Rosacea Classifications & Causes

Rosacea Tunisia

Rosacea

Is a chronic condition characterized by facial erythema (redness) and sometimes pimples. Rosacea affects all ages and has four subtypes, three affecting the skin and the fourth affecting the eyes (ocular type). Left untreated it worsens over time. Treatment in the form of topical steroids can aggravate the condition.

It primarily affects people of northwestern European descent and has been nicknamed the ‘curse of the Celts’ by some in Britain and Ireland, although recently this has been questioned. 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. In some cases, additional signs, 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.

Classification

There are four identified rosacea subtypes and patients may have more than one subtype present:

  1. Erythematotelangiectatic rosacea:Permanent redness (erythema) with a tendency to flush and blush  It is also common to have small widened blood vessels visible near the surface of the skin (telangiectasias) and possibly intense burning, stinging, and/or itching sensations. People with this ETR type often have sensitive skin. Skin can also become very dry and flaky. In addition to the face, signs can also appear on the ears, neck, chest, upper back, and scalp.
  2. Papulopustular rosacea:Some permanent redness with red bumps (papules) with some pus filled (pustules) (can last 1–4 days or longer; extremely varied signs); this subtype can be easily confused with acne.
  3. Phymatous rosacea:This subtype is most commonly associated with rhinophyma, an enlargement of the nose. Signs include thickening skin, irregular surface nodularities, and enlargement. Phymatous rosacea can also affect the chin (gnathophyma), forehead (metophyma), cheeks, eyelids (blepharophyma), and ears (otophyma). Small blood vessels visible near the surface of the skin (telangiectasias) may be present.
  4. Ocular rosacea:Red (due to telangiectasias), dry, irritated or gritty, eyes and eyelids. Watery eyes. Eyelids often develop cysts. Some symptoms include foreign body sensations, itching, burning, stinging, and sensitivity to light. Eyes can become more susceptible to infection. About half of the people with subtypes 1–3 also have eye symptoms. Blurry vision and loss of vision can occur.

There are a number of variants of rosacea, including:

  • Rosacea conglobata
  • Rosacea fulminans
  • Phymatous rosacea

Cause

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. 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:

  • 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 (specifically stimulants) 15%
  • Medical conditions 15%
  • Certain fruits 13%
  • Marinated meats 10%
  • Certain vegetables 9%
  • Dairy products 8%

It should be noted however that there exists significant disagreement amongst sufferers and clinicians as to the validity of these aggravators/triggers being categorized as causes of rosacea. The claim of rosacea being caused (as opposed to aggravate) by the above list has not been established by epidemiological scientific study. Many sufferers report that elimination of triggers has little or no eventual impact on the actual progression of the disease. The above list should in no way be taken as an explanation of rosacea causes, as the spectrum disease is more complex than simply a direct or sole result of habits and diet.

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