Rosy cheeks? Ruddy complexion? Pimples and pus bumps? Enlarged bumpy nose? Redness and irritation of the eyes? All of these symptoms suggest a diagnosis of rosacea, a chronic inflammatory condition of the skin. Patients often want to know what causes it. Researchers have been hard at work trying to answer that very question. The truth is that it’s probably partly genetic and partly from the patient’s environment. We’ve known for awhile that things like caffeine, hot beverages, alcohol, and spicy foods can cause flares. Sun exposure and sun damage tend to worsen the disease with time too. There are also organisms such as Demodex mites on the skin (yes, everybody’s skin) that may trigger flares in some people.
Some studies of twins showed that rosacea likely has a genetic basis as well. Identical twins who have the same set of genetic information have more similar rosacea scores than fraternal twins who have different sets of genes (but are as closely related as other sets of siblings). The genetic information someone inherits may control things like the immune system’s response to the environment. For example, a rosacea patient may have more inflammation from exposure to the same trigger than a normal person who is exposed to the same thing. There's also the idea that “vascular signals” are elevated in rosacea. This may explain why there is easy flushing and persistent redness.
There recently has been a large focus on rosacea and its association with other disease including heart disease, high blood pressure, gastroesophageal reflux and even dementia. While further study is needed in all of these areas, it does make sense that inflammation in the skin is not only confined to the skin, and some of this inflammation MAY be associated with disease elsewhere in the body. At this time, no increased testing is recommended for rosacea patients. We continue to recommend the routine screening tests that are recommended for the general population for our rosacea patients unless specific signs or symptoms are present.
Some new treatments have been developed in the last few years in addition to the tried and true therapies such as oral antibiotics and topical antibiotics. The relatively recent addition of topical ivermectin cream has helped a lot of patients achieve better control. Other topical medications can act on the blood vessels to decrease flushing and help with redness in particular. We continue to recommend photofacial treatments targeting the blood vessels as well. All of these treatments are best accompanied by consistent daily facial sunscreen use and gentle skin care.
With continued research on the horizon we have hopes that rosacea care will be even further improved in the future.