Rosacea is the bat-like spread of papules and pustules across a person's nose, cheeks and chin.


Rosacea is the bat-like spread of papules and pustules across a person’s nose, cheeks and chin. While often referred to as adult acne, rosacea is actually a vascular condition attributed to excessive flushing and blushing. It most commonly appears on Caucasians who live in northern climates. It’s as if one day those super-excited blood vessels in their faces just stayed open, broken, smack on the surface...

Rosacea was first written about in the 14th century by Dr. Guy de Chauliac, who called it "pustules de vin" (pimples of wine) and attributed the ravaging skin condition to excessive drink. Early treatments included blood-letting in the arm, forehead and nose, as well as applying leeches to the face. Unfortunately, rosacea still has no cure. Although it is not life-threatening, it is a chronic disorder of flare-ups and remissions which become increasingly severe without long term management. Rosacea sufferers must engage in strict lifestyle modification techniques, first monitoring and then avoiding aggravating food, drink and physical activity which makes them breakout. Most common are factors such as hot baths, cold weather, spicy foods, alcohol and emotional stress.

Basically, rosacea begins as an accentuation of the normal flush reaction in adolescence. It is also thought to stem from a vitamin B deficiency or a digestive disorder. Many sufferers first notice the redness on their skin and simply write it off as sunburn. Yet when the hot facial pain of rosacea is left unacknowledged, it advances at a quicker pace and the redness just becomes more permanent.

The disease advances in three stages. First, unsightly scarlet patches on the cheeks, nose and forehead wax and wane. The sufferer may sight small blood vessels breaking open and their eyes may feel gritty.

In the second stage, rosacea’s itchy warmth becomes ruddier and more pronounced. Bumps and pimples emerge and those tiny blood vessels that had just grazed the surface now expand without remorse. The sufferer’s eyes may become bloodshot.

The advanced stage of rosacea presents a severely inflamed face whose nose is often bumpy, swollen and ruby red. With time, the vessels of the face become fully dilated. The skin thickens and may become complicated by cysts and pustules. An oily sheen pervades. Long term eye damage is possible.

While rosacea is prevalent in both women and men, an especially nasty outgrowth of the advanced stage is more common in men. Rhinophyma ("nose growth") is when the sebaceous glands in the nose undergo hypertrophy (i.e. considerable expansion). As the deformity worsens, pits, nodules, fissures, lobulations, and pedunculations contort the snout into grotesque cosmetic proportions. The nasal ducts become elongated, dilated and plugged. Tiny bacteria can be found within the nose’s inflamed and tubular pits. Worse, the nasty little mite known as dermodex folliculorum regularly takes up residence in the units of these thick and swollen burning noses.

It is no great surprise that many of my patients suffer a huge loss of self-esteem, seeing as how their once peaches n’ cream complexion has turned trashy and efflorescent. The National Rosacea Society suggests that if a person finds themselves the object of stares during a flare- up, they should try to turn the awkward situation into a positive educational opportunity by openly discussing their condition and educating the offender. For example: "My rosacea is a vascular affliction. It does not have to do with uncleanliness or drink."

One of my strongest patients in this regard, Ms. A. (pictured here) told me that when she caught her priest (yes, her priest) staring at her flaring red skin in what she thought was disgust, she rose up one Sunday, faced the congregation and pronounced: "It is by the grace of the Lord that I do not give in. My skin is my salvation. I used to be a looker. Jesus brought me down. Yes the Lord cures all afflictions. For after He brings a disease, He always brings a remedy. My friends, I burn through my skin with love for the Lord."