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Recognizing Rosacea

By: Christian Jurist, MD
Posted: August 29, 2011, from the September 2011 issue of Skin Inc. magazine.

Rosacea is a chronic skin disorder characterized by microcirculation problems that primarily affect the face. It’s comprised of several related symptoms, such as couperose, or the dilation of facial blood vessels, and erythema, or redness. Extra-facial lesions on the neck and upper chest are not uncommon. The word “rosacea” comes from the Latin rosacea, derived from rosaceus meaning “pinklike.”

Approximately 16 million Americans and 45 million people worldwide suffer from rosacea. According to the National Rosacea Society (NRS), a Gallup survey found that 78% of Americans have no knowledge of this condition, including how to recognize it and what to do about it. (See Be Knowledgeable About Rosacea.) Although symptoms may occur during the teenage years, most people experience the onset of rosacea in their 30s, 40s or 50s, and it is more predominate in fair-skinned women. The precise cause of rosacea remains unknown, but research has shown that many factors are involved, such as genetic predisposition, heredity—especially European/Celtic descent, stomach dyspepsia and Helicobacter pylori infection, seborrhea, Demodex folliculorum mites, endocrine disorders, vitamin deficiency, liver disease and stress-related causes.

Discerning the enigma

Rosacea clients are generally prone to flushing and blushing mainly on the t-zone and cheeks. This can occur either spontaneously or can be precipitated by certain triggers that play a particular role in the development of this skin disorder, including the following.

  • Emotional stress
  • Heat and abrupt temperature changes
  • Caffeine
  • Sunlight and repeated sunburning
  • Alcoholic beverages
  • Spicy foods
  • Foods that contain histamine or cause the body to release histamine, such as tomatoes and pineapples
  • Medications, such as steroids

For example, a rosacea client may experience facial redness after drinking a hot beverage. One possible explanation would be that the heat from the beverage warms the blood irrigating the pharynx, which causes redirection of the blood flowing to the face from the brain, creating unwanted congestion at the facial level.

According to scientific belief, blood vessels become damaged when they are repeatedly dilated by stimuli, in part mediated by the hypothalamus. It has been proposed that the local release of vasoactive substances has an important implication in this pathology causing inflammation, stagnation and congestion of blood. Associated factors include minor vascular anatomical disorders, and dysfunction of the thermoregulatory vascular cooling system of the brain. These factors are partly responsible for causing blood backflow to the face with increased vessel pressure that secondarily affects the subpapillary venous plexus, leading ultimately to permanent vasodilation. Other very important factors that play a major role in damaging blood vessels include deterioration of the dermal matrix and the atrophy of supporting vessel tissues.