An Historical Picture of Acne Rosacea

The term "acne rosacea" first appeared in an English medical text by Dr. Thomas Bateman in 1812, who noted: "The perfect cure of acne rosacea is, in fact, never accomplished." Other 19th century references commonly listed rosacea among the different forms of acne.

Finally in 1891, Dr. Henri G. Piffard, a professor of dermatology in New York, called for distinctions among different forms of acne to more truly differentiate symptoms.

Today, dermatologists have learned that rosacea is a different disease from acne, and that therapy for acne can often make it worse. Although the precise cause of rosacea is still unknown, most experts believe it is a vascular disorder that seems to be related to the flushing of rosacea.

Research has also dispelled the centuries-old myth that rosacea is caused by heavy consumption of alcohol. While alcohol may aggravate rosacea, the symptoms of rosacea can be just as severe in one who never consumes alcohol. Reference : Wilkin, Jonathan K: Rosacea: Pathophysiology and Treatment. Archives of Dermatology. 1994;130:359-362.

A Picture of Rosacea

A rosacea picture can be effective in the treatment of rosacea. The chronic progressive skin disorder of rosacea can be tracked by a picture taken at various intervals of the treatment process. A chronological picture file is needed is useful in determining the progression of your rosacea condition and in judging the possible benefits of current treatment. It is difficult to tell from a picture of rosacea what degree of rosacea-related skin sensitivity may be present.

The Pre-Rosacea Picture

Dermatologists now recognize an early prelude to rosacea termed prerosacea. Prerosacea is the earliest noticeable stage of rosacea. Signs of this early stage of rosacea include frequent episodes of flushing or redness of the face and/or neck that come and go. Things that can cause an episode are exposure to the sun, emotional stress, alcohol, spicy foods, exercise, cold wind, hot foods and beverages, and hot baths. Again, each person is different and what might affect one person might not bother the next.

The Picture of The Latest Rosacea Research

The picture of rosacea research and treatment becomes more clear everyday.
Rosacea results from an overly acidic body and skin. The pH scale (potential of hydrogen) as you remember from your high school general science or chemistry class, ranges from 0 to 14 with 7 being neutral. As you rethink your past rosacea history, you will see that ‘all’ the rosacea triggers come from ‘acidic items’ regardless of whether they are foods, drinks, stress, out of breath due to not enough oxygen (alkaline) and not able to exhaust enough carbon dioxide (acidic).

Charting the Progression of Your Rosacea

A rosacea picture is very useful in helping one to understand a patient's skin problem. The chronic progressive skin disorder of rosacea can be tracked by a picture taken at various intervals of life.

Picture the Condition of Your Rosacea

Many times a picture can tell much about the condition of one's rosacea. Some people don't realise how much their rosacea has progressed until they see a picture of themselves.
Do you have an ocular component to your rosacea?

Rosacea Subtypes

The Rosacea Society Medical Committee has recently developed a "Rosacea Classification System" to help diagnose rosacea subtypes. While there is a trend for rosacea sufferers to proceed through the stages listed above, it is helpful to understand that based on genetics some rosacea sufferers are more susceptible to develop certain symptoms; therefore it was necessary to develop a rosacea classification system. This system helps rosacea sufferers better understand their symptoms and find the proper treatments. Below is a summary of each subtype adapted from the Journal of the American Academy of Dermatology. 2002; 46:584-587.

Erythematotelangiectatic Rosacea:
Erythematotelangiectatic rosacea is mainly characterized by flushing and persistent central facial redness. The appearance of telangiectasia is common but not essential for a diagnosis of this subtype. Central facial edema, stinging and burning sensations, and roughness may also occur. A history of flushing alone is common among patients presenting with erythematotelangiectatic rosacea.

Papulopustular Rosacea
Papulopustular rosacea is characterized by persistent central facial redness with transient papules or pustules. The papulopustular subtype resembles acne vulgaris, except that comedones are absent. Burning and stinging sensations may be reported by patients with papulopustular rosacea.
This subtype is often reported in combination with subtype 1, including the presence of telangiectasia. The telangiectasia may be obscured by persistent redness, papules, or pustules.

Phymatous Rosacea
Phymatous rosacea includes thickening of the nose skin, irregular surface nodularities, and enlargement. Rhinophyma is the most common presentation, but phymatous rosacea may occur in other locations, including the chin, forehead, cheeks, and ears.

Ocular Rosacea
The diagnosis of ocular rosacea should be considered when a patient's eyes have one or more of the following signs and symptoms: watery or bloodshot appearance, foreign body sensation, burning or stinging, dryness, itching, light sensitivity, blurred vision, telangiectasia of the conjunctiva and lid margin. Blepharitis, conjunctivitis, and irregularity of the eyelid margins also may occur.

Neuropathic Rosacea
This classification system has proven helpful to many general dermatologists. However, a gaping hole has been left in the system setup. This system has excluded one of the most important rosacea subtypes. It's important that all dermatologists become aware that a new clinical subtype has recently been identified. Though not officially recognized yet, Neuropathic Rosacea is believed to be the most debilitating form of the disorder.
Hallmarks of Neuropathic Rosacea include bouts of centrofacial burning and pain sensations following exposure to triggers. Such bouts usually last longer than 30 minutes. More serious cases can become semi-permanent if dermal inflammation or various inflammatory cytokines damage or permanently activate sensory nociceptors. In severe cases, underlying facial inflammation may trigger these sensory nociceptors in the absence of external triggers. It must be stressed that this subtype can cause physical disability comparable to diabetic neuropathy and other painful peripheral neuropathies.
Rosacea sufferers with Neuropathic Rosacea are best treated by a collaborative effort between dermatologists, neurologists with peripheral nerve treatment training and pain specialists.

Stages of Rosacea

Pre-Rosacea
In general, people who are prone to frequent bouts of facial flushing and blushing are placed into this category. At this stage, facial redness from the flush is very transient and immediately disappears after the instigating trigger is over. For example, a transient flush to a warm environment, exercise, facial cleansing, overheating, or embarrassing situation, can all be categorized as pre-rosacea flushes.
Although this stage is usually quite innocent in nature, pre-rosacea flushing is the first cardinal sign of rosacea.In the pre-rosacea stage, most sufferers experience a basic functional change in the reactivity of facial blood vessels - i.e., rosacea blood vessels dilate to more stimuli, open up wider, and stay open for longer periods of time than do normal facial blood vessels. This basic difference is responsible for the frequent facial flushing. At this early stage, there are usually no signs of physical damage to the blood vessel wall.


Mild Rosacea
The mild stage of rosacea begins when the facial redness induced by flushing persists for an abnormal length of time after the instigating trigger is over -- usually a half-an-hour or more after the trigger is over. During this stage, many rosacea sufferers also report that their facial skin has a healthy-looking glow to it.
Individuals who experience frequent bouts of pre-rosacea flushing are especially susceptible to progressing into mild rosacea (the first "true" form of rosacea). In mild rosacea, facial blood vessels tend to become even more reactive - dilating more easily than in pre-rosacea. This subtle change results in greater blood flow into the superficial layers of the facial skin. Facial blood vessels also remain open for exaggerated periods of time, resulting in facial redness that persists for an extended period of time after the initial trigger is over. In mild rosacea, there may also be minor structural damage to facial blood vessels, but this is not an important factor..... At least not yet.

Moderate Rosacea
The moderate stage of rosacea begins when the facial redness persists for days or weeks - often times becoming semi-permanent in the central areas of the face such as the nose and cheeks. This results in a generalized 'sunburned' or 'windburned' look. In facial areas where chronic flushing or redness is intense, swelling and burning sensations may also occur. A significant number of patients also report outbreaks of inflammatory papules (tiny red bumps), and pustules (tiny red bumps with pus) during this stage. In most cases there are prominent areas of telangiectasia that are located in facial areas where flushing is the worst.
As facial flushing becomes more frequent and intense, blood vessels become dysfunctional and often incur significant structural damage. These vascular changes result in long-lasting facial redness, broken blood vessels, swelling, and inflammatory papules. At this stage, facial blood vessels may exhibit several different levels of structural damage:
Mild damage: Blood vessels that have mild damage can still function normally. This damage can be fixed by the blood vessel's internal repair mechanisms.
Moderate damage: Blood vessels that have received moderate damage are usually 'sick', and function much differently than normal blood vessels. This structural damage is much harder to repair, and in some cases, cannot be fully fixed.
Severe damage: Blood vessels that have incurred severe damage are permanently dilated (telangiectasia). These blood vessels cannot fix themselves. These vessels serve as open tunnels for large volumes of blood flow.

Severe Rosacea
A small portion of sufferers progress to the final stage of rosacea which is characterized by intense bouts of facial flushing, severe inflammation, swelling, facial pain, and debilitating burning sensations. On top of the inflammation can emerge crops of inflammatory papules and pustules. At this stage, some patients may also develop rhinophyma (rino-fi-ma), a bulbous enlargement of the nose.
After months, years, or decades of uncontrolled flushing and inflammation, permanent changes take place in the facial skin and blood vessels.
Major changes include:
(1) Widespread damage to facial blood vessels,
(2) Extreme hyper-reactivity of the remaining blood vessels,
(3) Significant leakage from damaged blood vessel walls,
(4) Adverse changes to facial skin.

Rhinophyma and Rosacea

Rhinophyma is more often seen in pictures of men with rosacea. Rhinophyma is a large, bulbous, ruddy appearance of the nose.

Formation of an enlarged, red nose was once thought to be caused by heavy alcohol consumption, but this is not the case. Rhinophyma occurs equally in those who do not drink at all and those who drink alcohol in quantity. It is seen almost exclusively in men over age 40.

The cause of rhinophyma is unknown, though it is generally regarded as a severe form of rosacea. It is a relatively rare disorder involving thickening of the skin on the nose and the presence of many oil glands.

Although rhynophyma is a cosmetic disorder, it may cause emotional distress if symptoms are obvious or extensive.

Symptoms involve an abnormal appearance of the nose:

Thickening
Bulb shape
May be reddish
Waxy, yellow surface
Signs and tests Return to top

Rhinophyma may usually be diagnosed without any testing. A skin biopsy may be needed to confirm the diagnosis in unusual cases.

Surgical reshaping of the nose is the best known treatment for rhinophyma. This may be accomplished by laser, scalpel, or dermabrasion. Some physicians have reported good results from treatment with the acne medication Accutane.

Rhinophyma can be corrected surgically, but the condition may recur.