Management and treatment of rosacea across its four clinical subtypes

Rosacea is a skin disease that affects millions of people. The chief cause of rosacea is still unclear and hence all treatment is based on a preventive basis rather than a curative one. The management of this chronic condition is made easier by a combination of different therapies, which includes oral antibiotics, topical gel and latest laser treatments.

Rosacea is one of the chronic skin diseases which affects an astounding 13 million people in the United States alone. Initially characterized by reddening of the face, the disease may gradually develop eruptions on the face giving a totally distorted look. While we are aware that some external factors like food and temperature trigger a flushing we still don't have a clue as to what is the root cause of Rosacea. Apart from the damaging effects on the skin, in a majority of the cases the disease also affects the eyes in what is called in the medical parlance as ocular rosacea. So it is pretty clear that the disease has more than cosmetic consequences and if untreated may lead to loss of vision. The typical symptoms of Ocular rosacea include dryness and irritation of the eyes and a general gritty sensation. [Simon Darken]

The capillaries get dilated and this is the main cause for the reddening. In the advanced stage of the disease the dilated capillaries do not return back to their normal size thus creating a permanent reddening. In some cases severe bumps and pustules may develop on the nose. This condition is called as rhinophyma. [Ann Marie Lindstrom, 8] Rosacea has been recorded with black population but it is markedly more visible with the white community as they tend to blush more easily. Though there is not much of a gender bias, Rosacea is found to be more frequent among women while on the other hand the symptoms are more severe with men. Rosacea is predominantly associated with adults and that too in the age group of 30 to 60. It has a disruptive influence on the lifestyle of the patients and many of them develop a negative self-image leading to severe personality disorders. We still do not have a total cure for Rosacea but with the available treatment methods we can control its effects. There are basically four types of Rosacea.

Erythematotelangiectatic rosacea is a case where there is extensive flushing which may be sometimes accompanied by stinging sensations.

Papulopustular rosacea

This is a condition wherein pustules are observed on any part of the face along with the burning sensations.

Phymatous rosacea is a case where there is a noticeable thickening of the skin and abnormal projections. The most common and obvious case is that of rhynophyma wherein there is a distinct thickening and projections on the nose.

Ocular Rosacea

This is an important subtype of rosacea and a potentially dangerous one in that any negligence may lead to impaired vision. Complications may develop within the cornea, which can drastically affect the visual acuity. [Jonathan Wilkin]

Results

Since we have not yet clearly identified the cause for rosacea there is no complete cure and treatment methodologies revolve around prevention rather than cure. While mild symptoms can be treated with antibiotic tablets (tetracycline) and topical gels (metronidazole) very acute and chronic cases need surgical procedures. Although Corticosteroids can be very useful in suppressing symptoms of rosacea they are not advisable for long-term treatment due to adverse side effects. However observations have made it clear that discontinuation of either topical gels or oral antibiotics would incur the relapse of the symptoms.

Discussion

Though there is no full cure for rosacea there are lots of remedial solutions, which can greatly limit the intensity of the symptoms. One of the most basic treatment is the use of tetracycline tablets. Another very useful method is the use of metronidazole gels. Studies have indicated significant results in patients with more than 95% of them showing positive response to treatment. The anti-inflammatory effect of these medicines is the key in treating rosacea. Accutane tablets are also found to be very effective in preventing eruptions but they are not to be prescribed for pregnant women as it is found to cause serious birth related abnormalities. However in the case of severely affected patients (as in the case of Rhinophyma) medical treatment has little effect. Laser treatment is best advocated in these cases.

Laser pulses can be used to treat the symptoms of rocasea. Results have indicated a positive response when laser treatment is used in combination with other therapies. Laser treatments remove telangiectasia and greatly reduce the redness. Dr. Amy Forman Taub, director, dermatology division of the Northwestern Memorial Physicians Group, Northbrook, Ill says, "Lasers can get rid of blood vessels," "You've got somebody a lot better with medical treatment, but then you have fixed and dilated vessels and background redness that you can't get to go away. Lasers pick up where the medical treatment leaves off." [Fred Wilson] Currently Co2 lasers are used for treatment of rosacea symptoms. Though not fatal the disease has debilitating consequences on the personality of the patient and hence necessitates a thorough understanding and professional treatment.