A Red Face Can Mean Rosacea

Posted on Wed., Feb. 3, 2010
By Dr. John Lee

ROSACEA (ro-ZAY-shuh) IS BLUSHING run wild. The condition tends to run in families, and is most common in fair-skinned Scots-Irish (Celtic) people. But it can affect those with olive-colored skin as well.

Rosacea usually first appears during middle-age (30-60) simply as rosy cheeks, the result of dilated blood vessels (tiny tubes that carry the blood).

As the condition progresses, the blood vessels become fixed in the open position and may lead to red bumps (enlarged oil glands) and even pimples. Rosacea is sometimes called adult acne.

Some patients complain of burning or stinging sensations. Ultimately, this may lead to scar tissue, which can create the classic bulbous W.C. Fields nose, called rhynophyma.

Half of people with rosacea report some eye irritation as well. The eye symptoms may precede the skin changes, which can make the eye problem difficult to diagnose. These changes are often so gradual that they escape notice.

Delaying treatment of eye rosacea may lead to permanent eye changes and serious eye problems. Sometimes, rosacea appears intermittently in flares, which only require temporary treatment.

The cause of rosacea is unknown. Hair follicle mites or germs in the intestines may play a role, but evidence for both these possible causes so far is weak. The immune system might contribute, but how this works is unknown.

What we do know is anything that causes blood vessels to dilate can worsen the condition. These are called "triggers:"

Hot soups or beverages
Spicy foods
Alcohol (does not cause rosacea, but can make it worse)
Overheating from either weather or exercise
Sun (sunscreens are part of treatment)
Wind
Blushing in the easily embarrassed.

Lupus is a different disease that can cause a facial rash worsened by the sun. A blood test can help differentiate it from rosacea.

Also, prolonged use of strong corticosteroid creams on the face may cause redness similar to rosacea. Simply stopping the cream helps.

If rosacea reaches the bumpy, pimply phase, then antibiotic creams, like metronidazole (Metrogel) and antibiotic pills like Tetracycline or Doxycycline may help. They do not cure the condition, but can help control it.

Treating simple redness is more difficult. The use of mild, nonabrasive cleansers (like Cetaphil and Dove) can help. But avoiding the precipitating factors listed above remains the most important measure.

In more severe, resistant cases, Retin-A, a cream used for teenage acne and other skin conditions, can help. If the rosacea persists, Accutane, a powerful pill used for severe acne, can also help. The eye symptoms usually require oral antibiotics.

Cosmetic problems can result when the permanently dilated blood vessels expand into visible red lines called telangectasias. They can be treated with electrical destruction, dermabrasion or laser by your doctor. Often just covering the redness with green-tinted makeup is the most cost-effective solution.

So, if you have rosacea, you should:

Learn and avoid your rosacea triggers.
Apply sunscreen of 15 SPF or higher to your face daily.
Avoid touching, rubbing or scratching your face.
Gently wash your eyes and eyelids with an eyewash solution made for this purpose.
Consult your doctor for any facial redness that persists more than six weeks.

Lee practices family medicine and dermatology at the Contra Costa Regional Medical Center in Martinez.