This is the second article in a four-part medical article series on acne rosacea. My goal is to give you practical information about rosacea so that, if you have rosacea, you’ll have a better understanding of what’s happening on your skin. All of the information here comes from my 20-plus years practicing dermatology and the experiences of my many patients with rosacea.
In the first article of this series I presented an overview of rosacea. In this article, I’ll describe the symptoms of rosacea in detail to help you better understand the disease. In the third article, I’ll summarize what I’ve found to be important general supportive skin care tips that help prevent rosacea flair ups and maintain rosacea remissions. In the final post, I’ll discuss my dermatologic treatment approach to rosacea, including medicines, procedures and diet advice.
Acne rosacea symptoms in detail
The symptoms of rosacea may develop slowly over years or occur all of a sudden. Acne rosacea is a form of adult acne and typically comes on in the 20′s or later in life. Bright red rosy cheeks in childhood may indicate a predisposition to rosacea later in life.
Rosacea Facial Skin Symptoms:
The pimples of acne rosacea are most commonly tender red bumps which may or may not come to a whitehead. The pimples usually occur on the central face including the central forehead, cheeks nose and chin. They’re more like a tender inflammatory nodule than the puss filled pimples characteristic of teenage acne vulgaris. They come up quickly and can take weeks to go away. They are easily irritated if you apply harsh acne medicines to them, thus behaving more like a rash than acne. Also, unlike regular acne vulgaris, adult acne rosacea does not cause blackheads.
General blotchy skin redness, irritation, swelling and scale often accompany the pimples of acne rosacea making for a really frustrating facial skin mess. This is compounded by the fact that people prone to rosacea are also prone to facial seborrheic dermatitis (a scaly red facial rash) and both conditions may be present at the same time. I discussed seborrheic dermatitis in a recent post. Both conditions need treatment in order for the skin to completely improve and my treatment recommendations for rosacea also work for seborrhea. The inflammation of rosacea may be related to skin mite overgrowth with demodex mites. I discussed some new scientific information connecting mites to rosacea in a recent post and you can bet that I like to treat mites as part of my rosacea therapy. Lastly, most rosacea patients complain of excessively oily skin, but some have dry sensitive skin and this too impacts which rosacea treatment products I recommend.
Broken capillaries and facial flushing from rosacea may be constant or occasional. The longer you’ve had rosacea the ‘bigger better more’ your facial capillaries become. The capillaries aren’t actually ‘broken’, they’re just big and visible. It’s important to understand that normally the skin is covered by a fine and invisible network of capillaries. The flushing of a normal capillary network gives your cheeks a charming pink blush. In rosacea, however, your robust capillary network is visible to the naked eye. The flushing of rosacea capillaries turns you as red as a beet, and sometimes is so intense that your skin hurts. These abnormal rosacea capillaries can be large, long and straight, especially in the nose creases. Alternatively, they can be a dense network of tiny blood vessels branching like a spider’s web all over the surface of your cheeks, chin and nose.
Not only are facial rosacea capillaries larger, more numerous and visible, they also have an abnormal tendency to engorge when you’re exposed to a variety of stimuli including heat, exercise, spicy food, alcohol, emotion, climactic temperature change, a menopausal hot flash, and sometimes just for no reason at all. The parts of your face most prone to develop these abnormal rosacea blood vessels are the central face where your pimples from acne rosacea are the worst. I occasionally also see rosacea patients with large dark, deep capillaries on the sides of the cheeks near the ears too.
Oil and enlargement from acne rosacea is fascinating at the same time it’s annoying. It shows up in two ways: 1. small yellow bumps on the skin surface (called sebaceous hyperplasia papules). These growths are lumpy and have a central indentation that’s actually the opening of the pore, and 2. Enlargement, thickening and a bulbous shape to the nose due to a confluence of enlarged oil glands under the skin surface (this may be a subtle roundness of nasal shape or an extreme thickening and lumpiness called rhinophyma-like the nose of the actor W.C. Fields). Severe nasal enlargement isn’t common, but the little yellow bumps are.
(Science nerd digression: sebaceous hyperplasia is fascinating because the skin bumps that you see actually look like big versions of what an oil gland looks like under the microscope; every pore has an oil gland, whether there’s a hair coming out of the pore or not. Normally the pore’s oil gland is an invisible, microscopic creamy-colored lobular blob that sits on the side of the pore and opens into it. It’s yellow and lumpy much like the yellow sebaceous hyperplasia papules seen in rosacea. When the sebaceous gland grows in rosacea it encircles the pore and becomes a donut-like bump with a central hole where the pore is. Understanding this explains one of my favorite ways to get rid of sebaceous hyperplasia papules — stay tuned for that in the next post.)
Your eyes can suffer from rosacea too. The whites of your eyes (the sclera) can get inflamed, feel gritty and turning red. Your lash line can swell, itch, redden and produce a grainy matter. This usually happens when your face is really inflamed, but also may be present as a subtle chronic itch on the lash line. Most topical rosacea products are designed for skin treatment, not eye care, making treatment of ocular rosacea a challenge.
Rosacea Symptoms Of Non-facial Skin:
Yes, rosacea symptoms can extend down your neck and onto your chest. On the neck and chest I see mostly the enlarged, hyperactive capillaries. Occasionally the skin breaks out in pimples and a red scaly rash too. Rosacea can coexist with pityrosporum folliculitis, a common cause of back and chest pimples which I describe in another article.
The take-home message here is that acne rosacea is common — so common that it’s almost a normal skin type for Caucasian skin. The skin symptoms of acne rosacea may be subtle or severe. There are three main rosacea symptoms and you don’t have to suffer from all three to qualify for the diagnosis. My next post will discuss general skin care tips to prevent rosacea flare-ups. My fourth article in this rosacea series will include my treatment approach for rosacea.
My 5 Article Series On Rosacea:
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Photo: Gratitude & thanks to Mitch