Rosacea is a facial rash that occurs in middle-aged men and women. It is three times more common in women, but usually more severe in men. Rosacea used to be called “acne rosacea” but it is different from acne. The red spots and pustules are dome-shaped rather than pointed and there are no blackheads, whiteheads, deep cysts, or lumps. Rosacea affects the cheeks, nose and forehead – rarely, it involves the trunk and upper limbs.
The cause of rosacea is unknown, but many factors have been suspected of influencing it: alcoholism, menopausal and other flushing, a tendency towards seborrhea, local infection, B-vitamin deficiencies and gastrointestinal disorders. Most cases are associated with moderate to severe seborrhea, although in many cases sebum production is not increased. Flushing is prevalent, and migraine headaches are three times more common amongst sufferers. It affects people mainly in their 30s and 40s, especially those with fair-skin, blue eyes or of Celtic origin.
Facial flushing can make symptoms worse and even cause flare-ups in patients whose rosacea had been under control. It is the chronic flushing in rosacea which causes the telangiectasia. Flushing can be triggered by many things, the most common being hot drinks, alcohol, spicy foods, stress, sunlight and extreme heat or cold. Other causes of flushing and telangiectasia include heredity, exercise, emotions, hormones, cortisone medications and other rare skin diseases.
In more advanced cases of rosacea, a condition called rhinophyma may develop. The oil glands enlarge, causing a bulbous, enlarged red nose and puffy cheeks. Thick bumps can develop on the lower half of the nose and near to the cheeks. Rhinophyma occurs less commonly in women than in men.
Keep your face cool. Experts say you should avoid anything that causes flushing. However, what bothers one person may not cause a problem in another. Keep a diary of flushing episodes and note associated foods, products, activities, medications or other triggering factors.
Signs, symptoms & indicators of Rosacea
Irritated eyes
Red, sore or ‘gritty’ eyelids are sometimes caused by rosacea. Ocular manifestations may include many different eye problems and may precede skin involvement, thus delaying the diagnosis of rosacea.
Red eyelids
An enlarged nose
Rosacea may cause the nose to slowly enlarge. When rosacea is not treated, some people – especially men – may eventually get small knobby bumps on the nose. As more bumps appear, the nose looks swollen.
Facial burning/tingling
Visible veins on face
Facial flushing
Rosacea is often accompanied by a red face due to flushing. Sometimes the affected skin is swollen and hot.
Dark/flushed/dark facial coloring
Counter Indicators
Pale facial coloring
Not being prone to facial flushing
Conditions that suggest Rosacea
Sebaceous Hyperplasia
Chronic rosacea can be associated with sebaceous gland hyperplasia and lymphedema, causing disfigurement of the nose, forehead, eyelids, ears, and chin.
Not having rosacea
Risk factors for Rosacea
Helicobacter Pylori Infection
A high incidence of Helicobacter pylori infection in the stomach has been found amongst rosacea patients.
Rosacea suggests the following may be present
Helicobacter Pylori Infection
A high incidence of Helicobacter pylori infection in the stomach has been found amongst rosacea patients.
Rosacea can lead to
Recommendations for Rosacea
Caffeine/Coffee Avoidance
Avoid coffee, alcohol, hot beverages, spicy foods and any other food or drink that causes flushing.
Conventional Drugs / Information
Never apply a topical steroid like cortisone to rosacea unless directed to do so by your doctor for a specific reason. Cortisone treatments can worsen rosacea over the long term and make it even more resistant to treatment.
Personal Hygiene Changes
Please see the description of a new soap being used to treat facial skin problems under “Personal Hygiene Changes”.
Hydrochloric Acid (Trial)
Gastric analysis of rosacea patients has led to the theory that it may be the result of hypochlorhydria. HCL supplementation results in marked improvement in rosacea patients who have achlorhydria or hypochlorhydria.
Digestive Enzymes / (Trial)
Rosacea patients often have a reduced secretion of pancreatic lipase, an enzyme which aids in fat digestion. Pancreatic or plant enzyme supplementation, especially when prepared with extra lipase, will improve this digestive weakness.
Test for Food Allergies
The incidence of migraine headaches and flushing accompanying rosacea points to some form of food intolerance.
Cosmetics / Moisturizers
Avoid oil-based facial creams. Use a water-based make-up and sunscreen. The skin may be very sensitive to local applications.
Vitamin B Complex
The administration of large doses of B-vitamins has been shown to be effective, riboflavin being the most important. While B-vitamins are important, some rosacea patients may be aggravated by large dosages of these nutrients.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
| Reasonably likely to cause problems |
Glossary
Acne
A chronic skin disorder due to inflammation of hair follicles and sebaceous glands (secretion glands in the skin).
Cysts
A closed pocket or pouch of tissue; a cyst may form within any tissue in the body and can be filled with air, fluid, pus, or other material. Cysts within the lung generally are air filled, while cysts involving the lymph system or kidneys are fluid filled. Cysts under the skin are benign, extremely common, movable lumps. These may develop as a result of infection, clogging of sebaceous glands, developmental abnormalities or around foreign bodies.
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Seborrhea
Skin disease characterized by dry or moist, greasy, yellow crusts or scales.
Gastrointestinal
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Sebum
The oily liquid covering the skin surface.
Migraine
Not just a headache, but a disorder affecting the whole body, characterized by clearly defined attacks lasting from about 4 to 72 hours, separated by headache-free periods; progresses through five distinct phases. Prodrome: experienced by about 50% of migraineurs and starting up to 24 hours before the headache - changes in mood, sensory perception, food craving, excessive yawning, or speech or memory problems. Aura: experienced by about 15% and starting within an hour before the headache - disruption of vision (flashing lights, shimmering zigzag lines, blind spot) or sensation (numbness or 'pins and needles' around the lips or hand), or difficulty speaking. Headache: usually pulsating and occurring on one side of the head, it may occur on both sides of the head and alternate from side to side. Muscles in the neck and scalp may be tender; there may be nausea and the desire not to eat, move, see or hear. Resolution: the headache disappears and the body returns to normal. Resolution may occur over several hours during sleep or rest; an intense emotional experience or vomiting may also end the headache. Postdrome: After the headache stops, the sufferer feels drained, fatigued and tired. Muscles ache, emotions are volatile and thinking is slow.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Telangiectasia
Small, unsightly red, purple or blue blood vessels found along the surface on the face, upper chest, neck and rarely on other parts of the body. Similar veins are found on the legs but called spider veins.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Rhinophyma
A condition of the skin that can severely deform the nose.
Helicobacter Pylori
H. pylori is a bacterium that is found in the stomach which, along with acid secretion, damages stomach and duodenal tissue, causing inflammation and peptic ulcers. Although most people will never have symptoms or problems related to the infection, they may include: dull, 'gnawing' pain which may occur 2-3 hours after a meal, come and go for several days or weeks, occur in the middle of the night when the stomach is empty and be relieved by eating; loss of weight; loss of appetite; bloating; burping; nausea; vomiting.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.