Rosacea Skin Disease - Not Your Ordinary Rosy Cheeks

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Could it be rosacea skin disease? Consistent rosy cheeks could be more than blushing. The skin rash on your face could be more than acne. It could be rosacea.

What is Rosacea?

It is a common chronic skin disease that causes inflammation and primarily affects the facial skin. One common onset sign of rosacea is rosy cheeks and nose. The redness can also extend to the chin and forehead.

At the onset of rosacea skin disease, you may not identify any difference of rosacea with acne or rosacea with eczema. Most patients have facial pimples that resemble acne. Although unrelated to acne, rosacea was once called acne rosacea, while other people would call it adult acne.

Interesting Facts About Rosacea

Rosacea is not a cosmetic condition but rather a medical one. One of the characteristics of the skin condition is vascular reactivity. Some enlarged and visible abnormal facial blood vessels are one physical sign of rosacea.

According to one review and meta-analysis on global rosacea prevalence, the average global population of adults affected is about 5 - 46 percent. This chronic skin disease affects about 14 million people in the US.

The average age of the most affected by rosacea is between 30 and 50. Women are more prone to rosacea compared to men. However, when rosacea occurs in men, it may develop lumps that would later form an enlarged rosacea nose, a type called rhinophyma.

One renowned actor and comedian of the old WC Fields (1880 - 1946) had a bulbous nose that became his trademark. The bulbous nose was a result of rosacea rhinophyma, probably triggered by his excessive alcohol drinking.

Rosacea is a skin disorder that profoundly affects fair-skinned people, such as the Scottish and English descents. It is most prevalent with the Celtic that they dubbed it as the 'curse of the Celts.'

Rosacea can affect anyone without any discrimination. It is difficult to identify the early onset symptoms of rosacea black skin due to skin pigmentation.

Skin flushing and dilated blood vessels may not be visible on colored skin. In the recent past, there was an assumption that the condition did not affect such skin types. Limited information on rosacea symptoms in patients with skin of color has, in most cases, led to under-treatment.

You can easily mistake rosacea to be acne or sunburn in the four stages of rosacea symptoms. For easy diagnosis, you must fill your doctor with precise details on how you feel and your family history.

Research is ongoing to ascertain the etiology or the cause of rosacea and how to get rid of rosacea permanently by curing it.

One of the challenges in diagnosing and treating rosacea is how it manifests into different types.

Rosacea has four different subtypes, and hence the symptoms vary. Each type has different symptoms making it easy for the doctors to differentiate the types when diagnosing. Some rosacea patients have multiple types of rosacea at the same time.

Types of Rosacea

The following are the four types of rosacea and their symptoms:

Erythematotelangiectatic Rosacea (ETR). ETR is a rosacea type that primarily features noticeably broken blood vessels (telangiectasias).

Other signs or symptoms of erythematotelangiectatic rosacea are rosy cheeks or flushing, facial skin redness (erythema), swollen, burning-stinging, and sensitive facial skin. Also, the skin can be scaly and rough due to dryness.

Papulopustular Rosacea (PPR) or Acne Rosacea. PPR is more common to women in their middle age. It resembles acne breakouts. The typical features or symptoms of papulopustular rosacea are pinpoint pustules, papular rash, and facial redness. Skin swelling can often accompany the PPR skin rash.

Rhinophyma or Phymatous. Rhinophyma or phymatous is a type that predominantly affects men. It is a disfiguring type that progresses to affect the sebaceous glands and the skin's connective tissue.

The symptoms of rhinophyma are unique. The phymatous signs would primarily feature thick skin that forms a bumpy texture. It mainly affects the nose, which often results in an enlarged 'rhino' nose and hence the name rhinophyma.

Rhinophyma is a severe and an end-stage of rosacea. It can cause disfigurements such as a large nose, severe papules, or skin lesions accompanied by discharging pustules.

Ocular Rosacea. Ocular rosacea is a type that affects the eyes. Sometimes ocular rosacea can precede other skin symptoms or develop both at the same time.

Some of the ocular rosacea symptoms are eye-stinging, light sensitivity, irritation, dryness, and sensation like a foreign object in the eye, eyes redness, swollen, and inflamed eyelids, or rosacea blepharitis.

Rosacea is a progressive skin disease that develops in stages.

Four Stages of Rosacea

There are four rosacea stages as the disease progresses. These are:

First Stage - Mild Rosacea. In this early stage of rosacea, you may experience intermittent redness on the cheeks, forehead, nose, or the chin. The red part of the skin may feel raw with a burning sensation, especially when applying some lotions or alcohol-based makeup.

At this stage, rosacea can go unnoticed in many patients due to skin color, or it may be confused with blushing or sunburn.

In rare cases, eye irritation may occur during the first stage of rosacea. Other patients may get it during the second or even the third stage.

Second Stage - Moderate Rosacea. From the mild stage, the skin condition may progress to the moderate stage when you fail to seek urgent treatment or ignore the early stage signs.

The facial redness intensifies, and the skin becomes more sensitive with burning or stinging sensation. Rough, scaly, and dry skin may follow skin sensation. At this stage, you may also experience visible small blood vessels on the cheeks and nose (telangiectasias).

Third Stage - Severe Rosacea. The facial skin color becomes deep red as the skin disease progresses to the advanced stage. The blood vessels increase in number to appear as some red lines on the facial skin.

Also, the skin develops painful skin bumps due to inflammation. At this stage, your face may look swollen due to multitudes of bumpy papules and discharging pustules.

Fourth Stage - Rhinophyma Rosacea. The main feature of the much-advanced stage of rosacea is a swollen and bumpy red nose. The rosacea nose enlarges to earn its name, rhinophyma. The disease spares most women of such facial disfigurement of a bumpy swollen nose. Rhinophyma is, therefore, rare in women and common in men.

Rosacea doesn't have to progress through all the stages. What is the reason for rosacea to progress from stage to stage? Rosacea triggers are the primary contributors to the progression of skin disease.

You can prevent the rosacea symptoms from developing into other stages by seeking medical expertise for treatment. Once you observe and adhere to your treatment disciplines, you can stop or reverse the rosacea effects.

Rosacea Triggers

One of the methods your dermatologist may require you to observe is recognizing and avoiding your rosacea triggers. Your doctor can help you identify situations or substances that trigger your face to flush.

According to the National Rosacea Society, the list of such triggers varies with each case. The most common triggers are:

From the above graph illustration, you can see that sun exposure is the primary rosacea trigger followed by emotional stress.

Now that you know some of the rosacea triggers, you may be wondering what the cause of rosacea skin condition is.

Rosacea Causes

It may not be clear what causes rosacea. Unless researchers discover the real cause of rosacea, we'll be left to assume yet unconfirmed reasons for rosacea skin disease onset.

Rosacea is not a hygiene case as many people may wrongly think; it is a skin condition typically associated with some environmental and hereditary factors.

Rosacea Risk Factors

According to the National Rosacea Society, some potential risk factors discovered and still undergoing more research are:

Innate Immune System. While trying to protect your skin from pathogens like bacteria, some innate immune system molecules may cause rosacea symptoms. Some of such symptoms are pimples and bumps through inflammation. Others are vascular defects such as the visible blood vessels and flushing.

Demodex Mites. Normal skin is a habitat of healthy human microbiomes, such as Demodex mites. A balanced number of Demodex mites live in the hair follicles and sebaceous glands of the skin.

However, under abnormal circumstances, these microorganisms can increase beyond the required healthy number. Researchers have noted that people with rosacea have an overabundance of these microorganisms.

The enlarged number would be associated with bacteria that can cause inflammation or trigger an immune response. Such a response would then cause pimples and skin bumps.

Neurovascular System. According to one documented study, the nervous system links with the vascular system to make one system, neurovascular, which is a cause of rosacea symptoms.

Some common triggers of rosacea, such as UV radiation exposure, alcohol, spicy food, and skin cosmetics irritants, may stimulate the neurovascular system to react. Rosacea symptoms such as swelling and redness would be the reaction to the neurovascular system response.

Hereditary. Some studies link genetics to rosacea and suggest that anyone from a rosacea family history has a high chance of having rosacea compared to those without. The genetic factors shared in the family are some of the high risks of rosacea skin condition.

Drs. Meg and Daniel are two researchers from Case Western Reserve University, who discovered a possible link of genes in one study of twins who had rosacea. The findings were that identical twins are most likely to share rosacea genetically compared to non-identical or fraternal twins.

Environmental Factors. Some environmental factors are both rosacea risks and symptoms triggers. Exposure to the sun UV radiation is a common ecological factor for rosacea. Extended exposure to UV radiation can lead to oxidative stress, which can harm the skin cells.

Other environmental factors that can aggravate rosacea symptoms are wind and humidity.

Is Rosacea Preventable?

You might be curious to know how you can prevent rosacea and especially if you are at a high risk of the onset.

Rosacea is a mysterious disease that scientists know little about. For instance, it is not yet clear what causes the disease and how to cure it. How to prevent rosacea is also a mystery.

However, you can control and prevent rosacea by avoiding the risk as mentioned earlier factors and especially if you are at a high risk of rosacea onset. You can also control existing rosacea from remitting once treated if you identify the triggers of your skin condition flares.

An untreated and long-lasting rosacea can lead to other health complications.

What are Rosacea Complications? 

Rhinophyma. Failing to have your rosacea skin condition treated and inhibit progression, can worsen the disease. Over time, you may start to experience changes in your nose's shape and the skin texture of your cheeks.

The sebaceous glands, the oil glands of your skin, can then enlarge to cause skin tissue buildup on your cheeks and around your nose. Your cheeks become bumpy, and your nose grows with uneven skin texture. Rhinophyma is the complication and the worst stage of rosacea.

Rhinophyma is more prevalent in men than in women. It may take years of rosacea progression to get to the rhinophyma stage.

Conjunctivitis. As we had mentioned earlier, ocular rosacea is a type of rosacea that affects the eyes. It causes inflammation, light sensitivity, irritation, burning or stinging. Inflammation of conjunctiva (the transparent membrane of the eye) which can then lead to conjunctivitis.

Early diagnosis and treatment of rosacea could inhibit such complications.

How to Diagnosis of Rosacea

Diagnosing rosacea is not complicated, like many other skin diseases. Your dermatologist would first require to know your history to determine the origin of the skin disease. The doctor may ask you about your working environment and your family history of skin disease.

You may need to answer a series of questions for your dermatologist to learn more about your background and other risk factors involved in your condition.

Your physical appearance is another way to diagnose rosacea. Your doctor would then examine the condition of your skin and eyes.

Lastly, your doctor may take you through some tests of other similar skin conditions such as eczema, acne, lupus, and psoriasis to rule them out.

If your doctor confirms that it is rosacea, you are taken through some rosacea treatment options and their procedures. Such standard rosacea treatments would not cure the disease but would:

  • Inhibit rosacea from progressing
  • Eliminate or reduce rosacea symptoms
  • Correct disfigured areas

Rosacea Treatment

Treatment of rosacea skin condition would vary with individuals and the symptoms. Your doctor may opt for any of the following best rosacea treatments depending on your symptoms.

Medication Topical Medicines. To treat redness, your doctor may prescribe brimonidine or oxymetazoline to constrict blood vessels for up to twelve hours.

The effect of this treatment is quick, but it is temporal, and therefore you need to continue using this topical treatment to maintain the results.

For moderate rosacea, your doctor may prescribe some topical medicines such as metronidazole, azelaic acid (containing dicarboxylic acid), and ivermectin or sodium sulfacetamide.

This regimen is for the treatment of papules and pustules. You may not notice any changes until about one month of continuous topical treatment.

Ivermectin is also useful in treating Demodex mites in the moderate rosacea. It is a twice-a-day application of up to four months or longer if necessary.

Topical metronidazole rosacea cream or gel is useful in the treatment of pimples.

Oral Medicines. Doxycycline, tetracycline, minocycline, erythromycin, clindamycin, and clarithromycin are some of the antimicrobial antibiotics, especially for papulopustular rosacea (PPR) or acne rosacea. This regimen is effective in PPR rosacea, mainly due to its anti-inflammatory properties.

The prescription for oral antibiotics is for a short time to support topical therapies in improving and controlling rosacea while suppressing flares.

A low dose of oral isotretinoin is useful in treating papulopustular rosacea and phymatous rosacea, two of the difficult to treat rosacea types.

Laser Resurfacing CO2 Laser. Ablative laser is a CO2 laser treatment useful in removing the disfigured outer skin layer. It uses ultra-pulse light energy to remove the affected skin layer. This laser treatment helps to treat dilated blood vessels, lumpy skin, and rhinophyma disfigurement.

Such therapy aims to sculpt and reshape the disfigured areas by debulking the excess tissue. This type of surgery involves wounding and treating the preferred skin areas but with less bleeding.

The laser therapy removes the outer disfigured skin layer, then heats the dermis or the underlying skin layer to stimulate new collagen fibers growth. The outer layer then regrows with a smoother and tighter appearance.

Pulsed-dye Laser (PDL). There are three main types of pulsed-dye lasers, which are V-star, V-beam, and Cynosure. This laser treatment uses a pulsed light beam of the required wavelength. The dye is for changing the visible blood vessels and the redness of the vascular lesions.

Light Therapy Intense Pulsed Light. This type of surgery uses several light wavelengths all at once. It is useful in correcting redness or any pigmentation defects to even skin tone.

Traditional Surgery. Loop electrosurgical excision and scalpel are the primary tools for regular surgery. Conventional therapy with surgical shave technique is more challenging compared to laser treatment. However, it is another way of reshaping the rhinophyma nose by removing the excess tissue.

Ophthalmological Treatment. For ocular rosacea, your ophthalmologist may prescribe oral tetracycline with lid care and artificial tears. For moderate or severe ocular rosacea, Ciclosporin drops can be the optional therapy.

Maintaining eye health, especially for ocular rosacea, is optimal for managing and inhibiting other eye infections.

Rosacea Disease Complementary and Alternative Therapy

There are various alternative treatments for rosacea health issues. However, you may require consulting your health practitioner for the best therapy and advice. The following are some of the recommendations from our natural health practitioner, Yvonne Dollar Perc.

We do Live Blood Analysis and look at dry blood samples specifically.

Skin Challenge Pattern:

Observed in Layer(s):

The edge of the sample appears as a double coastline of small beads. This may relate to skin challenges and usually implies a deficiency of vitamin C and sulphur-based amino acids.

The following are our recommendations for rosacea. 

Milk Thistle (60 Caps) - Milk thistle is used in Herbal Medicine to help support liver function and relieve digestive disturbances/dyspepsia. Milk thistle is used as a hepatoprotectant/liver protectant. Milk thistle is one of the most commonly used herbs for a range of digestive disturbances and liver complaints.

Rejuvenaid, 30 Packets - Source of antioxidants that help fight against cell damage caused by free radicals. Helps in energy metabolism and tissue formation. Helps in the normal function of the immune system. Helps to support immune function. Helps support and maintain a healthy digestive system. L-Arginine (a non-essential amino acid) is involved in protein synthesis.

Zambroza with Acai And Pomegranate (458 ml) - Nature's Sunshine Zambroza is a combination of 14 of the most recognized healthful fruits and extracts gathered from around the world. Zambroza's ingredients are rich in bioflavonoids, polyphenols and antioxidants. Zambroza has been independently tested by Newbrunswick Laboratories to deliver a high ORAC (Oxygen Radical Absorbance Capacity) value. Among Zambroza's key ingredients is mangosteen, a fruit found in eastern tropical countries, such as Thailand. Mangosteen fruit and its pericarp (peel) contain the greatest known supply of highly-researched, polyphenolic compounds called xanthones. Other ingredients of note are açai berry, pomegranate, blueberry, and wolfberry (goji berry). Conclusion

Rosacea is a severe skin condition few people know very little about. Such ignorance of the disease leads to late treatment or misdiagnosing and hence wrong treatment. It can then cause other severe complications such as rhinophyma or conjunctivitis.

The skin disease can also alter your life to cause distress in relationships, either socially, at home, or even at work.

It might comfort you to know that while conventional or standard treatment has no cure for rosacea, you can reverse it using natural therapies.

Do you want to know what the best natural remedy for rosacea? You can ask Yvonne, the Master Herbalist and Natural Health Practitioner at Island Healthworks Natural Clinic.

Please book for your consultation today by visiting our Island Healthworks Natural Clinic or through on-telephone consultation by calling our telephone number +250-468-7685. You can also use our email This email address is being protected from spambots. You need JavaScript enabled to view it. for help on any of your health concerns.

Was the information on rosacea skin disease helpful? You can share it with anyone you think might benefit from it.

Would you like to know more about other skin diseases, additional health information, or our reliable, high-quality natural health products? Open our Island Healthworks website to find everything you need concerning your health and much more.

Please leave us your comments or add on what you know about rosacea for anyone going through it.

Your health is our concern. Be sure to watch for more skin disease articles in our series on skin issues.

"Glowing skin is the result of proper skincare. It means you can wear less makeup and let skin shine through." - Michael Coulombe


Yvonne Dollard Perc: Owner of Island Healthworks, Natural Health Practitioner, Teacher, Writer and Editor.
Elizabeth Njuguna: Researcher, Freelance Writer, with a Focus on Natural Health.
Sherry Robb: Print, Web and Social Media Designer Specializing in the Natural Health and Fitness Industries.

Island Healthworks offers in-person and virtual consultations for assessment of your specific needs, with health & lifestyle coaching, featuring the best of integrative natural health care. To book your consultation, please call 250-468-7685!

This article is intended for educational purposes and the information contained within is not intended to treat, diagnose or cure any disease or health problem. Please seek appropriate medical attention for any health complaints. We cannot take responsibility for your health care decisions. Our intent is only to offer health information to help you with your search for better health. 

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Thursday, 22 October 2020