Treatment pales rosacea's red face - skin disorder

FDA Consumer, April, 1994 by Margie Patlak

When she was a teenager and her friends were bemoaning the whiteheads and blackheads erupting on their faces, Marcia Meyer of Kensington, Md., had a clear, ruddy complexion. She was surprised, then, when her face broke out in pimples for the first time when she was in her 20s. Feeling she was "too old for this," Meyer says, and upset over her appearance, she went to see her dermatologist, who told her she had a skin disorder known as rosacea.

Although few people are familiar with the disease, rosacea is a common skin disorder that afflicts about 1 in 20 people in this country, estimates dermatologist and rosacea expert Jonathan Wilkin, M.D., of Ohio State University in Columbus. Despite its prevalence, many people with the condition go undiagnosed, he says.

Wilkin has seen patients who seek care for other skin disorders and don't realize they have rosacea until he points it out to them. "Most people with rosacea are surprised to hear it's something the medical field can help them with," he says, "because they think it's just a complexion problem that runs in their family."

The disorder can be effectively curbed with various drugs, laser treatments, and surgery, including products regulated by the Food and Drug Administration, as well as by preventive measures. Without proper care, in contrast, rosacea may progress to a more disfiguring condition.

Although it can occur among adults of any age and of any skin color, rosacea is more prevalent among fair-skinned people between the ages of 30 and 50. The disease is more common in women, but more severe when it strikes men. People who flush easily are more prone to rosacea, as are people with peaches-and-cream complexions, including many with Irish, English, or Eastern European ancestry, a survey by the National Rosacea Society suggests. The tendency towards rosacea appears to be inherited; often several people in a family have the condition.

Red Mask

Rosacea usually begins with frequent flushing of the face, particularly of the nose and cheeks, although sometimes the redness spreads to the chin and forehead as well. The flushing is caused by swelling of the blood vessels under the skin of the face and can last as little as a few minutes to as long as a few hours. In most cases, however, eventually the blood vessels stay dilated and a sunburn-like redness becomes a permanent feature on the central areas of the face.

This red mask can serve as a red flag for attention. Meyer notes that people tend to tease her about being out in the sun too much. "I'm probably the only person who uses makeup to tone down her face, rather than the reverse," she says.

Once the redness becomes permanent, it often is accompanied by pus-filled or solid md pimples. There are no blackheads or whiteheads with rosacea, and the pimples are usually limited to the central portion of the face. Thin md lines that resemble a road map also tend to surface. These lines are actually small blood vessels in the upper layers of the skin that have become enlarged. If rosacea is not treated, a condition called rhinophyma can develop in some people. Rhinophyma occurs much more frequently in males than in females. The hallmark of rhinophyma is a big bulbous red nose like the one sported by the late comedian W.C. Fields, who had rosacea with rhinophyma. The nose can also become thicker at the base.

This disfiguring condition "has never killed anyone," notes Wilkin, "but it has mined a lot of lives."

Rosacea can also cause a persistent burning and grittiness of the eyes or inflamed and swollen eyelids. In severe cases, vision may become impaired.

Waxing and Waning

Rosacea is a chronic ailment that waxes and wanes. Between flare-ups, some people have no signs of the disorder. But other people still have facial redness or red lines, accompanied by pimples during flare-ups.

Dermatologists usually diagnose rosacea by its symptoms; no tests are available, but on rare occasions skin biopsies can pinpoint the condition. Few people with rosacea have all the symptoms of the disorder, which can make it tricky to diagnose at times, Wilkin admits. He strongly suspects rosacea in people with just a few symptoms of the disorder if other people in their family have the condition.

There is also a condition known as steroid-induced rosacea, which occurs in some people after applying corticosteroid ointments to their face for a long period to treat eczema or other rashes. The onset of this condition is sudden. The same telltale redness, pimples, and thin, wavy red lines appear on the face as in standard rosacea, but people with steroid-induced rosacea usually have these symptoms wherever the steroid ointment was applied--up to the hairiine--and not just centrally located on the face, for example. People with steroid-induced rosacea also often have a distinctive shine to their facial skin.

Steroid-induced rosacea is treated first by stopping the steroid and then by taking the same medications as with standard rosacea. Although it can take several months of treatment before symptoms subside, steroid-induced rosacea is not likely to recur unless corticosteroids are applied again on the face. Less commonly, oral or inhaled corticosteroids can also induce rosacea.