One of the most common skin diseases is also one of the least diagnosed.
Rosacea, a chronic inflammatory skin condition that begins with flushing and redness of the face, affects at least 13 million Americans. But because those early symptoms are often neglected or misdiagnosed, many people don't seek treatment until later, when the disease has advanced to red bumps, pus-filled pimples, skin thickening and, in severe cases, enlargement of the nose. The late comedian W.C. Fields had rosacea. So do actress Cynthia Nixon and former President Bill Clinton.
While systemic antibiotics and topical creams are common medical interventions, experts and patients say avoiding trigger factors, including sun exposure, alcohol and spicy foods, is essential to maintaining remission. People with milder cases say that lifestyle adjustments, natural remedies and customized facials often are enough to control their rosacea.
The cause of rosacea is unknown, but research suggests that sufferers have facial blood vessels that dilate easily and remain dilated, increasing blood to the surface of the skin and making it appear red and flushed, says Martin Steinhoff, a dermatologist at UCSF Medical Center and an expert in rosacea. About 20 percent of rosacea sufferers also have small intestinal bacterial overgrowth, he says. Treating the overgrowth with antibiotics clears up rosacea in up to 80 percent of them.
For the majority of sufferers, rosacea and the burning and stinging that come with it are very problematic, particularly in social situations.
"This flushing can be very embarrassing," says Steinhoff, who has seen more than 2,000 cases of rosacea. "It has a huge impact on their quality of life. Depression is frequent in people with rosacea, because they lose confidence and become unhappy in their work and relationships."
People at the greatest risk of developing rosacea are those with fair skin or of European ancestry who tend to flush or blush easily. But that doesn't rule out Asians and African-Americans, says dermatologic surgeon Min-Wei Christine Lee, who used laser treatment to reduce redness and remove visible blood vessels caused by her own rosacea.
"Their faces don't show it (flushing) as easily, but it's there," says Lee, director of the East Bay Laser and Skin Care Center in Walnut Creek. By the time many seek help, they're exhibiting symptoms of stage two, or papulopustular rosacea, including bumps, pimples, enlarged veins and pores. "If you nip it in the bud early, it won't progress to those deformities (of the nose)."
Lee is referring to stage three, or phymatous rosacea, a thickening of the skin on and around the nose that makes the nose appear ruddy and bulbous. It is more common in men, because they have a greater concentration of large pores and oil glands near the nose, she says. Rosacea is also a progressive condition, and men do not seek treatment as early or often as women.
"Women tend to be more aware and sensitive about their skin and appearance," Lee says.
In 2010, Andrea Weisheimer started noticing red bumps on her cheeks and around her nose when she became overheated or after she consumed red wine or tomatoes. She was diagnosed with rosacea and prescribed a topical cream.
When the cream didn't improve her skin, she turned to natural remedies. Ultimately, she found that applying unrefined virgin coconut oil mitigated the redness and bumps. V-beam laser treatment, an advanced pulsed dye laser most commonly used to treat facial veins, scars and rosacea, also helped.
"I just decided to get healthy, because that's what it's really about," says Weisheimer, 37, of Walnut Creek, Calif. She stays away from alcohol, especially red wine, and wears hats in the sun.
Cindy Hudson, of Pleasant Hill, also saw results after an aesthetician used laser therapy on the rosacea pimples across her nose and the sides of her face. Hudson, 56, has had rosacea half her life and says customized facials using products with redness-reducing vitamin C and cooling green tea produce the best results on her skin.
"I also stay away from harsh scrubs and skin products with a lot of chemicals," she says.
Shabnam Madani, the head of cosmetic dermatology at Kaiser Permanente Walnut Creek, concurs. Before using any product on the skin, rosacea patients should always do a test on the inner arm to check for irritation. Highly perfumed products or products with vitamin A, fruit or glycolic acids also should be avoided.
"If you have rosacea, you also have really sensitive skin," Madani says. "The best thing to do is play it safe and avoid anything harsh."
One (erythematotelangiectatic rosacea)
Symptoms: Flushing, persistent redness; visible blood vessels
Two (papulopustular rosacea)
Symptoms: Persistent redness; transient bumps and pimples
Three (phymatous rosacea)
Symptoms: Skin thickening and possible enlargement of nose from excess tissue
Four (ocular rosacea)
Symptoms: Dry eye, tearing and burning; swollen eyelids, recurrent styes, potential vision loss from corneal damage
Causes: Research suggests that facial blood vessels in sufferers may dilate too easily, and the increased blood near the skin surface makes skin appear red and flushed. Rosacea affects all segments of the population, but individuals with fair skin who tend to flush or blush easily are at greatest risk. Common triggers include sun exposure, exercise, stress, alcohol and spicy foods.
About 20 percent of rosacea patients test positive for an overgrowth of H. pylori, the bacteria commonly known to cause stomach infections. Treating the bacteria overgrowth clears up the rosacea in as much as 80 percent of that population.
Treatments: Medical therapies include systemic antibiotics and topical solutions. Lifestyle changes, such as avoiding sun exposure and irritants found in cosmetics and skin care products, prevent flare ups. Sufferers with mild rosacea have seen results from applying coconut oil, iced green tea and customized facials or lasers. Consult your doctor before seeking any treatment.
Resources: National Rosacea Society (www.rosacea.org), Rosacea Support Group (http://rosacea-support.org)
-- National Rosacea Society
Tips and Tricks
The following lifestyle changes and natural remedies are culled from patients, aestheticians and physicians. They can make a difference in mitigating rosacea symptoms.
1. Use makeup with green undertones. They counter redness.
2. Drink cold white wine instead of room temperature red wine.
3. Wear SPF 50 sunscreen or a hat even on cloudy days.
4. Splash cold water on your face before and after workouts.
5. If you drink hot coffee or tea, put a lid or cover on it.
6. Cook with a lid on your pots and pans as much as possible.
7. Freeze green tea in ice cube trays. Wrap cubes in towel and apply to skin to reduce redness.
8. Unrefined virgin coconut oil can reduce redness and irritation for some rosacea patients.