Recognizing Rosacea: Signs, Symptoms and Subtypes
Rosacea is a chronic skin condition that is characterized by a persistent redness of the face, affecting the cheeks, nose and forehead. Initially, rosacea exhibits frequent flushing or blushing of the face that becomes more permanent as rosacea progresses into a more chronic inflammation of the face. In later stages, rosacea patients frequently suffer from pastules (red bumps that resemble acne), papules (pus-filled bumps) and permanently dilated blood vessels that become visible through the skin (telangiectasias).
Rosacea is estimated to affect 45 million people worldwide and primarily affects fair-skinned people between the ages of 20 and 50. Rosacea symptoms often get worse by trigger factors such as sun exposure, extreme heat or cold, foods containing high levels of histamine and stress. Many rosacea patients seek help when the condition has progressed to a later stage. Rosacea symptoms can be treated with topical rosacea treatments (over-the counter and by prescription) and by an oral regimen of antibiotics. Although symptoms can be kept under control for long periods of time, inflammation of the skin frequently flares up due to a variety of trigger factors.
An official classification system of rosacea was established in 2002 and defines four subtypes of rosacea, which include the various primary and secondary signs and symptoms of rosacea. Rosacea patients can have more than one subtype at any given time. In 2004, a standard grading system was added to the classification system. Symptoms are graded as mild, moderate or severe. The 4 subtypes of rosacea are:
Erythematotelangiectatic rosacea: A persistent redness (erythema) of the face with the possibility of visible (enlarged) blood vessels near the surface of the skin (telangiectasias). Sometimes, telangiectasias are not visible due to the facial redness and become more visible when the redness of the face clears up. The presence of telangiectasias is not necessary for a diagnosis. Patients with this subtype often blush easily and frequently experience painful, itchy skin.
Papulopustular rosacea: This subtype often exists before a diagnosis of rosacea is made. It is characterized by permanent redness (erythema) with red bumps (papules), some of which are filled with pus (pustules). Burning and stinging sensations of the skin usually are present as well. The papules and pustules often retreat with the right treatment. This subtype resembles regular acne.
Ocular rosacea: Symptoms of ocular rosacea include a burning and itching sensation of the eyes. The eyes appear red and inflamed (with associated multiplication of small blood vessels) and patients often complain of a “foreign body” sensation in the eyes. Eyes can be dry and sensitive to light and some patients may experience blurred vision. Inflammation of the tear glands and eye lids are common. Some patients may develop loss of vision due to corneal complications. Since ocular rosacea is such a serious condition, patients are encouraged to have their eyes checked regularly.
Phymatous rosacea: Commonly associated with an enlargement of the nose (rhinophyma). This sub-type is predominantly found in men. The main symptom of phymatous rosacea is thickening of the skin with unevenly shaped nodules and the associated enlarged nose, but the thickening of the skin can also affect the cheeks, chin, forehead, ears and eyelids. Telangiectasias may be present as well.
Because of the progression of this skin disorder, most rosacea patients only seek help when their condition is in a later stage. While the symptoms can be controlled with the right treatment, the skin of these patients will have a substantial number of telangiectasias (permanently dilated blood vessels) that leads to a residual redness. The rosacea classification and grading system allows more patients to receive the proper care quicker and will prevent the condition from becoming worse.
