hair loss Hair care matters Insider secrets What is psoriasis Diagnosis & treatment Skin, hair & nail care Triggers Insider secrets What [aad.org]

• Blepharitis

  We report the case of a 79-year-old woman with a long history of red eye and relapsing conjunctivitis-blepharitis caused by ocular rosacea. [ncbi.nlm.nih.gov]

  MARAZZI / SCIENCE PHOTO LIBRARY Other symptoms can include: dry skin swelling, especially around the eyes yellow-orange patches on the skin sore eyelids or crusts around roots of eyelashes – this could be blepharitis thickened skin, mainly on the nose [nhs.uk]

  “Blepharitis, an inflammation of the edge of the eyelids, is very common in rosacea and in fact may be present in a majority of rosacea cases,” he says. “You need to seek medical advice if your eyes become sore or irritated.” [thetimes.co.uk]

• Eye Irritation

  Other potential signs and symptoms of rosacea include: Eye irritation: The eyes might be irritated, and appear watery or bloodshot in some people with rosacea. [my.clevelandclinic.org]

  Type 4: Eye irritation This rosacea may involve a reddening of the eyes, a feeling of ‘grit’ in the eyes or crusting on the lashes and sometimes a clear discharge. The eyes may also become dry or teary with a burning sensation. [div.net.au]

  Avoid contact with the eyes, mouth, and other mucous membranes. Azelaic acid has been reported to cause irritation of the eyes. [rosaceaconcierge.com]

  Rosacea also may appear on the neck or cause eye irritation. The exact cause of rosacea is unknown. Some people have triggers that seem to cause flare-ups. [premierhealth.com]

  This is called ocular rosacea, and it affects the eye area, including eye irritation. Rosacea in Ireland You might have heard this one before, but rosacea is commonly called ‘The Curse of the Celts’. [theskinnerd.com]

• Conjunctival Injection

  The main symptom is conjunctival injection, which is sometimes accompanied by chalazion or episcleritis. Rosacea patients should therefore be seen by an ophthalmologist early in the disease course [ 100 ]. [doi.org]

• Excessive Tearing

  Subtype 4: Eye Irritation (Ocular Rosacea) – This type is found around the eye, including dry eyes, excessive tearing, burning eyes, swollen eyelids, vision lost, recurrence of sties, and corneal damage. [riversol.com]

• Facial Redness

  Physicians are often presented with patients complaining of facial redness and difficult to control rosacea. [ncbi.nlm.nih.gov]

  Acne rosacea is a common and chronic skin condition that often triggers facial redness. Also known simply as rosacea, it can spread to other areas of the body as well and cause other symptoms. [stanfordhealthcare.org]

  The skin condition, which typically manifests as facial redness, visible blood vessels, or little red pustules, has been attributed to a whole host of causes, from abnormalities in the the blood vessels to an increase of microscopic mites on the surface [bustle.com]

  The facial redness, which might come and go, often is the earliest sign of the disorder. Persistent redness: Persistent facial redness might resemble a blush or sunburn that does not go away. [my.clevelandclinic.org]

• Red Nose

  Eventually, redness will persist around the nose area, extending to the rest of the face. [uclahealth.org]

  Symptoms may include: Redness of the face Blushing or flushing easily A lot of spider-like blood vessels (telangiectasia) of the face Red nose (called a bulbous nose ) Acne-like skin sores that may ooze or crust Burning or stinging feeling in the face [nlm.nih.gov]

  […] and cheeks that cause an enlarged, bulbous red nose (almost only seen in men) In addition, rosacea often affects the eye and eyelid. [hopkinsmedicine.org]

  Reduce Redness A red nose is synonymous with rosacea, and rhinophyma is no exception. [rosacea.ie]

• Facial Edema

  We herein report the case because it presented in atypical fashion, as a solitary indurated plaque on the nose, likely representing Morbihan's disease or solid persistent facial edema of rosacea (rosacea lymphedema). [ncbi.nlm.nih.gov]

  Edema. Edema may accompany or follow prolonged facial erythema or flushing. Sometimes soft edema may last for days or be aggravated by inflammatory changes. [rosacea.org]

  Hisashi Uhara, Shigeo Kawachi and Toshiaki Saida, Solid Facial Edema in a Patient with Rosacea, The Journal of Dermatology, 27, 3, (214-216), (2015). Gerd Plewig and Albert M. [doi.org]

  Persistent erythema of the central face, subtle telangiectasias, facial edema, and ocular inflammation may also be present. [ahdbonline.com]

  edema Phymatous (subtype 3) Marked skin thickening and irregular nodularities of nose, chin, ears, forehead, or eyelids More common in men Rhinophyma Ocular (subtype 4) Watery, bloodshot eyes Affects nearly 60 percent of patients with rosacea Dry eye [aafp.org]

• Hot Flushes

  Stress & Fatigue: Stress stimulates the nervous system, which causes dilation of blood vessels flushing the skin. Menopause: Lowered oestrogen levels trigger hot flushes worsening Rosacea. [miskin.ie]

• Irritability

  “Non-soap cleansers also have a more neutral pH (i.e. they are not acidic) so they tend to be less irritating than soap based cleansers.” [instyle.com]

  "These treatments irritate the skin, which aggravates rosacea," she warns. [everydayhealth.com]

  To cleanse and moisturize your face, you should select facial products that do not burn, sting, irritate or cause redness when they are applied. [drugs.com]

  They may appear red and irritated or bloodshot or watery. The eyelids may swell. Styes are common in those who suffer from eye irritation caused by rosacea. Watch Your Diet Your diet plays an important role in your health. [globalhealingcenter.com]

• Burning Sensation

  Visible vessels (called telangiectasias), facial swelling and burning sensations are also experienced. Red bumps or pimples may be seen as well. Rosacea can develop gradually, as mild episodes of facial blushing. [laserandskin.ie]

  Symptoms include facial redness, a burning sensation and inflamed pustules. The cause of rosacea is unknown, but we know that the inflammatory symptoms are primarily triggered by Staphylococcus aureus bacteria. [gladskin.com]

  Some people with rosacea might also experience bumps, inflammation, swelling and/or a burning sensation. In rare cases the skin on the nose thickens, causing it to appear bulbous. [proactiv.com]

  The eyes may also become dry or teary with a burning sensation. Other possible symptoms include swollen eyelids, recurrent styes and potential vision impairment from corneal damage if no treatment is undertaken. [div.net.au]

• Tingling

  It usually covers wide areas of the face, especially the central face, and is frequently associated with flushing, burning, stinging and tingling. [rosacea.net]

  I feel the tingling and flushing start under my jawline and then, depending on the severity of the flare-up, it spreads across my chest up to my forehead. It even takes hold of my scalp, which results in seriously limp roots. [thesun.ie]

  Avobenzone can irritate skin with rosacea, causing it to tingle and sting. Instead, Baumann recommends physical sunscreen with zinc oxide as the main active ingredient. [self.com]

  And if you’re an acid fiend, it might be time to toss some of your favorite potent essences and serums, or at least anything that creates a tingle. Common acne treatments can also further irritate your skin. [allure.com]

  When you apply this medicine, you may feel some tingling or burning at first. This feeling tends to go away as you continue to use the medication. If it doesn’t, be sure to tell your dermatologist. [aad.org]

The diagnosis is made clinically. Sometimes a skin biopsy is done to rule out other cutaneous diseases, like lupus or sarcoidosis. The typical history and visible signs are more than sufficient to diagnose a case of rosacea.

• Demodex Folliculorum

  The causative role of Demodex folliculorum should be considered in immunocompetent children with rosacea or rosacea-like refractory eruptions. In such cases, treatment with ivermectin can be beneficial. [ncbi.nlm.nih.gov]

  The microorganisms that have been associated include Helicobacter pylori, Demodex folliculorum, Staphylococcus epidermidis, and Chlamydia pneumonia ; all the studies have been inconclusive. [doi.org]

Prior to any therapy, it is better to identify and avoid the triggering factors that flare up the patient's rosacea. These factors can be different for every individual. In some patients, it is seen that regular facial massage helps in reduction of lymphedema. Fairly high doses of prednisolone (30-60 mg/d) followed by oral isotretinoin helps in treatment of rosacea fulminans.

All patients with rosacea should use a broad-spectrum sunscreen that protects against both UV-A and UV-B rays on a daily basis [4]. 

Laser treatment can be done to treat enlarged or dilated blood vessels or remove surplus nose tissue in cases of rhinophyma.

Cosmetic change of rhinophyma can be done by various techniques like mechanical dermabrasion, carbon dioxide laser peel, and surgical shave.

The first line of treatment is generally topical metronidazole. Topical azelaic acid, sulfacetamide products, and topical acne medications are frequently used. Antibiotics are also very effective in both ways i.e. orally or topically, and for ocular rosacea, they are generally the first-line therapy. Some people also recommend using retinoids for treating rosacea [5] [6] [7].

Medicines that help in reducing the flushing like beta-blockers, clonidine, naloxone, ondansetron, and selective serotonin reuptake inhibitors can also help in treating rosacea.

In some patients who complain of rosacea that worsens with their hormonal cycles, oral contraceptive therapy can be beneficial.
Dapsone is helpful for patients who cannot take isotretinoin [8] and is used in cases of severe refractory rosacea.

Development of rosacea is different for every individual, depending on various factors like genetics, skin sensitivity, skin complexion, amount of time spent in sunlight without sunscreen, intake of alcohol and spicy foods, and exposure to extreme temperatures. With the help of suitable treatment and avoidance of triggering factors, rosacea can be controlled.

The etiology of rosacea is unknown. Different aggravating factors leading to incidents of flushing and blushing play a role in developing rosacea.

Various factors like vasculature, climatic exposures, pilosebaceous systems abnormalities, dermal matrix degeneration, chemicals and consumed agents, microbial organisms, reactive oxygen species (ROS), increased neoangiogenesis, ferritin expression, and dysfunction of antimicrobial peptides (AMPs), may also lead to its development [1].

It primarily affects people of northwestern European descent. Although it affects both the sexes, women are three times more prone to it as compared to men. 30-60 years is the most vulnerable age to suffer from rosacea.

As the exact cause of rosacea is unknown, following are the theories that explain the development of this skin condition:

• Vasculature: High amount of blood flowing through the vessels of face and numerous blood vessels that are nearer to the facial surface might be the cause of redness and flushing related to rosacea.

• Climatic conditions: Harsh climatic conditions harm the cutaneous blood vessels along with the dermal connective tissue. Hence we know the reason why rosacea is prevalent on the face and flares up in spring due to the solar irradiation exposure.

• Dermal matrix degeneration: Rosacea leads to the damage of endothelium and deterioration of the dermal matrix.

• Chemicals and ingested agents: Spicy foods, alcohol, and hot beverages are generally considered as triggering factors for flushing in rosacea patients. Also, medications like amiodarone, topical steroids, nasal steroids, and increased dosage of vitamins B-6 and B-12, can also lead to flares in rosacea patients.

• Inflammation: An inflammatory infiltrate present in either perivascular or a perifollicular area or present in both the places may also lead to rosacea.

• Microbial organisms: Demodex species (mites generally seen human hair follicles) might lead to development of rosacea. Research suggests that Demodex has preference for rosacea afflicted areas of the skin like nose and cheeks [2].

• Ferritin expression: Iron acts as a catalyst in converting hydrogen peroxide to free radicals that cause injury to the tissues by destroying cell membranes, proteins, and DNA. Skin biopsy of the patients with rosacea when immunohistochemically analyzed, showed significant rise in number of ferritin-positive cells in diseased individuals in comparison to controlled individuals. Also, raised ferritin positivity correlated with more progressive subtypes of rosacea. Hence, marked release of free iron from proteolysis of ferritin can cause oxidative damage to the skin, which can also speed up the development of rosacea [3].

• Reactive oxygen species: In the beginning of an inflammatory process, the neutrophils release the reactive oxygen species (ROS), which are considered to play a vital role in the inflammation that is associated with rosacea.

Rosacea cannot be prevented but the symptoms can be controlled by knowing and avoiding the common triggering factors [9] [10] like hot drinks, exercise, alcohol, spicy foods, emotions, caffeine, sunlight, extreme heat or cold. These factors increase the blood flow and lead to dilation of small blood vessels of the facial skin. It is necessary to identify one’s own trigger factors and pay special attention towards avoiding them.

Rosacea is a common chronic skin condition characterized by symptoms of facial erythema (redness) and a wide range of clinical signs, like telangiectasia, roughness of skin, and an inflammatory papulopustular eruption looking like acne.

Age is no bar for rosacea affection. Rosacea can be divided into four types, of which three affect the skin and the last one affects the eyes.

Rosacea is a chronic inflammatory skin disease manifested as widespread redness and red boils generally over the forehead, cheeks, and nose. It is commonly seen in females of the reproductive age group and is easily diagnosed just by seeing.

As there is no way of preventing rosacea, measures can be taken to reduce the symptoms and their frequency of development. The first and foremost step is avoiding the triggering factors. Then comes, taking care of the skin in general by cleansing and moisturizing your face regularly. Prefer facial products that do not burn, sting, irritate or cause redness when use. One must develop a habit of washing face with lukewarm water and a mild soap.

One must avoid alcohol and acetone based products like toners, scrubs, etc. as they tend to dehydrate the skin. Hydroxy acids and tretinoin like Retinon A have good chances of sensitizing your skin to sun and thereby worsening rosacea. Patients must make it a norm to use broad spectrum sunscreens and sun blockers daily and generously for protecting your face [4]. Use sunscreens that have SPF factor of 30 or more.

During winter patients must take extra care of face by using a scarf or ski mask to protect it. In case one wants to use makeup, one can go for green-tinted foundation creams and powders as they are designed specially to prevent redness of the skin.

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2. Bonnar E, Eustace P, Powell FC. The Demodex mite population in rosacea. J Am Acad Dermatol. 1993 Mar;28(3):443-8.
3. Tisma VS, Basta-Juzbasic A, Jaganjac M, et al. Oxidative stress and ferritin expression in the skin of patients with rosacea. J Am Acad Dermatol. 2009 Feb;60(2):270-6.
4. Powell FC. Clinical practice. Rosacea. N Engl J Med. 2005 Feb 24;352(8):793-803.
5. Ceilley RI. Advances in the topical treatment of acne and rosacea. J Drugs Dermatol. 2004 Sep-Oct;3(5 Suppl):S12-22.
6. Ertl GA, Levine N, Kligman AM. A comparison of the efficacy of topical tretinoin and low-dose oral isotretinoin in rosacea. Arch Dermatol. 1994 Mar;130(3):319-24.
7. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. 2005 May;19(3):273-85.
8. Baldwin HE. Systemic therapy for rosacea. Skin Therapy Lett. 2007 Mar;12(2):1-5, 9.
9. Greaves MW, Burova E. Flushing: causes, investigation and clinical consequences. J Eur Acad Dermatol Venereol. 1997;8:91-100.
10. Higgins E, du Vivier A. Alcohol intake and other skin disorders. Clin Dermatol. 1999 Jul-Aug;17(4):437-41.