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Classification and external resources

An Old Man and His Grandson, by Domenico Ghirlandaio shows skin damage from end-stage rosacea[1]
ICD-10 L71.
ICD-9 695.3
DiseasesDB 96
MedlinePlus 000879
eMedicine derm/377
MeSH D012393

Rosacea (pronounced /roʊˈzeɪʃɪə/) is a chronic condition characterized by facial erythema (redness).[2] Pimples are sometimes included as part of the definition.[3] Unless it affects the eyes, it is typically a harmless cosmetic condition. Treatment, if wanted, usually involves topical medications to reduce inflammation.

It primarily affects Caucasians of mainly northwestern European descent and has been nicknamed the 'curse of the Celts' by some in Britain and Ireland, but can also affect people of other ethnicities. Rosacea affects both sexes, but is almost three times more common in women. It has a peak age of onset between 30 and 60.

Rosacea typically begins as redness on the central face across the cheeks, nose, or forehead, but can also less commonly affect the neck, chest, ears, and scalp.[4] In some cases, additional symptoms, such as semi-permanent redness, telangiectasia (dilation of superficial blood vessels on the face), red domed papules (small bumps) and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red lobulated nose (rhinophyma), may develop.


Types of rosacea


There are four identified rosacea subtypes[5] and patients may have more than one subtype present[6]:176:

  1. Erythematotelangiectatic rosacea: Permanent redness (erythema) with a tendency to flush and blush easily. It is also common to have small blood vessels visible near the surface of the skin (telangiectasias) and possibly burning or itching sensations.[citation needed]
  2. Papulopustular rosacea: Some permanent redness with red bumps (papules) with some pus filled (pustules) (which typically last 1–4 days); this subtype can be easily confused with acne.
  3. Phymatous rosacea: This subtype is most commonly associated with rhinophyma, an enlargement of the nose. Symptoms include thickening skin, irregular surface nodularities, and enlargement. Phymatous rosacea can also affect the chin (gnatophyma), forehead (metophyma), cheeks, eyelids (blepharophyma), and ears (otophyma).[7] Small blood vessels visible near the surface of the skin (telangiectasias) may be present.
  4. Ocular rosacea: Red, dry and irritated eyes and eyelids. Some other symptoms include foreign body sensations, itching and burning.

Variants of rosacea

There are a number of variants of rosacea including:[8]:689




Richard L. Gallo and colleagues recently noticed that patients with rosacea had elevated levels of the peptide cathelicidin[9] and elevated levels of stratum corneum tryptic enzymes (SCTEs). Antibiotics have been used in the past to treat rosacea but they may only work because they inhibit some SCTEs.[10]

Intestinal bacteria

Intestinal bacteria may play a role in causing the disease. A recent study subjected patients to a hydrogen breath test to detect the occurrence of small intestinal bacterial overgrowth (SIBO). It was found that significantly more patients were hydrogen-positive than controls indicating the presence of bacterial overgrowth (47% v. 5%, p<0.001).

Hydrogen-positive patients were then given a 10-day course of rifaximin, a non-absorbable antibiotic that does not leave the digestive tract and therefore does not enter the circulation or reach the skin. 96% of patients experienced a complete remission of rosacea symptoms that lasted at least 9 months. These patients were also negative when retested for bacterial overgrowth. In the 4% of patients that experienced relapse, it was found that bacterial overgrowth had returned. These patients were given a second course of rifaximin which again cleared rosacea symptoms and normalized hydrogen excretion.[11]

In another study, it was found that some rosacea patients that tested hydrogen-negative, were still positive for bacterial overgrowth when using a methane breath test instead. These patients showed little improvement with rifaximin, as found in the previous study, but experienced clearance of rosacea symptoms and normalization of methane excretion following administration of the antibiotic metronidazole, which is effective at targeting methanogenic intestinal bacteria.[12]

These results suggest that optimal antibiotic therapy may vary between patients and that diverse species of intestinal bacteria appear to be capable of mediating rosacea symptoms.

Demodex mites

Studies of rosacea and demodex mites have revealed that some people with Rosacea have increased numbers of the mite, especially those with steroid induced rosacea.[13] When large numbers are present they may play a role along with other triggers. On other occasions Demodicidosis (Mange) is a separate condition that may have "rosacea-like" appearances.[14]

Other causes

Triggers that cause episodes of flushing and blushing play a part in the development of rosacea. Exposure to temperature extremes can cause the face to become flushed as well as strenuous exercise, heat from sunlight, severe sunburn, stress, anxiety, cold wind, and moving to a warm or hot environment from a cold one such as heated shops and offices during the winter. There are also some food and drinks that can trigger flushing, including alcohol, food and beverages containing caffeine (especially, hot tea and coffee), foods high in histamines and spicy food. It should be noted that foods high in histamine (red wine, aged cheeses, yogurt, beer, cured pork products such as bacon, etc.) can even cause persistent facial flushing in those individuals without rosacea due to a separate condition, histamine intolerance.

Certain medications and topical irritants can quickly trigger rosacea. Some acne and wrinkle treatments that have been reported to cause rosacea include microdermabrasion and chemical peels, as well as high dosages of isotretinoin, benzoyl peroxide, and tretinoin. Steroid induced rosacea is the term given to rosacea caused by the use of topical or nasal steroids. These steroids are often prescribed for seborrheic dermatitis. Dosage should be slowly decreased and not immediately stopped to avoid a flare up.

A survey by the National Rosacea Society of 1,066 rosacea patients showed which factors affect the most people:[15]

  • Sun exposure 81%
  • Emotional stress 79%
  • Hot weather 75%
  • Wind 57%
  • Heavy exercise 56%
  • Alcohol consumption 52%
  • Hot baths 51%
  • Cold weather 46%
  • Spicy foods 45%
  • Humidity 44%
  • Indoor heat 41%
  • Certain skin-care products 41%
  • Heated beverages 36%
  • Certain cosmetics 27%
  • Medications 15%
  • Medical conditions 15%
  • Certain fruits 13%
  • Marinated meats 10%
  • Certain vegetables 9%
  • Dairy products 8%


Most people with rosacea have only mild redness and are never formally diagnosed or treated. There is no single, specific test for rosacea.

In many cases, simple visual inspection by a trained person is sufficient for diagnosis. In other cases, particularly when pimples or redness on less-common parts of the face are present, a trial of common treatments is useful for confirming a suspected diagnosis.

The disorder can be confused with, and co-exist with acne vulgaris and/or seborrhoeic dermatitis. The presence of rash on the scalp or ears suggests a different or co-existing diagnosis as rosacea is primarily a facial diagnosis, although it may occasionally appear in these other areas.


Treating rosacea varies from patient to patient depending on severity and subtypes. A subtype-directed approach to treating rosacea patients is recommended to dermatologists.[16] Mild cases are often not treated at all, or are simply covered up with normal cosmetics.

While medications often produce a temporary remission of redness within a few weeks, the redness typically returns shortly after treatment is suspended. Long-term treatment, usually one to two years, may result in permanent control of the condition for some patients.[citation needed] Lifelong treatment is often necessary, although some cases resolve after a while and go into a permanent remission.

Alternative medicine has cited that an acidic diet contributes to rosacea, and have turned to nutrition as a way to lessen the effects of rosacea through a diet that counters the toxic effects of acidity. A suggested alkaline diet includes foods that contribute to alkalinity: vegetables (carrots, spinach), almonds, soups and some juices, lower sugar fruits, salads and omega oils, as well as plenty of pure water (2-3 liters per day, preferably alkalized by lemon juice drops).

A limited degree of evidence exists for the use of camphor to treat rosacea: in a study by El-Shazly et al. (2004)[17] rosacea patients were treated with daily 1/3 diluted camphor oil with glycerol and 500 mg metronidazole for fifteen days, with successful outcomes and no adverse effects. However, the study did not specifically identify camphor oil as the effective element of the treatment; furthermore, camphor can irritate the skin and has been reported to cause reversible hepatotoxicity in extreme cases.[18][19]


Trigger avoidance can help reduce the onset of rosacea but alone will not normally cause remission for all but mild cases. It is sometimes recommended that a journal be kept to help identify and reduce food and beverage triggers.[20]

Because sunlight is a common trigger, avoiding excessive exposure to sun is widely recommended. Some people with rosacea benefit from daily use of a sunscreen; others opt for wearing hats with broad brims.

People who develop infections of the eyelids must practice frequent eyelid hygiene. Daily, gentle cleansing of the eyelids with diluted baby shampoo or an over-the-counter eyelid cleaner and applying warm (but not hot) compresses several times a day is recommended.[citation needed]

A recent publication discusses how managing pre-trigger events such as prolonged exposure to cool environments can directly influence warm room flushing.[21]


Oral tetracycline antibiotics (tetracycline, doxycycline, minocycline) and topical antibiotics such as metronidazole are usually the first line of defense prescribed by doctors to relieve papules, pustules, inflammation and some redness.[22] Topical azelaic acid such as Finacea (15%) or Skinoren (20%) may help reduce inflammatory lesions, bumps and papules. Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed.[23] Isotretinoin has many side effects and is normally used to treat severe acne but in low dosages is proven to be effective against papulopustular and phymatous rosacea.

The treatment of flushing and blushing has been attempted by means of the centrally acting α-2 agonist clonidine, but this is of limited benefit on just this one aspect of the disorder.[24] The same is true of the beta-blockers nadolol and propranolol. If flushing occurs with red wine consumption, then complete avoidance helps. There is no evidence at all that antihistamines are of any benefit in rosacea. However: people with underlying allergies and who respond strongly to foods that are high in histamine or that release a lot of histamine in the body do find sometimes that their flushing symptoms diminish with oral antihistamines (for instance loratadine). Another medication that can help some people with facial flushing and burning is mirtazapine (remeron).

One alternative skin treatment, fashionable in the Victorian and Edwardian eras, was sulfur. Recently sulfur has regained some credibility as a safe alternative to steroids and coal tar.[citation needed]

Recently, a clinically-trialled product range combining plant-sourced Methylsulfonylmethane (MSM) and Silymarin has been used to treat rosacea, skin redness and flushing.[25]


Dermatological vascular laser (single wavelength) or Intense Pulsed Light (broad spectrum) machines offer one of the best treatments for rosacea, in particular the erythema (redness) of the skin.[26] They use light to penetrate the epidermis to target the capillaries in the dermis layer of the skin. The light is absorbed by oxy-hemoglobin which heat up causing the capillary walls to heat up to 70 °C (158 °F) , damaging them, causing them to be absorbed by the body's natural defense mechanism. With a sufficient number of treatments, this method may even eliminate the redness altogether, though additional periodic treatments will likely be necessary to remove newly-formed capillaries.

CO2 lasers can be used to remove excess tissue caused by phymatous rosacea. CO2 lasers emit a wavelength that is absorbed directly by the skin. The laser beam can be focused into a thin beam and used as a scalpel or defocused and used to vaporise tissue. Low level light therapies have also been used to treat rosacea. Photorejuvenation can also be used to improve the appearance of rosacea and reduce the redness associated with it.[27][28][29]

Famous people

Self-conscious about his rosacea, J. P. Morgan hated being photographed.

Famous people with Rosacea include:

See also


  1. ^ Koepsell, Thomas (2002). "Domenico Ghirlandaio: An Old Man and His Grandson (ca 1480-1490)". Arch Pediatr Adolesc Med 156: 966. 
  2. ^ rosacea at Dorland's Medical Dictionary
  3. ^ "Glossary - Dermatology - Online Medical Encyclopedia - University of Rochester Medical Center". Retrieved 2009-02-21. 
  4. ^ "All About Rosacea". National Rosacea Society. Retrieved 2008-11-10. 
  5. ^ Wilkin J, Dahl M, Detmar M, Drake L, Liang MH, Odom R, Powell F (2004). "Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea" (PDF reprint). J Am Acad Dermatol 50 (6): 907–12. doi:10.1016/j.jaad.2004.01.048. PMID 15153893. 
  6. ^ Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. ISBN 1-4160-3185-5.
  7. ^ Jansen T, Plewig G (1998). "Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities". Facial Plast Surg 14 (4): 241–53. doi:10.1055/s-2008-1064456. PMID 11816064. 
  8. ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
  9. ^ Yamasaki K, Di Nardo A, Bardan A, et al. (August 2007). "Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea". Nat. Med. 13 (8): 975–80. doi:10.1038/nm1616. PMID 17676051. 
  10. ^ See the August 5, 2007 issue of Nature Medicine for details.
  11. ^ Parodi A,Paolino S,Greco A,Drago F,Mansi C,Rebora A,Parodi AU,Savarino V (May 2008). "Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication". Clin Gastroenterol Hepatol. 6: 759. doi:10.1016/j.cgh.2008.02.054. PMID 18456568. 
  12. ^
  13. ^ Erbagcaronci Z, Özgöztascedili O (June 1998). "The significance of Demodex folliculorum density in rosacea". Int J Dermatol. 37 (6): 421–5. doi:10.1046/j.1365-4362.1998.00218.x. PMID 9646125. 
  14. ^ a b Baima B, Sticherling M (2002). "Demodicidosis revisited". Acta Derm Venereol 82 (1): 3–6. doi:10.1080/000155502753600795. PMID 12013194. 
  15. ^
  16. ^ Aaron F. Cohen, MD, and Jeffrey D. Tiemstra, MD (May-June 2002). "Diagnosis and treatment of rosacea". J Am Board Fam Pract. 15 (3): 214–7. PMID 12038728. 
  17. ^ El-Shazly AM, Hassan AA, Soliman M, Morsy GH, Morsy TA. Treatment of human Demodex folliculorum by camphor oil and metronidazole. J Egypt Soc Parasitol. 2004 Apr;34(1):107-16.
  18. ^ Martin D, Valdez J, Boren J, Mayersohn M (Oct 2004). "Dermal absorption of camphor, menthol, and methyl salicylate in humans". J Clin Pharmacol 44 (10): 1151–7.
  19. ^ Uc A, Bishop WP, Sanders KD (Jun 2000). "Camphor hepatotoxicity". South Med J. 93 (6): 596–8.
  20. ^
  21. ^ Dahl, Colin (2008). A Practical Understanding of Rosacea - part one.. Australian Sciences. 
  22. ^ Dahl MV, Katz HI, Krueger GG, Millikan LE, Odom RB, Parker F, Wolf JE Jr, Aly R, Bayles C, Reusser B, Weidner M, Coleman E, Patrignelli R, Tuley MR, Baker MO, Herndon JH Jr, Czernielewski JM (June 1998). "Topical metronidazole maintains remissions of rosacea". Arch Dermatol 134 (6): 679–83. doi:10.1001/archderm.134.6.679. PMID 9645635. 
  23. ^ Hoting E, Paul E, Plewig G (December 1986). "Treatment of rosacea with isotretinoin". Int J Dermatol 25 (10): 660–3. doi:10.1111/j.1365-4362.1986.tb04533.x. PMID 2948928. 
  24. ^ Cunliffe WJ, Dodman B, Binner JG (January 1977). "Clonidine and facial flushing in rosacea". Br Med J 1 (6053): 105. doi:10.1136/bmj.1.6053.105. PMID 137764. 
  25. ^ Berardesca E, Cameli N, Cavallotti C, Levy JL, Piérard GE, de Paoli Ambrosi G (2008). "Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation". J Cosmet Dermatol 7 (1): 8–14. doi:10.1111/j.1473-2165.2008.00355.x. PMID 18254805. 
  26. ^ Marla C Angermeier (1999). "Treatment of facial vascular lesions with intense pulsed light". J Cutan Laser Ther. 1 (2): 95–100. doi:10.1080/14628839950516922. PMID 11357295. 
  27. ^ Rigel, Darrell S.; Robert A. Weiss, Henry W. Lim, Jeffrey S. Dover (2004). Photoaging. Informa Health Care. pp. 174. ISBN 0824754506. 
  28. ^ "PHOTO REJUVENATION". Retrieved 2008-08-14. 
  29. ^ "Research a cosmetic surgery procedure". Retrieved 2008-08-14. 
  30. ^ a b Jane E. Brody (March 16, 2004). "Sometimes Rosy Cheeks Are Just Rosy Cheeks". New York Times. 
  31. ^
  32. ^ Burnham, Virginia (2003). The Two-Edged Sword: A Study of the Paranoid Personality in Action. Sunstone Press. pp. 61. 
  33. ^ 4 May 2009-4-5 p.m.
  34. ^ Rosie O'Donnell - ELLE
  35. ^ I've got thighs and buttocks — I'm never going to be a size zero - Times Online
  36. ^ Subscription Center - News Archive
  37. ^ Q&A | OMM | The Observer
  38. ^ Lisa Faulkner: My unslightly rosacea - Celebrity gossip on Now Magazine

External links


Up to date as of January 23, 2010

From Wikibooks, the open-content textbooks collection


Rosacea (IPA: ɹəʊ.ˈzeɪ.ʃʌ) is a common but often misunderstood condition that is estimated to affect over 45 million people worldwide.


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