Follicle Disorders

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Overview

Rosacea is a disorder of the follicles and surrounding skin that usually occurs on the forehead, nose, and chin. It involves reddening, acnelike lesions, and broken blood vessels. Rosacea improves and worsens in unpredictable cycles. The exact cause is unknown.

Causes and Risk Factors

Although rosacea can appear at any age, it is most prevalent between 30 and 60 years old. It occurs about equally in men and women, although severe cases are more common in men. Rosacea seems to have a genetic component. Individuals whose family members have rosacea have a higher incidence of the disorder.

Emotional and physical stress, windy conditions, heat, and sun exposure can exacerbate rosacea. Dietary triggers include dairy products, certain spices, hot liquids, and alcohol.

Some people with stomach ulcers are prone to develop rosacea. The cause of a high percentage of stomach ulcers is infection with the bacterium Heliobacter pylori (H. pylori). While studies are still inconclusive, eradication of H. pylori in ulcer patients can lead to improvement in rosacea. There is increasing evidence that this bacterium causes a variety of systemic disorders. However, rosacea appears without H. pylori and vice versa.

Signs and Symptoms

Doctors usually diagnose rosacea by observing the appearance of the skin. Not all redness, flushing, and blushing is caused by rosacea. However, redness that takes a long time to clear up, or never clears up, often indicates rosacea.

Acne pustules sometimes develop with this condition; however, blackheads are not a hallmark. Bacterial infections can contribute to inflammation. As the disorder progresses, the patient's facial skin exhibits broken blood vessels. A rare symptom is rhinophyma, a thick, leathery texture of the nose skin. The eyes can be affected with irritation and increased light sensitivity.

Treatment

There is no cure for rosacea; however, treatment may minimize symptoms. When inflammation and pustules develop, the doctor may prescribe topical or oral antibiotics. Mild acids that peel surface skin layers can help promote normal skin growth. Topical vitamin K can reduce the appearance of surface vessels, which lessens the reddening.

Metronidazole (MetroGel®) is a prescription medication that is applied topically once a day to treat rosacea. Side effects include skin irritation (e.g., burning, dryness, redness), tingling or numbness in the arms and legs, nausea, and a metallic taste in the mouth.

In severe cases, the dermatologist may treat the blood vessels in one of two ways: (1) by injecting a concentrated saltwater (saline) solution into the vessels to close them; or (2) by using a laser or cautery to seal broken vessels and prevent blood flow to the surface.

Prevention

If people predisposed to rosacea, preventive steps involve managing the environmental and dietary triggers related to the disorder. The use of sunscreen minimizes the effects of sun exposure. Staying indoors and using air conditioning during hot, humid weather reduces the heat component. An individual whose rosacea is triggered by dairy products, alcohol, or certain spices should restrict their intake or eliminate them from the diet.

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