How to Recognize Rosacea

Rhinophyma, a.k.a "W.C. Fields nose"

The big red bulbous nose of W.C. Fields is the extreme example of rosacea and certainly not how this condition appears in most people.  I mention this for 2 reasons: 1.) If you have rosacea don’t freak out that this is going to happen to your nose (you can get this condition under control long before it develops into rhinophyma) and 2.) You can learn to recognize rosacea in its early stages so you can start managing it right away.

The biomedical cause of rosacea is still unknown.  Rosacea typically affects people between the ages of 20 and 50 and is seen most often in those with fair complexion.  Women are affected more often than men, although the condition tends to be more severe in men (is this because they tend to wait longer to seek medical intervention?  Who knows.)  Rosacea is a chronic inflammatory condition of the skin that affects the face (mostly the cheeks, nose and forehead) and sometimes the eyes.   I have rosacea and I will describe my experience because it is rather typical and gives a good idea of what the early stages look like.

Mild Rosacea (I'm not wearing any makeup here). Note the difference between my neck and my face.

I wish I would have recognized the signs 20 years ago when they first began to show up in my late teens.  It began with flushing.  I would blush rather easily if embarrassed and especially if angry or upset.  Even with light aerobic activity my face would look like a tomato immediately – I am pretty sure everyone in the spinning class thought my head was going to explode but I was barely breaking a sweat.  I looked like I had sunburn (on my whole face) whenever I was out in the sun or wind for even a short period (even though it wasn’t actually a burn).  This easy flushing went on for many years but it always disappeared in a reasonable amount of time, so I never gave it much concern.  It wasn’t until last year (at the age of 37) that the flushing appeared and then no longer disappeared.  Oh sure, my friends were jealous because I looked like I was wearing blush even when I had no makeup on.  But when I examined my face closely I could see tiny little purple capillaries on my cheeks that looked like spider veins.  Within a few months of discovering the telangiectasia (dilated capillaries), the skin on my face began to sting a little; nothing major, but it felt a bit like mild sunburn all the time (I assure you, it was not sunburn).  My face is easily irritated and gets bright red whenever I rub it – no matter how gently I apply a minimal amount of pressure – when I wash it, when I apply moisturizer, when I towel dry it.  I like beer and wine, but I don’t drink very much or very often.  But now even a few sips of alcohol will instantly (within minutes) make my rosy cheeks flush even rosier.  Spicy foods, hot tea and coffee do it, too (it is the heat, not the caffeine that triggers this).  For a while I was developing small zits on my cheeks but I eventually cleared those up with an herbal toner that I made (more on that in the next post).  Most recently I began to notice some eye symptoms – slightly puffy and itchy eyelids with the sensation that a grain of sand or a little piece of fuzz is in my eye.  Now, I really shouldn’t jump to the conclusion that this is the ocular aspect of rosacea.  It could just as easily be seasonal allergies, as those have started very early this year in northern Colorado.  But I am being vigilant about it.

Rosacea can resemble acne

I am doing several things to manage my condition and I hope to have it fully under control before long.  But if I were to let it go on, it could easily get much more severe.  As rosacea progresses, the flushing becomes permanent (nontransient erythema), more papules and pustules (zits) develop, more telangiectasia occurs (permanently dilated blood vessels), and the skin (esp. of the nose) can thicken and hypertrophy (called rhinophyma, which is irreversible).  Eye symptoms can also develop.

When there is just flushing and redness on the cheeks, rosacea can be mistaken for lupus erythematosus.  The papules and pustules of rosacea are easily mistaken for acne in adults.  It is really important to determine which condition you may have because the treatments and prognosis will differ quite a bit.  So be sure to see your dermatologist if you have significant facial flushing/redness or you start developing what you think may be acne after age 20.

In our next posts we will cover the TCM diagnoses of rosacea and we will discuss the most common triggers and what you can do to avoid them.  Here’s your first tip: do a better job of avoiding alcohol than I have been doing lately.  I just now took a sip of beer as I get ready to publish this post and I can already feel the heat building in my face!  Dang it!

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