The Red Face: The Rosacea Spectrum
Rosacea is an inflammatory skin condition affecting the most prominent sun-exposed areas of the face ( forehead, nose, cheeks, chin) . Rosacea is a chronic disorder that waxes and wanes and it is unclear why it happens to aging skin and( typical onset is ages 30 to 50 years of age and mostly in males). All skin types can suffer from rosacea but it is more easily diagnosed on lighter skinned individuals. There exists overlap between permanent sundamage and photoaging with rosacea. Common symptoms include facial redness, flushing, oiliness, and acne-like breakouts. In some, the skin inflammation leads to facial swelling, soreness, tenderness, itch, in addition to red, uncomfortable eyes ( ocular rosacea). Others are simply bothered by the disfiguring pimples and pustules, broken blood vessels and potential presence of large oil glands. Since there is a wide range of presentations of rosacea, confirming the diagnosis is key to successful treatment. While hot foods, caffeine, cheeses, wine, exercise and other things that lead to increased blood flow to face may exacerbate facial flushing, these things are not the causes of rosacea. Sun exposure also aggravates rosacea and good sunscreen use is a critical part of managing this condition.
Treatments are geared towards the clinical presentation and symptoms. Topical anti-inflammatories help address the disruption of inflammatory pathways that lead to redness, facial swelling, and acne-like pimples ( topical antibiotics, topical anti-parasitics, azelaic acid, sodium sulfacetamide/sulfur preparations). For ocular rosacea and more severe facial breakouts with pimples and pustules, oral tetracycline class anti-inflammatory antibiotics are the standard of care. If oiliness and large oil glands are prominent, topical or oral retinoids can help manage the disease. If the broken blood vessels is the only feature, the most effective intervention is to remove the blood vessels with various lasers. Again, there is no cure for rosacea, so broken blood vessels may return and must be retreated.
Other skin conditions, such as eczema, seborrheic dermatitis, and cutaneous lupus can also lead to a red face. Therefore, it is important to get an accurate diagnosis and that skin biopsies be obtained if there is no response to treatment or concerns about other disorders.