Last updated date: 10-Feb-2023

Originally Written in English

What is Rosacea?

    Our skin is an incredible organ. Did you know that the skin is the largest body organ? Skin and its appendages (nails, hair, and certain glands) form the largest organ in the human body with a surface area of 2 meters square. 

    The skin also comprises about 15% of the total body weight. The thickness of the skin ranges from the thinnest part at the eyelid which measures about less than 0.1 mm to the thickest part at the palm of the hands and soles of the feet which measure about 1.5 mm. 

    The structure of the skin is so fascinating. Each part does its job in a very accurate and organized way. 


    What is the structure of the layer? 

    The skin consists of several layers. The first layer is the epidermis, which is composed mainly of keratinocytes. 

    Under the dermis there is this multilayered structure that anchors the epidermis to the next layer, it is known as the basement membrane of the dermo-epidermal junction. After the basement membrane is the dermis layer. The layer beneath the dermis is the hypodermis; a layer that is mainly composed of fat. 

    This is briefly the structure of the skin but if you want to understand your skin more and know how it works, keep reading this article. 

    The skin structure is more than just enumerating each layer because its layer has its unique structure and functions. 


    So, let’s start with the first layer, the Epidermis. 

    The Epidermis is the outermost layer of the skin. It is a relatively thin layer; however, it is a tough layer.

    It is formed mainly of stratified squamous epithelium. In other words, it is composed of keratinocytes in different stages of differentiation. The keratinocytes originate from the cells in the deepest layer called the basal cell layer. 

    New keratinocytes are continuously migrating up towards the surface of the epidermis. When the keratinocytes reach the surface of the skin, they are gradually shed and replaced by new cells from below.

    The epidermis layer itself has an outermost portion called the stratum corneum. It is the waterproof portion of the epidermis and when undamaged, it prevents bacteria, viruses and other organisms from entering the body. So, it is a protective layer.

    And that is the whole point of having skin, the epidermis, along with the other layers of the skin, also protects the internal organs of the body, muscles, nerves and blood vessels from possible injuries.

    This protective power is increased in certain areas of the body where there is repeated friction such as the palms of the hands or the soles of the feet. In these areas, the stratum corneum is much thicker.


    In the basal layer of the epidermis, there are cells called melanocytes, which are scattered all over the basal layer. 

    Those specialized cells produce a pigment called melanin, which is the main factor that gives the skin its colour.

    However, melanin's primary function is not the coloring of the skin, in fact, its main function is to filter out the damaging and harmful ultraviolet radiation from sunlight.

    You can't imagine how important this function is if you don't know the harmful effects of ultraviolet rays on the human skin.

    Ultraviolet rays can directly damage our DNA causing numerous harmful problems such as skin cancers. 

    The epidermis doesn't only contain melanocytes, it also contains Langerhans cells which are part of the immune system of the skin.

    These cells defend the skin by detecting any infection or foreign substance. They also play a role in some types of skin allergies 


    The Dermis


    The next layer after the epidermis is the dermis. It is a thick layer composed of fibrous and elastic tissues. It is made mostly of collagen and a small amount of elastin that gives the skin its flexibility and strength.

    The dermis is the layer that contains the important skin appendages ( sweat glands, oil glands and hair follicles), nerve endings and blood vessels.

    The nerve endings are responsible for our feelings of pain, touch, pressure and temperature. Some areas have more nerve endings than others, for example, the fingertips and toes contain many nerve endings and are highly sensitive to touch.

    The sweat glands in this layer are responsible for the sweat on hot days and in response to stress. Human sweat is composed of water, salt and other chemicals. Sweat is very important in the regulation of the temperature of the body because as the sweat evaporates it helps cool down the body.

    Some areas of the body have specialized sweat glands such as in the armpits and the genital regions. They are called apocrine sweat glands and they secrete a thick oily sweat that produces a specific body odor when it is digested by the bacteria in these specific areas.

    There is another type of gland in this layer which is the sebaceous gland. Sebaceous glands are made specifically to secrete sebum/oil into the hair follicle. This sebum or oil helps keep the skin moisturized and soft and acts as a barrier against foreign organisms.

    The hair follicles make the various types of hair found in different areas of the human body. Some people think that hair is there only for appearance, while, in fact, hair has several physical roles.  Here are some of the hair functions:

    • Regulates body temperature.
    • Protects from injury.
    • Enhances sensations.
    • A portion of the follicle contains stem cells that help regrow damaged epidermis.


    Do you know what else helps regulate the body's temperature? 

    Blood vessels in the dermis layer. In addition to providing important nutrients to the skin, they help regulate the body's temperature.

    When the weather is hot, those blood vessels dilate, allowing large amounts of blood to circulate near the skin surface where the body can get rid of the heat.

    While cold weather makes the blood vessels constrict to retain the body's heat.

    The number of nerve endings, blood vessels, hair follicles and sebaceous glands is not the same throughout the body.

    The top of the head, for example, has many more follicles whereas the palms of the hands have none.  


    The last layer of the skin is the fat layer.

    It lies below the dermis and helps insulate the body from heat and cold. It also provides protective padding to the body. 

    Most importantly, the fat represents a great energy storage area for the body. This layer varies in thickness from a fraction of an inch on the eyelid to several inches on the buttocks and abdomen.

    The fat cells of this layer are held together by fibrous tissue to keep their integrity.


    This is how our skin works. Sometimes a simple disorder can disrupt the whole system of the skin.

    The skin, just like any other organ, has a variety of diseases and disorders that affect it.

    In this article, we are going to discuss one of the common disorders that affect the skin of the face, Rosacea.

    Have you ever heard about Rosacea? 

    Either the answer is yes or no, in this article, you are going to learn everything about this skin disease.


    What is Rosacea?

    Rosacea is a common skin disorder that usually affects the skin of the face. It makes the face look red, especially on the nose, cheeks, chin and forehead.

    As time goes by, the redness doesn't get better, on the contrary, it may become more intense taking on a ruddy appearance. Small blood vessels may even become visible.

    It may also produce small pus-filled bumps. 


    But the question is, does it only appear on the facial skin?

    Sometimes rosacea appears on the chest, ears, scalp or neck.

    It can also affect the eye making them irritated and appear bloodshot or watery all the time. It is then called ocular rosacea. Styes also may occur.


    Who is more liable to get Rosacea?

    Liable to get Rosacea

    Rosacea usually affects people who have fair skin and tend to blush easily. They are at a higher risk of developing it.

    It doesn't have a certain age group but it is more commonly seen in adults over the age of 30, they are more likely to be affected. However, rosacea also occurs in adolescents. It is rarely seen in children but children can get some infections that give them a slapped cheek appearance.

    And, of course, a family history of rosacea increases the risk of getting it.

    Rosacea is more common in women, but it can affect men and when it does, the symptoms are way more severe, possibly because men usually delay the treatment until the case is severe.

    Rosacea can be quite challenging to spot because it is always mistaken for natural ruddiness or acne, especially that its signs and symptoms flare up for weeks to months and then go away for a while.


    What are the symptoms of Rosacea? 

    Humans are different, and so are the symptoms of any possible disease.

    Rosacea symptoms vary greatly from one person to another.

    Besides, the symptoms don't appear all at once. Most of the time symptoms include at least one of the primary signs. Many secondary signs might also develop.


    What are those primary signs?

    Primary signs of rosacea include:

    • Flushing. People who have rosacea usually have a history of frequent blushing or flushing. This facial redness that often comes and goes is usually the earliest sign of this skin disorder. It might be difficult to notice this flushing in people with brown or dark skin.
    • Persistent redness. Some people might think it is a blush or a sunburn that doesn't go away but it is not. It might be one of the early symptoms of rosacea.
    • Bumps and pimples. When rosacea is not treated, small red bumps and pus-filled pimples can develop. Because bumps might resemble acne, people think it is just acne. But it is not acne because blackheads are absent. 
    • Burning and stinging. Patients might also feel burning or stinging pain. The skin feels hot and tender.
    • Visible blood vessels. People who have rosacea can see small blood vessels visible in the skin of their cheeks and nose, it is sometimes called "spider veins".

    Those are the primary signs, but other potential signs and symptoms include:

    • Eye irritation. It is a condition called ocular rosacea, in which the eyes are always watery and appear bloodshot. The eyes also appear red and eyelids become swollen. In some cases, the eye symptoms occur before the skin symptoms. If it is left untreated, it can lead to serious corneal damage and loss of vision.
    • Burning or stinging sensations. Some cases have reported burning, stinging, itching sensations, and others reported a feeling of tightness in the face.
    • Plaques. It means that raised red patches develop in the area affected by rosacea while the surrounding healthy skin is intact.
    • Dry appearance. The area of the face that is affected by rosacea appears dry and rough. Plaques also develop and make it look dry.
    • Swelling. Sometimes facial swelling can develop. It can occur independently or associated with other signs of rosacea.
    • Skin thickening. Some cases of rosacea develop a condition known as "Rhinophyma". In this condition, the skin thickens and enlarges from excess tissue. It most often occurs on the nose, giving it a bulbous appearance. Rhinophyma occurs more often in men than in women.
    • Signs in other areas beyond the face. Sometimes symptoms and signs develop in other areas beyond the face, as we mentioned before, in areas like the chest, scalp, ears and neck.


    When should you see a doctor?

    If you notice that you have persistent blushing or other symptoms on your face or eyes and they don't go away, contact your dermatologist for a diagnosis and effective treatment.


    But why is this persistent blushing? What causes Rosacea? 

    Doctors haven't recognized a single specific cause of rosacea up until this moment. However, different theories exist regarding the cause. One theory suggests that rosacea might be a component of a more generalized disorder of the blood vessels. Other theories claim that it might be due to microscopic skin mites, fungus, psychological factors or a connective tissue disorder under the skin.

    Some dermatologists think it could be due to an overactive immune system, hereditary, environmental factors or a combination of all these factors. But the sure thing is rosacea doesn't happen due to bad hygiene and it is not contagious.

    Flare-ups, however, usually happen if triggered by: 

    • Hot drinks.
    • Spicy food.
    • Red wine and other alcoholic beverages.
    • Extremes of temperature.
    • Sun or wind.
    • Psychological state or emotions.
    • Some cosmetic, skin or hair care products.
    • Exercises.
    • Drugs that cause dilation of the blood vessels, including some blood pressure medications.  


    There are also some identified risk factors. As we mentioned, anyone can develop rosacea, but some people are more likely to develop it if they exhibit these risk factors:

    • Being a female.
    • Having fair skin that burns easily in the sun.
    • Being over 30.
    • Smoking.
    • Having a family history of rosacea.


    How is Rosacea diagnosed? 

    Most dermatological diseases can be diagnosed just by looking at the lesion and assessing the symptoms and signs.

    And it is the same with rosacea.

    If you have rosacea, or you suspect you have it, your doctor will conduct a thorough examination of your signs and symptoms.

    He or she will also take a detailed medical history from you.

    During this examination, you should tell your doctor or dermatologist everything about your symptoms or any problems you are having with your faces such as redness, itching, pimples, bumps or burning.

    But you must know that, unlike other diseases, there isn't a specific test for rosacea.

    So, in conclusion, the main things that your doctor relies on to diagnose you are examinations of your skin and the history of your symptoms.


    But what if your doctors asked for some tests? 

    Don't worry. In this case, your doctor either suspects another diagnosis or wants to rule out other conditions such as psoriasis or lupus.

    This is significantly important in people who have dark skin because studies show that rosacea can be missed or misdiagnosed as an allergic reaction or seborrheic dermatitis in people of colour.

    If your symptoms involve the eyes, your doctor will refer you to an ophthalmologist who might also ask for some tests or examinations.


    How is Rosacea treated?


    Unfortunately, there is no specific treatment for rosacea. Treatment only controls the symptoms and prevents their further progress. Most often this means that treatment involves good skincare and prescription drugs.

    The duration of treatment depends on the type of rosacea you have and the severity of your symptoms. But you must know that it usually recurs.


    What are the medications used in the treatment of Rosacea? 

    Prescription drugs for rosacea include:

    • Topical agents that reduce flushing. Doctors prescribe topical creams or gels for mild to moderate rosacea to apply to the affected skin. Some topical agents reduce flushing by constricting blood vessels such as brimonidine and oxymetazoline. Results can be noticed as soon as 12 hours after use. But the effect is temporary, therefore the cream or gel must be applied regularly to improve the case.
    • Topical agents to control pimples. These drugs include azelaic acid, metronidazole and ivermectin. Azelaic acid and metronidazole don't show instant improvement of mild rosacea. Ivermectin may take even longer to improve the skin condition but it results in longer remission than metronidazole.
    • Oral antibiotics. For moderate to severe rosacea with bumps and pimples, doctors may suggest oral antibiotics such as doxycycline.
    • Oral acne drugs. People who have severe rosacea that doesn't respond to regular treatment may be prescribed isotretinoin. It is a very powerful oral acne drug that helps clear acne and acne-like rosacea pimples. But this drug can't be used during pregnancy because it has severe side effects on babies, it can cause serious birth defects.


    Are there other modalities of treatment?

    Treatment options rather than oral drugs and topical agents are present.

    Currently, laser therapy is strongly involved in the treatment of many skin conditions.

    And rosacea is no exception. Laser therapy can be used to make large blood vessels less visible because it targets visible veining. That's why it is the most effective option for skin that isn't tanned, brown or dark. For brown and dark skin, laser therapy might cause long-term or permanent discoloration of the treated area of the skin.

    But, of course, like any other treatment option, there are some risks and side effects.

    Laser side effects  for rosacea include:

    • Swelling.
    • Bruising that might last for a few days.

    People usually are discouraged to go through the whole laser therapy experience because, during the recovery period of the laser therapy, icing and gentle skincare will be needed. So, they think too many steps and instructions are needed.

    Besides, the full effect of the treatment might not be noticed for weeks. Multiple sessions might be needed periodically to maintain the improved appearance of the skin.

    Another issue about laser treatment is that insurance companies usually consider it as a cosmetic procedure, so they don't cover it.


    Some people prefer natural solutions and home remedies to treat their conditions.

    So, here are some of the lifestyle tips and home remedies you can follow to help you control your rosacea signs and symptoms and prevent flare-ups:

    • The first step you need to take is to identify your triggers. Pay attention to your routine and identify the factors that tend to trigger flare-ups for you and avoid them.
    • A very important step is to always protect your face. Apply sunscreen generously daily on your face before going outdoors. Use a broad-spectrum sunscreen that blocks both ultraviolet  A and ultraviolet B rays. Apply sunscreen after you apply your medicated face creams and before any cosmetic products.
    • Take other steps to protect your skin. Wear a hat and avoid the midday sun. In cold, a d windy weather, wear a scarf.
    • Treat your skin gently. Don't touch your face too much and don't rub it harshly. Always choose fragrance-free products for your skin.