Rosacea

If you want to strike terror in someone’s eyes, tell them they have Rosacea. But what an unfair, bad rap that diagnosis has. Stay tuned and I’ll tell you how Rosacea’s bark is much worse than it’s bite.

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Rosacea is one of the few diagnoses in dermatology that has an awful social stigmas attached to it, bringing paralyzing fear and anxiety to people who think they have it. That probably is rooted in the infamous bulbous and distorted nose of W.C. Fields, the most famous Rosacea sufferer who had an exaggerated form of Rhinophyma, a rare complication of Rosacea. So rare that in 30 years I have only seen two patients with it.

So let’s get past the ungrounded fear and anxiety and explain the reality of Rosacea, which is almost a hybrid between acne and eczema… with the inflammatory red pimples and cysts of acne… and the skin sensitivity and inflammation of eczema… with disproportionate redness.

When you have the pimples and cysts, it’s called Acne Rosacea, but unlike regular acne, instead of the blemishes predilecting your T zone, in Acne Rosacea, they are mostly on your central face, on and around the nose, on the central part of the cheeks, and on the lower forehead.

When you have only the eczema part, the skin of the central two thirds of your face, or even the entire face, is pink or red with red blotches or red spider veins, or both… It feels sensitive… and can even be swollen or flakey. In severe cases the eyes and eyelids can be affected.

Rosacea tends to be more common in pale skinned people of Celtic, Northern or Eastern European background. It usually starts in your 30’s, 40’s or 50’s and is not seen in people with dark skinned. In people who have Rosacea, certain factors aggravate it. Some of the most important are unprotected sun exposure, alcohol consumption, stress, cold weather, exercise, many foods such as spices, hot beverages and dairy… and even certain skincare products.

While Rosacea can’t be “cured” it can definitely be controlled by oral and topical medicines and lifestyle modifications, all of which I’ll discuss in the DermTV episode on the treatment and control of rosacea.