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AcneNet This Month
Special Feature 2000
Acne Rosacea
A severe case of acne rosacea is
illustrated in this picture:
[Used with permission of
the American Academy of Dermatology National Library of Dermatologic
Teaching Slides, and the Sulzberger Institute for Dermatologic
Education]
What is acne rosacea? Is it:
- A severe form of acne vulgaris?
- A facial disfigurement of
alcoholics?
- A skin disorder caused by chronic
over-exposure to sunlight?
- A skin disorder of unknown cause?
- A form of lupus erythematosus?
Acne rosacea is not a form of
acne vulgaris, although some patients have acne vulgaris as
adolescents and develop acne rosacea later.. So far as is known,
however, the conditions that cause acne vulgaris are not involved in the cause of acne rosacea.
Acne rosacea is not associated
with the consumption of alcohol, although alcohol consumption can
temporarily contribute to the "flushed" appearance of acne
rosacea. The red, swollen face of a person with acne rosacea has
frequently, and wrongly, been identified as a "drunkard’s
face". Not only is this wrong, it is often extremely hurtful to
the person with acne rosacea. Whether a person drinks or doesn’t
drink alcohol has nothing to do with whether or not he/she has acne
rosacea.
Acne rosacea is not caused by
over-exposure to sunlight. Over-exposure to sunlight may temporarily
contribute to the "flushed" appearance of acne rosacea.
Acne rosacea is not a form of
lupus erythematosus. Lupus is an autoimmune disease, and so far as is
known, acne rosacea is not caused by an autoimmune process. It is
possible to mistake one disease for another, however, on the basis of
appearance. Both the person with acne rosacea and the person with
lupus may have "flushed" faces. In the case of lupus, the
flush often has a "butterfly" shape across the cheeks.
Because the treatments for acne rosacea and lupus are very different,
it is important that the disease be correctly diagnosed.
After discussing what acne rosacea
is not, we come to what it is—a skin disorder of unknown cause.
Acne rosacea is an inflammatory
disorder that predominantly affects the central portion of the face.
It rarely affects people less than 30 years old, and most often occurs
between ages 40 and 60 years although it may appear in the early 30s.
It is more common in women, but most severe in men. About 13 million
people in the United States have acne rosacea.
The characteristics of acne rosacea are
redness of the skin (erythema), red, dilated small blood vessels (telangiectasia),
and superficial pus-filled lesions (pustules). The overall appearance
of acne rosacea is a flushed, slightly swollen face with
inflamed-looking small blood vessels and pustules. Unlike acne
vulgaris, acne rosacea rarely occurs on the chest, back, shoulders or
scalp.
Acne rosacea is a chronic, and
progressive, disorder. That is, it seldom goes away spontaneously and
it tends to worsen over time. As acne rosacea progresses, it can
affect the eyes and nose. Eye lesions are common, and include eyelid
inflammation and a feeling of burning or grittiness in the eyes.
Severe eyelid problems may eventually lead to vision impairment. In
its most severe form, acne rosacea causes tissue over-growth in the
nose and a condition known as rhinophyma—a permanently swollen, red,
lumpy-looking nose. Rhinophyma is commonly—and very wrongly—called
"drunkard’s nose".
Is anything known about the cause of
acne rosacea?
Acne rosacea may be a disorder of the
blood and lymph vessels of the skin, primarily involving the cheeks,
nose and eyelids. However, some investigators believe the cause is
still not explained. The disorder is believed to be inflammatory, but
the underlying cause of the inflammatory process is not known. In
women, who are affected more often than men, hormonal changes
associated with menopause may be involved in some cases.
For reasons that are not understood,
the people most at risk for getting acne rosacea are (1) those of
northern European ancestry, and (2) those who have a strong tendency
to flush or blush in response to physical or emotional stress, alcohol
consumption, hot drinks, spicy food, or temperature extremes.
Acne rosacea typically has three stages
of development:
- a transient flush that stays longer
than usual—for example, after exercise;
- the appearance of small red bumps
(papules) on the face; and
- telangiectasias, pustules,
enlargement of oil glands, and swelling of cheek and nose tissue.
There is no cure for acne rosacea, but
its progress can often be slowed and disfigurement prevented or kept
to a minimum. The earlier the disorder is recognized and accurately
diagnosed, the greater is the likelihood of effective treatment.
Treatments may include:
- oral antibiotics
- topical metronidazole
- cool soaks
- diet modifications to avoid foods
and drinks that cause flushing
- lifestyle modifications to avoid
temperature extremes, lift-and-load exercises, and sun exposure
- counseling to help a patient cope
with social and emotional problems
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