Rosacea

Introduction

Does your face always look red? Do others think you are blushing even when you are not? If so, you may be one of the 14 million Americans estimated by the National Rosacea Society to have rosacea (roh-ZAY-sha) ? a chronic skin condition that often causes the face to be red and flushed.

What is it?

Rosacea is a chronic, usually progressive inflammatory disorder characterized by persistent redness (flushing) of the face. If the condition worsens, blisters, red bumps (papules), or pus-filled eruptions (pustules) resembling acne may appear. In some cases, thickening of the skin may result in an enlarged nose. Rosacea may also cause eye irritation and conjunctivitis (inflammation of the clear membrane covering the eyeball and the inside of the eyelids). While rosacea most commonly appears on the central parts of the face (cheeks, chin, forehead, and nose), it may also occur on other parts of the face and on the chest, scalp, neck, back, and even the arms or legs.

Sometimes, rosacea is called "adult acne". In fact, it was formerly called "acne rosacea," a term that is no longer used because it suggested a connection with "acne vulgaris" (the acne that commonly affects teens). Unlike teen acne, rosacea has no relationship to hormone levels and it does not cause clogged pores.

The course of rosacea is highly individualized?meaning that what each person experiences is different. Additionally, symptoms of rosacea can come and go ? flaring up at times followed by periods of remission.

Although rosacea symptoms vary greatly, four major subtypes of rosacea currently are recognized by the National Rosacea Society. Subtypes are based on general patterns of symptoms. Some individuals have only one subtype of rosacea; others may experience more than one subtype at the same time. Many rosacea patients start with subtype I and then develop other subtypes.

Individuals with any subtype of rosacea often describe a burning or stinging sensation similar to a severe sunburn on their faces. The addition of a fifth subtype, tentatively called "neuropathic rosacea", has been suggested by some dermatologists to classify this burning facial pain that is not always accompanied by other rosacea symptoms.

Each of the subtypes of rosacea is further classified by a severity grading scale of 0 to 3:

Grade 0 ? no symptoms

Grade 1 ? mild symptoms

Grade 2 ? moderate symptoms

Grade 3 ? severe symptoms

Please click on the following links to learn more about the different subtypes of rosacea.

Subtype I ? Persistent Redness (Erythematotelangiectatic Rosacea)

In this most common form of rosacea, the face is easily irritated and the affected individual may appear to be blushing for prolonged periods of time. Persistent redness (flushing) may affect any part of the face, but it generally occurs on the central areas (nose, cheeks, forehead, and chin). Frequently, tiny widened or broken blood vessels (known as telangiectasia ? tel-AN-je-ek-tay-ze-ah) can be seen under the skin.

Subtype II ? Acne-Like Rosacea (Papulopustular Rosacea)

In addition to persistent facial redness and irritation, acne-like rosacea includes the development of red dome-shaped bumps known as papules (pustules, if they contain pus) on the face. The severity grading scale for subtype II rosacea is based on the size and quantity of bumps ? from grade 1, which involves relatively few small, mild papules and/or pustules through grade 3 with more numerous, larger, and more severe eruptions

Subtype III ? Thickening of the Nose (Phymatous Rosacea)

In the third subtype of rosacea, persistent skin flushing and inflammation is accompanied by thickened skin. Occurring mainly on and around the nose, the thickened skin is also bumpy, spongy, or pitted in appearance. It may become yellowish in color and waxy in texture due to increased size of the oil glands in the skin. The resulting large, rounded, red nose is known medically as rhinophyma (ri-no-FI-ma) and it occurs almost totally among middle-aged and older men. In some cases of subtype III rosacea, the chin, forehead, ears, and/or eyelids may also be affected. In Grades 2 and 3 of subtype III rosacea, papules and/or pustules appear on the face. Severe rhinophyma may block normal breathing.

Subtype IV ? Eye Irritation (Ocular Rosacea)

Ocular rosacea eventually affects more than half of individuals with rosacea. Their eyes may itch, burn, or sting; feel as if they are swollen or dust is in them; and/or look red or bloodshot. Vision may be blurred and an inability to tolerate light may develop. Many individuals with ocular rosacea experience dry eyes due to abnormalities in tear production. On the other hand, this rosacea subtype can also make the eyes water. While ocular rosacea is not usually severe, it may cause scars on the eyelids or even on the corneas (the thin transparent coverings of the eyes). Rarely, vision may be damaged permanently.

What causes it?

Relatively little is known about possible causes of rosacea. Changes in the ways that the body reacts to micro-organisms (such as bacteria that ordinarily live on the surface of the skin or mites that live in oil glands and hair follicles of the face) may be involved. Fungal infections of the skin may also play a role in developing rosacea. Recently, some cases of rosacea have been identified in patients who also have food allergies or stomach ulcers, but no definite links have been established. Another theory associates rosacea with the breakdown of connective tissues (such as collagen) that usually support the tiny blood vessels under facial skin. None of these possible causes has been proved and most researchers believe that several different factors may be involved in rosacea.

Although rosacea?s causes are still a mystery, it is well known that many factors can start (or trigger) a rosacea flare-up. Alcohol, caffeine, exercise, menopause, hot baths or showers, hot beverages, spicy foods, smoking, stress, weather, wind, long-term use of topical steroids, and ultraviolet light (from natural sunlight or tanning beds) may all trigger and/or aggravate the condition for susceptible individuals. Specific triggers do not always cause a flare-up for the same individual, however; and different factors may produce flare-ups for different individuals.

Rosacea is not contagious ? direct contact with a person who has it will not result in developing it. Similarly, rosacea is not associated with poor hygiene. Also, even though a reddish complexion and a large, bumpy, rounded nose are often attributed to alcoholism, no evidence links alcohol consumption with causing rosacea. Drinking alcohol causes blood vessels to widen, though, so drinking may trigger or worsen a flare-up. Rosacea has a strong ethnic relationship and an inherited tendency to blush easily is common among rosacea patients. Probably, both genetic and other factors contribute to developing rosacea.

Who has it?

An estimated 14 million Americans have rosacea. Sometimes called the "Curse of the Celts", rosacea is more likely to be diagnosed among fair-skinned individuals ? especially those of Celtic, Northern European, or Scandinavian origin. In populations with naturally darker skin (such as African-Americans, Asians, Hispanics, or Native Americans) rosacea may be less likely to occur, it may have different symptoms, or it may not be as noticeable. Although women are two to three times as likely to develop rosacea, the condition tends to be more severe in men. Most new cases are seen in individuals who are between 30 and 50 years of age.

What are the risk factors?

Risk factors are characteristics that can make an individual more likely to develop a condition. Having specific risk factors does not necessarily mean that getting a particular disease or condition is certain. However, having more than one risk factor usually increases the chance of developing the condition. If you have risk factors for rosacea, you may want to discuss ways to prevent or treat it with your doctor. Some of the main risk factors associated with developing rosacea are:

  • Being female
  • Having light-colored skin
  • Being 30 to 50 years of age
  • Having a close family member with the condition
  • Being from any of the following ethnic backgrounds: English, Scottish, Scandinavian, and Northern or Eastern European

What are the symptoms?

Early symptoms of rosacea may not be recognized right away because they usually develop gradually ? often over many years. Individuals with rosacea tend to blush easily, even as children, so reddened facial skin may not be considered unusual until it becomes chronic or other rosacea symptoms develop. In addition, rosacea symptoms are not always apparent; they may come and go repeatedly at irregular intervals. Due to similar symptoms, rosacea may also be confused with other skin conditions such as acne, eczema, psoriasis, or seborrheic dermatitis.

The most common early symptoms of rosacea include:

  • Frequent blushing
  • Persistent facial redness (flushing) that resembles a sunburn
  • Tiny but visibly widened (dilated) blood vessels ("spider veins") on the face
  • A warm or burning sensation on facial skin
  • Red bumps or pimples on the face
  • Dry, watery, or irritated eyes

Other facial symptoms of rosacea may include:

  • Blisters, papules, or pustules
  • Plaques (raised red patches)
  • Rough, dry, or scaly skin
  • Skin thickening
  • Swelling

Individuals with symptoms that might be from rosacea are advised to seek care. Typically, rosacea is treated by a dermatologist, a doctor who specializes in treating skin conditions. Early evaluation of symptoms will help to determine the best course of treatment. Although rosacea cannot be cured, its symptoms may be controlled and appropriate treatment may also slow or prevent its progression.

Untreated rosacea may become physically disfiguring. Because it most often appears on the face, even mild rosacea may cause psychological problems by making patients self-conscious about their appearance. Individuals with rosacea may tend to avoid social engagements and their job performance may decline during flare-ups. In some cases, rosacea may lead to serious anxiety or depression.

How is it treated?

While rosacea currently has no cure, various treatments are available that can help control it. Treatment may also keep it from progressing. Since the symptoms of rosacea usually vary not only from individual to individual, but also from time to time for any one patient, the choice of treatment will depend on the subtype and severity of rosacea, as well as on the patient?s emotional and physical impairment. Some rosacea treatment options include topical antibiotics, other topical preparations, oral antibiotics, laser therapy, and plastic surgery. Treatments for rosacea involving the eye may require recommendations from an eye doctor.

The main goals of rosacea treatment are to control the flare-up, prevent or decrease progression, and improve the appearance of the skin. Unfortunately, several weeks or months of treatment may be needed before improvement is apparent. In fact, topical treatments may even worsen facial redness at first. Most often, laser therapy is used to eliminate tiny widened blood vessels under the skin, and surgery removes thickened skin (most commonly from the nose). Laser and surgical treatments usually result in bruising and/or swelling that may take several days to disappear.

Drug Treatment

Generally, a rosacea flare-up is treated with a combination of prescription drugs. A topical product (an antibiotic and/or another type of drug) may be applied to the affected areas and oral antibiotics may be taken, as well. Both topical and oral medications are used to reduce inflammation and/or control micro-organisms that may be involved with the flare-up. Once the flare-up is under control, oral antibiotics usually are discontinued. Topical products are often used continuously, however, to help maintain remission and prevent recurrence.

Topical Preparations

The U.S. Food and Drug Administration (FDA) has approved three topical products ? metronidazole, azaleic acid, and sodium sulfacetamide and sulfur ? for treating rosacea. Topical preparations, which may come in a variety of forms that include creams, gels, ointments, and solutions, are applied directly to affected areas of the face. While topical antibiotics are widely used to treat rosacea, their effectiveness may be due more to anti-inflammatory or antioxidant properties than to antibiotic activity. A cream or gel form of metronidazole is the topical antibiotic most often used for rosacea. Other topical antibiotics that may be used to treat the condition include clindamycin and erythromycin.

Topical tretinoin, a vitamin A derivative that is not an antibiotic, sometimes is used to reduce rosacea papules and pustules. Benzoyl peroxide, commonly used in both prescription and over-the-counter products to treat teen acne, may also treat rosacea eruptions. Not only antibacterial, benzoyl peroxide also promotes exfoliation (also called desquamation) ? it causes dead skin cells to fall off. It may cause stinging and worsen redness for some patients, however. In fact, most topical medications cause dryness, which may make skin look and feel more irritated ? especially when therapy is begun. Gently applying small amounts of the topical preparation only twice a day, avoiding sunlight, and applying a water-based moisturizer can help reduce irritation.

Oral Antibiotics

Short treatments (a few days or weeks) of an oral antibiotic, such as azithromycin, clarithromycin, doxycycline, erythromycin, minocycline, or tetracycline, may be given to control a flare-up. Frequently, these drugs are also used to treat teen acne. Due to possible side effects, longer-term oral antibiotics usually are reserved for rosacea patients with more severe forms of the condition or for those with eye-related symptoms. Typically, oral antibiotics are more effective than topical antibiotics in clearing papules and pustules.

Occasionally other types of oral drugs may be used to treat rosacea. For example, isotretinoin, which is used mainly for teen acne, may help clear rosacea papules and pustules. Improvement may take several weeks to be visible, though, and oral isotretinoin has multiple side effects that limit its use for some individuals. Some women with rosacea have seen improvement in skin eruptions while taking oral contraceptives. Certain blood-pressure medications may reduce facial redness for some individuals. These treatments are not FDA-approved for rosacea.

To learn more about topical antibiotics, other topical preparations, and oral antibiotics used to treat rosacea, click on the drug class links below.

Laser Therapy

Mainly used for the removal of tiny broken blood vessels in the skin, vascular laser therapy can also be used to reduce red bumps and skin thickening. Currently, Pulsed Dye Lasers (PDLs), which work by releasing a strong burst of precisely-directed, single-wavelength light onto the affected skin, are used in treating rosacea. Heat from the vascular laser causes damaged blood vessels under the skin to collapse and disappear. Usually lasting for about 15 to 30 minutes at a time, PDL treatments generally cover a small area of the face at a time. Typically, multiple treatments are needed. Because patients may need several days to recover from bruising, pain, redness, or swelling that may follow laser treatments, the treatments are typically scheduled at 4 to 6 week intervals.

Laser therapy may improve skin appearance, but it cannot remove excess tissue. Because they do not break the skin, vascular laser techniques usually result in little or no scarring. However, most patients feel a painful stinging sensation during the laser pulses and up to one-fifth of patients experience temporary or permanent hyperpigmentation (darkened spots) after laser treatments for rosacea. During treatment, the face may have a patchwork appearance of treated and untreated areas.

Dermabrasion

Dermabrasion involves the use of a rough material to wear away the top layers of skin that has been deadened with a chemical spray. The new skin that appears in about a week is usually smoother. For rosacea, dermabrasion is used mainly for patients who have thickened skin. The use of dermabrasion for other forms of rosacea is controversial; some dermatologists think it may worsen skin reddening. Dermabrasion may also leave scars or darkened areas of skin.

Plastic Surgery

Usually, plastic surgery is reserved for patients whose skin has thickened severely. Most often, a type of surgery called rhinoplasty ("a nose job") is used to restructure the nose. It involves removing the excess skin and other tissue that has accumulated. Surgically removing tissue not only can reduce the size of the nose, it can also lessen surface bumps ? often improving appearance dramatically. To treat rosacea, surgery is usually an outpatient procedure performed under local anesthetic in a clinic, doctor?s office, or hospital outpatient department.

Several different surgical techniques have been successful for rosacea depending on the extent of deformation. They include:

  • Traditional plastic surgery ? Using a scalpel (a thin knife blade), the surgeon cuts away excess tissue and remodels areas it has deformed. Rosacea patients undergoing traditional surgery may be hospitalized ? especially if large areas of tissue must be removed. They may need general anesthesia and recovery may take several weeks. Possible side effects from traditional plastic surgery include bruises, headaches, pain, scarring, and swelling. Since traditional plastic surgery involves cuts in the skin, infection may occur.

  • Electroknife (Hot Knife) ? This technique uses a highly-localized electric current applied through a fine wire to remove skin and reshape the disfigured nose. The heat from the electric current closes off the ends of tiny blood vessels, which helps to reduce bleeding and bruising. Damage to surrounding areas of the face may be less than with traditional plastic surgery, but similar side effects may occur. Recovery time may be shorter, however, usually about two weeks.

  • Laser ? Lasers used in surgery (usually an argon, CO2, or YAG laser) are different from the vascular lasers used to remove broken blood vessels and red spots. Light from a surgical laser penetrates deeper and literally vaporizes extra tissue. Laser treatment is usually less painful than traditional plastic surgery, but burns and swelling may result.

Emotional Support

In addition to treating the physical aspects of rosacea, attention also should be given to any related psychological issues. While treatment of the physical symptoms often helps to relieve self-esteem problems that may be associated with rosacea, several weeks or months of drug treatment may be needed to see improvement in skin appearance. Laser treatment may produce areas of normal-looking skin among patches of not-yet-treated, reddened skin. Either laser or surgical treatments may leave temporary swelling and/or permanent discoloration or scars. Individuals who experience emotional side effects of rosacea may want to consider counseling or join a rosacea support group. If anxiety or depression interferes with daily life, medication may be needed.

To learn more about non-drugs ways that can help keep rosacea under control, click on the "Helping Yourself" button at the top of this webpage.

Helping Yourself

Keep a diary:

One of the best ways to help prevent rosacea flare-ups is to avoid potential triggers. Keeping a written record of your flare-ups ? when they occur, what you eat and drink, what the weather conditions are, and other information ? can help you and your doctor to determine your triggers. The National Rosacea Society (www.rosacea.org) provides printable diary forms that you can fill out to help you keep track of relevant information.

Avoid foods and beverages that may trigger flare-ups:

Generally, individuals with rosacea should avoid hot spices such as cayenne, black pepper, chili, and curry. For many individuals, monosodium glutamate ? an ingredient often used in processed and Oriental foods ? causes facial flushing that may aggravate rosacea. Limiting intake of hot beverages, caffeine, and alcohol also lessens or prevents flare ups for many rosacea patients. Certain fruits and vegetables, dairy products, and marinated meats are other common foods that may trigger rosacea. You may want to avoid eating foods that you think may affect your rosacea.

Pay attention to facial cleansing and make-up:

  • Choose cosmetics and cleansers that do not contain alcohol, fragrances, or preservatives
  • Wash your face with a gentle soap or facial cleanser and lukewarm water
  • Try not to wash your face too often ? no more than twice a day, if possible
  • Pat your face dry with a soft towel or let it air-dry
  • Let your face dry completely before applying medication or make up
  • Use an electric razor instead of a straight razor blade
  • Avoid hot water, hot tubs, and saunas
  • Avoid powder make-up
  • Avoid scrubbing facial skin with rough cloths, sponges, and cleansers

Protect your face from the sun and extreme weather:

  • Avoid outdoor activities as much as possible during peak sun hours (from about 10 AM to 2 PM) and in very cold weather.
  • If you must be outside, always use a sunscreen of at least 15 SPF (sun-protecting factor), even on cold or cloudy days. Consider using a sunscreen that is sold for children because children?s products tend to be milder, possibly helping to reduce irritation. In addition, make sure your sunscreen protects against both UVA and UVB rays.
  • Wear a hat with a wide brim to shade your face from the sun.
  • In cold weather, cover your cheeks with a scarf to decrease skin dryness.

Try to avoid medications that can cause flushing:

Some medications can cause flushing, which may increase the redness and irritation of rosacea. If possible, avoid the use of topical steroids such as betamethasone, fluocinolone, and hydrocortisone.

Other common drugs that may cause or worsen flushing include:

  • calcitonin (for osteoporosis)
  • calcium channel blockers, such as nifedipine and verapamil (for high blood pressure)
  • dipyridamole (for preventing blood clots)
  • hydralazine (for high blood pressure)
  • morphine (for pain)
  • minoxidil (oral for the heart, topical for hair loss)
  • niacin (for high cholesterol and found in multiple vitamins)
  • nitroglycerine (for the heart)
  • raloxifene (for osteoporosis)
  • sildenafil (for erectile dysfunction)
  • tamoxifen (for breast cancer)

Many other drugs, including some that are given to treat cancer and others used to prevent rejection of transplanted organs, may cause facial flushing. If you notice a worsening of your rosacea when you take certain medications, discuss the benefits and risks of changing to a different drug with your doctor.

Avoid extreme exertion:

  • Discuss a new exercise program with your doctor before you begin it
  • Choose low intensity workouts
  • Exercise for short periods ? 15 to 30 minutes at a time
  • If you exercise outside, exercise in the morning or evening when temperatures are cooler

Try to avoid extreme temperatures (especially during flare-ups):

Since heat and cold can both cause flare-ups, try to stay in a well-ventilated, temperature-controlled room during extreme weather. When the weather is very hot and humid, limit the time you spend outdoors, sip cool drinks, or chew on ice chips to keep cool. In the winter, minimize exposure to cold and wind by staying indoors as much as possible. Try to avoid overheating while exercising by having a damp towel and cool drinks readily available.

Take care of your eyes:

  • As much as possible, avoid rubbing your eyes, and always wash your hands before touching your eyes.
  • For dry eyes, artificial tears may be used several times a day to replace moisture. Humidifying the air of the home may also help relieve dry eyes.
  • You also need to keep your eyes and eyelids clean. A cotton swab dipped in an over-the-counter eyelid cleanser or in baby shampoo that has been diluted with an equal amount of water may be used to clean the eyelids and eyelashes. Rinse thoroughly with lukewarm water.
  • Covering the eyes with a compress ? a clean cloth that has been dipped in warm (but not hot) water ? for a few minutes several times a day may help to loosen scaly skin and open clogged tear ducts.
  • To treat eye infections or inflammation that occasionally may be associated with rosacea, your doctor may prescribe antibiotic, anti-inflammatory, or antiviral eye drops or ointments.

Try stress-management techniques:

  • Practice deep breathing exercises
  • Stretch muscles as a whole-body stress reliever
  • Read or make time for another quiet, relaxing activity

What is on the horizon?

Even though no cure exists for rosacea, studies are being performed to find better treatments for the condition. For instance, drugs approved for other conditions are potential new drug treatments for rosacea. They include:

  • A topical form of azithromycin, an antibiotic similar to erythromycin
  • Permethrin, a drug commonly used to treat scabies and other skin conditions
  • Adapalene, a topical retinoid currently approved to treat acne

Zinc sulfate is a mineral that may have antioxidant properties. Oral zinc sulfate has been found to be effective in managing several dermatological conditions, including acne, and is currently being studied to see if it is an effective treatment for rosacea.

Additionally, some researchers have noticed that many individuals with rosacea also have stomach ulcers and that rosacea symptoms may improve when ulcers are treated. This possible link between rosacea and the bacterium Helicobacter pylori, a cause of peptic ulcer disease, is under investigation.

A new laser therapy, Intense Pulse Light (IPL), is also beginning to be used for rosacea. Similar to Pulsed Dye Laser (PDL) treatments, IPL uses more wavelengths of intensified light. IPL is believed to focus better on the damaged blood vessels and eliminate more of them permanently. Possibly, less normal tissue may be damaged and less bruising, pain, and swelling may result. Therefore, treatments may be scheduled more often and fewer treatments may be needed. Studies are currently being performed to determine efficacy and safety of this new laser therapy.

Research is also in progress to learn more about what causes rosacea. One promising area of research centers on the endoglin gene. Early study results seem to show that a mutation in the endoglin gene may make an individual more likely to develop telangiectasia (widened or broken blood vessels under the skin) when the face is exposed to environmental factors that can contribute to rosacea. Although all the functions of endoglin are not yet understood, it is known to have a role in the development and maintenance of blood vessels.

Higher than usual amounts of another natural body chemical, vascular endothelial growth factor (VEGF) may also be involved in rosacea. Researchers have found increased VEGF levels in skin that was exposed to ultraviolet light. Although the reasons for increased VEGF levels and their possible relationship to rosacea are not known, research into a potential link is ongoing.

Other researchers are investigating whether abnormal amounts of natural body chemicals may be associated with developing rosacea. For example, nitric oxide ? a chemical produced mainly in the linings of blood vessels ? may be overproduced in rosacea patients. Nitric oxide not only may promote inflammation, it also causes blood vessels to widen. Abnormal amounts of other natural substances, known as cathelicidins, adenosine triphosphate (ATP), and tumor necrosis factor alpha (TNF-alpha) may either cause rosacea or contribute to its development among individuals who are prone to get it. In addition, immune system malfunction may be associated with rosacea. All these theories are under study, but none has been proved, yet.

References

14 million Americans have rosacea and most of them don't know it. National Rosacea Society. No date given. Available at: http://www.rosacea.org/index.html. Accessed December 21, 2006.

Altinyazar HC, Koca R, Tekin NS, Esturk et al. Adapalene vs. metronidazole for the treatment of rosacea. International Journal of Dermatology. 2005;44(3):252-255.

American Academy of Dermatology: Rosacea. Available at: http://www.aad.org/public/Publications/pamphlets/Rosacea.htm. Accessed December 21, 2006.

Bakar O, Demircay Z, Gurbuz O. Therapeutic potential of azithromycin in rosacea. International Journal of Dermatology. 2004;43(2):151-154.

Bamford JT. Rosacea: current thoughts on origin. Seminars in Cutaneous Medicine and Surgery. 2001;20(3):199-206.

Bamford J,. Gessert C, Renier, C. Measurement of the severity of rosacea. The American Academy of Dermatology. 2004;51(5):697-703.

Blount, B, Pelletier A. Rosacea: A common, yet commonly overlooked, condition. American Family Physician. 2002;66(3):435-440.

ClinicalTrials.gov: Acne Rosacea. National Institutes of Health. Available at: http://clinicaltrials.gov/ct/gui/show/NCT00395226?order=1. Accessed December 21, 2006.

Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. Journal of the American Academy of Dermatology. 2004;51(3):327-341.

Curnier A, Choudhary S. Triple approach to rhinophyma. Annals of Plastic Surgery. 2002;49(2):211-214.

Draelos ZD. Facial hygiene and comprehensive management of rosacea. Cutis. 2004;73(3):183-187.

Gerd P, Jansen T. Rosacea. In: Freedberg IM, Eisen AZ, Wolff K, et al., eds. Fitzpatrick?s Dermatology in General Medicine, 5th edition. New York: McGraw-Hill, 1999. pp 785-799.

Laughlin SA, Dudley DK. Laser therapy in the management of rosacea. Journal of Cutaneous Medicine and Surgery. 1998;2(Suppl 4):S24-S29.

Lifestyle recommendations. International Rosacea Foundation. Last Updated December 21, 2006. Available at: http://www.internationalrosaceafoundation.org/lifestyle_recommendations.php4. Accessed December 21, 2006.

Lindow KB. Rosacea. An overview of diagnosis and management. Advance for Nurse Practitioners. 2004;12(12):27-32.

Lonne-Rahm S, Nordlind K, Edstrom DW, Ros AM, Berg M. Laser treatment of rosacea: a pathoetiological study. Archives of Dermatology. 2004;140(11):1345-1349.

Millikan L. The proposed inflammatory pathophysiology of rosacea: implications for treatment. SKINmed. 2003;2(1):43-47.

National Institute of Arthritis, Musculoskeletal and Skin Diseases. U.S. National Institutes of Health. Questions and answers about rosacea. June 2002. Available at: http://www.niams.nih.gov/hi/topics/rosacea/rosacea.htm. Accessed: December 21, 2006.

National Rosacea Society. Medical scientists report advances during rosacea research workshop. Rosacea Review Newsletter. Fall 2001. Available at: http://www.rosacea.org/rr/2001/fall/article_1.html. Accessed July 29, 2005.

National Rosacea Society. NRS awards new research grants to study life-disruptive disorder. Rosacea Review Newsletter. Winter 2005. Available at: http://www.rosacea.org/rr/2005/winter/article_1.html. Accessed July 29, 2005.

Patlak M. US Food and Drug Administration. (FDA). Treatment pales rosacea?s red face. U.S. Food and Drug Administration. FDA Consumer. June 2002. Available at: http://www.fda.gov/bbs/topics/CONSUMER/CON0279d.html. Accessed July 19, 2005.

Pelle MT, Crawford GH, James WD. Rosacea: II. Therapy. Journal of the American Academy of Dermatology. 2004; 51(4):499-512.

Randleman JB, Loft E. Ocular rosacea. eMedicine. Last Updated September 29, 2006. Available at: http://www.emedicine.com/OPH/topic115.htm. Accessed December 21, 2006.

Rohrich RJ, Griffin JR, Adams WP Jr. Rhinophyma: review and update. Plastic and Reconstructive Surgery. 2002;110(3):860-870.

Romagnolo SC, Benedetto AV. Rosacea in a new light. SKINmed. 2005;4(1):47-48. Medscape. Available at: http://www.medscape.com/viewarticle/499712. . Accessed. July, 19 2005.

Rosen T, Stone MS. Acne rosacea in blacks. Journal of the American Academy of Dermatology. 1987;17(1):70-73.

Sibenge S, Gawkrodger DJ. Rosacea: a study of clinical patterns, blood flow, and the role of Demodex folliculorum. Journal of the American Academy of Dermatology. 1992;26(4):590-593.

Swenor ME, Yagli K. Is permethrin 5% cream effective for rosacea? The Journal of Family Practice. 2003;52(3):183-184.

Tan SR, Tope WD. Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life. Journal of the American Academy of Dermatology. 2004;51(4):592-599.

Thiboutot D. Acne rosacea. American Family Physician. 1994;50(8):1691-1697.

Wilkin J, Dahl M, Detmar M, Drake L, Feinstein A, Odom R, Powell F; National Rosacea Society Expert Committee. Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. Journal of the American Academy of Dermatology. 2002;46(4):584-587.

Wilkin J, Dahl M, Detmar M, Drake L, Liang MH, Odom R, Powell F; National Rosacea Society Expert Committee. Standard grading system for rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. Journal of the American Academy of Dermatology. 2004;50(6):907-912.

Rosacea Health Condition Last Updated: September 2007

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.

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