All pimples are not the same: Rosacea is a disease without a known cause or cure

Rosacea starts with reddened facial skin, progresses to fine red lines and inflammation, then pus-filled bumps and finally enlargement of the tiny blood vessels that supply blood to the cheeks and nose.

Myupchar August 21, 2019 19:54:09 IST
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All pimples are not the same: Rosacea is a disease without a known cause or cure
  • A chronic skin disease called rosacea manifests itself in the form of reddened facial skin

  • It later progresses to fine red lines and inflammation and graduates into pus-filled bumps

  • Finally, it leads to the enlargement of the tiny blood vessels that supply blood to the cheeks and nose

What do the late Princess Diana, former US president Bill Clinton and the 17th-century Dutch painter Rembrandt have in common? The answer is extra rosy cheeks that are symptomatic of a chronic skin disease called rosacea.

Rosacea starts with reddened facial skin (erythema), progresses to fine red lines (telangiectasia) and inflammation, then pus-filled bumps and finally enlargement of the tiny blood vessels that supply blood to the cheeks and nose. Research is now shining the light on how rosacea may be underreported and under-treated in darker-skinned people who may have delayed or less obvious symptoms.

All pimples are not the same Rosacea is a disease without a known cause or cure

Princess Diana. Reuters

This year, researchers led by New York-based Andrew F. Alexis wrote: “Skin characteristics of rosacea in a patient with skin of colour, outside of readily visible erythema or telangiectasia, might include dry appearance, oedema, and hyperpigmentation.” Their research appeared in an article titled 'Global epidemiology and clinical spectrum of rosacea, highlighting skin of colour: Review and clinical practice experience' in the June issue of the Journal of the American Academy of Dermatology.

Rosacea in India

Epidemiological studies show that traditionally, the Swedes had the highest prevalence of rosacea (10%),  followed by the Americans (approximately 5%) and then the French and Germans (2-3%). This is rapidly changing, though, as inter-racial marriages and migration lead to more mixed populations. Rosacea is now one of the emerging skin diseases among the Indian population, too - 15-40% of patients have a family history of rosacea.

The exact cause of the disease is unknown. Doctors argue that a number of things can trigger the condition, from abnormalities in blood vessels to stress and a reaction against microscopic mites on the face.

Though the exact mechanism how rosacea occurs and spreads is also unknown, some researchers link it back to dysregulation in the innate (by birth) immune system, overgrowth of commensal skin organisms or aberrant neurovascular signalling to the facial skin. All of these collectively, they feel, may lead to the manifestation of the clinical symptoms.

Telltale signs

HarvardHealth, a magazine published by the Harvard Medical School, described the clinical symptoms of rosacea in four stages: First, flushing and intermittent facial redness. Second, persistent redness on the cheeks, nose, chin or forehead. Third, small red bumps or pus-filled bumps along with red lines and patterns on the face - telangiectasias. In the fourth and final stage, bumps and phymatous rosacea on the nose.

It’s easy to mistake rosacea for sunburn or acne through most of these stages. Your doctor will make a diagnosis based on your symptoms as well as detailed family medical history - so be sure to fill them in on it.

What next?

Researchers are investigating a possible link between caffeine and preventing rosacea. 'Association of Caffeine Intake and Caffeinated Coffee Consumption With Risk of Incident Rosacea in Women', an article published in December 2018 in the peer-reviewed journal JAMA Dermatol, concludes that caffeine intake is inversely proportional to occurrence of rosacea. However, there is a need for more research to claim the result.

For now, doctors say that if you have rosacea, it’s best to avoid the things that trigger or exacerbate your condition - sunlight, hot drinks, alcohol and spicy food have all been identified as rosacea triggers in different patients. They increase blood flow and aggravate the disease. Moisturising the skin and applying sunscreen might help to a certain extent.

On the surface

Though there’s no cure for rosacea, topical ointments like Brimonidine or oxymetazoline can constrict the facial blood vessels and reduce redness. Topical antibiotics like metronidazole and tetracycline can also yield results; please consult your doctor, none of these are without side-effects. In 2003, the U.S. Food and Drug Administration (FDA) had approved azelaic acid - a gel containing dicarboxylic acid - to be used on inflammatory pimples of mild to moderate rosacea. Doctors have also attempted newer treatments like laser therapy, to constrict the blood vessels or to remove excess nose tissue.

Alternatively, surgical shave techniques or dermabrasion can also provide surface relief, by removing excess nose tissue.

Anxiety and embarrassment

In 2016, Dr Carsten Sauer Mikkelsen et al published an article in the Dermatology Reports journal. In it, they quantified the psychological and mental health toll on rosacea patients - while 77% of patients are affected emotionally, 63% are affected at work, 67% are affected socially, and 53% are affected in their relationships and dating behaviour. Patients can experience anxiety, embarrassment and low self-esteem, the report said.

The situation is often worse in places like India, where few people have the disease and fewer still know about it.

In 2004, Mumbai-based Homai Baria wrote to the Rosacea Review (published in Illinois, U.S., by the National Rosacea Society), saying that she had stopped going to parties after being diagnosed with rosacea. Often, she wrote, people who didn’t know about rosacea made insensitive remarks.

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