About Rosacea - Diagnosis, Signs and Symptoms
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What is Rosacea?
Rosacea is a chronic skin disorder that affects the facial skin and eyes. It usually begins quite innocently as a mild flush across the nose, cheeks, chin, and forehead. During the early stages, this flush comes and goes, seeming to have a mind of its own. As the disorder progresses, facial redness becomes more intense, taking on the appearance of mild sunburn or windburn. In areas of facial redness, tiny broken blood vessels and red bumps may also become visible.
In the moderate to severe stages, facial inflammation usually intensifies, resulting in permanent redness, swelling, and burning sensations. In the most advanced cases, rosacea can cause facial disfigurement and disabling burning sensations.
According to the latest epidemiological studies, rosacea affects over 45 million people worldwide. In the United States alone an estimated 14 million Americans are afflicted with this disease.
Diagnosing: Rosacea Phenotype
Diagnosis of rosacea should be considered when:
- A centralised redness of the face that varies with intensity, but persists and/or
- Swelling of the sebaceous glands as seen as phymatous* changes.
*Phymatous rosacea is characterised by thickened skin with enlarged pores and irregular surface nodularities. These changes are most commonly found on the nose (rhinophyma), but can occur on the ears, chin and forehead.
Secondary Signs:burning or stinging, swelling and dry appearance, may also develop but are not diagnostic.
Major Features: Facial Redness, Flushing, Breakouts, Broken Veins, Eyes
- Transient centrofacial erythema – central face area frequent flushing; persistent erythema (ie, lasting for at least 3 months); .
- Inflammatory papules/pustules
- Telangiectasia – condition in which widened tiny blood vessels cause threadlike red lines or patterns on the skin. (spider vein like that can form in clusters)
- Ocular manifestations – eye involvement, eye redness, burning and itching eyes and swollen eyelids
Minor Features: Facial Burning, Fluid Retention, Dry Skin
- Burning/stinging sensation
- Oedema *build-up of fluid causes affected tissue to become swollen
- Dry sensation/appearance
Rosacea: The Severity Scale of Rosacea
Rosacea normally advances in the same generalized fashion: In the beginning rosacea symptoms usually starts out quite innocently as a mild flush across the nose, cheeks, chin, and forehead. As rosacea progresses, the hypothalamus, an area of the brain that regulates many important bodily functions, becomes overactive. A ‘sensitized’ hypothalamus triggers nerve activity and hormone release, which in turn, accelerates all rosacea symptoms. These changes usually occur in stages:
Stage 1: Pre-Rosacea
Frequent bouts of facial flushing. At this stage, facial redness from the flush is very brief and immediately disappears after the trigger is over. For example, a short term flush brought on by a warm environment, exercise, facial cleansing, overheating, or embarrassing situation, can all be categorized as pre-rosacea flushes. rosacea skin closeup
Although this stage is usually quite innocent in nature, pre-rosacea flushing is the first 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 wider, and stay open for longer periods of time than do normal facial blood vessels.
✔ Facial flushing comes and goes
✔ Sensitivity to topical products
✔ Burning or stinging sensations
✔Facial redness triggered by internal and external insults
Stage 2: Mild Rosacea
Abnormally long periods of facial flushing The mild stage of rosacea begins when the facial redness induced by flushing persists for an abnormal length of time (usually a half-an-hour or more after the trigger).
During this stage, many rosacea sufferers also report that their facial skin has a healthy-looking glow to it. mild rosacea
In mild rosacea, facial blood vessels become even more reactive – resulting in greater blood flow through 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 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 this stage.
✔ Blood vessels become sensitive to external and internal stimuli
✔ Blood vessels dilate even wider and can stay dilated for 30 to 90 minutes at a time
✔ Mild skin inflammation
✔ Skin inflammation begins to damage cell membranes
Stage 3: Moderate Rosacea
Persistent redness that lasts for days or weeks. The moderate stage of rosacea begins when the facial redness persists for days or weeks – often becoming semi-permanent in the central areas of the face such as the nose and cheeks. This results in a generalized ‘sun-burnt’ or ‘wind-burnt’ 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 tiny red bumps during this stage. In most cases there are prominent areas of dilated blood vessels in facial areas where flushing is the worst. Rosacea How To Guide
General Discussion On Rosacea
As facial flushing becomes more frequent and intense, blood vessels become more dysfunctional and often incur structural damage. These vascular changes result in long-lasting facial redness, broken blood vessels, swelling, and inflammatory bumps. Facial blood vessel damage can range from mild damage that can still function normally, to severe damage denoted by permanently dilated vessels that cannot repair themselves.
The result is skin that is in a chronic inflammatory state. This in turn stimulates the growth of new vessels to handle the increased blood flow, and the fusion of pre-existing damaged vessels. Both of these changes, in turn, worsen the entire vascular disease. The damaged and dysfunctional facial blood vessels can also contribute to swelling, inflammatory papules and pustules.
✔ Facial redness becomes more intense
✔ The appearance of mild sunburn or windburn occurs
✔ Papules, pustules and swelling often develop; Centro-facial pores enlarge
✔ Swelling occurs in the cheek and nose area.
✔ In areas of facial redness, tiny broken blood vessels and red bumps may also become visible.
✔ Burning and itching sensations intensify
Stage 4: Severe Rosacea
Intense bouts of facial flushing, severe inflammation, swelling and burning sensations. 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, pustules, and nodules. At this stage, some patients may also develop rhinophyma, 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: Widespread damage to facial blood vessels, extreme hyper-reactivity of the remaining blood vessels, significant leakage from damaged blood vessel walls, and adverse changes to facial skin structure.
In severe rosacea, the uncontrolled flushing leads to structural damage,
which contributes to the inflammation, which in turn further stimulates the flushing.
This is a vicious cycle that is difficult to break because permanent damage has now been done,
new vessels have grown, and inflammatory shunt vessels have formed.
✔ Intense facial flushing, permanent redness and severe facial swelling
✔ An increase in papules, pustules and the appearance of deep inflammatory nodules.
✔ Extreme facial hyper-sensitivity and intense burning sensations
✔ Facial swelling
✔ Spread of excess facial tissue called fibroplasia may develop
Additional recommended articles about rosacea:
- Common medical terms used to describe rosacea translated into every day English
- Helpful list of topics, questions and symptoms to discuss with your doctor about your rosacea. Why Keeping A Checklist Matters With Rosacea Treatment and Management to get the most out of your appointment.
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