Rosacea and its symptoms

Facial rosacea is a chronic skin condition with a variety of symptoms that most often affect areas of the face such as the cheeks, nose, forehead and chin. It is most common among middle-aged people, especially women, but it can occur at any age. Facial rosacea is marked by alternating periods of flare-ups and remission, during which symptoms may get worse or improve.

Types of facial rosacea

Facial rosacea is divided into several main types, depending on the nature of the symptoms and the areas of skin affected. The symptoms of each type can affect a patient's quality of life differently and may require a specific treatment plan.

Erythematotelangiectatic rosacea

This type of rosacea is characterised by persistent or recurring facial redness, which is often most pronounced on the cheeks, nose and forehead. The erythematotelangiectatic form also includes telangiectasias – small, dilated capillaries visible on the surface of the skin that create a spider-web-like appearance. This condition can cause discomfort and self-esteem issues because of the noticeable facial redness.

Papulopustular rosacea

Papulopustular rosacea is characterised by typical facial redness together with pus-filled papules and pustules. These bumps most often appear on the cheeks, chin and forehead. Papules and pustules can be painful, and their coming and going can cause considerable discomfort and make treatment challenging. This type is often mistaken for inflammatory acne, but rosacea does not involve the comedones (blackheads and whiteheads) typical of acne.

Phymatous rosacea (rhinophyma)

Phymatous rosacea, also known as rhinophyma, is characterised by thickening of the skin of the nose due to hyperplasia of the sebaceous glands. It is most common in older men and can be very noticeable. The skin of the nose becomes uneven, thicker, sometimes red and porous. This type of rosacea may require surgery or specialised skin treatments to reduce the thickening and improve the skin's appearance.

Ocular rosacea

Ocular rosacea affects the eyes and the surrounding area. Patients may experience red, dry eyes, a burning sensation, a feeling of something in the eye, watering and sensitivity to light. This type can make everyday activities such as reading or driving difficult and may require special eye drops or other treatments to control symptoms and prevent more serious eye health problems.

Symptoms

The main symptoms of facial rosacea are complex and varied, and each of them can affect patients' quality of life and emotional well-being. These symptoms are:

• Redness or erythema is one of the most noticeable and common symptoms of rosacea. The nose, cheeks, forehead and chin are usually temporarily or permanently red. This can be caused both by external factors, such as temperature changes or emotional stress, and by an internal inflammatory response. Redness may come and go in episodes or remain as a permanent feature that visibly affects the appearance of the face and can cause discomfort.
• Pustules and papules are inflammatory skin lesions that appear as small, red or skin-coloured bumps, which may be filled with pus. They can be painful and red, often causing discomfort. Although they may look like acne, it is important to note that rosacea does not involve comedones. These bumps can appear in cycles, with active periods of inflammation alternating with calm periods.
• Telangiectasia refers to dilated or prominent networks of blood vessels that appear on the surface of the skin as red or blue spider-web-like lines. This symptom is common in erythematotelangiectatic rosacea and can be aesthetically unappealing, sometimes causing emotional discomfort for patients. Telangiectasia often results from long-term skin inflammation and capillary damage.
• Rhinophyma is a manifestation of a more severe form of rosacea that most often affects older men. In this condition, the skin, especially on the nose, thickens and becomes uneven and porous due to sebaceous gland hyperplasia and skin inflammation. Rhinophyma can cause marked changes in facial contours that require special treatment methods, sometimes even surgery.

These symptoms form the basis for diagnosing and treating rosacea, and managing and controlling them is essential to improve patients' quality of life and reduce the impact of the disease.

Causes and pathogenesis

The causes of facial rosacea are still not fully understood, but there are several theories and identified factors that may contribute to the onset and progression of the disease:

• Genetic factors: Rosacea often runs in families, suggesting that genetic predisposition may play an important role. Research shows that certain genetic mutations related to immune system activity and the regulation of inflammatory substances may increase the risk of rosacea.
• Immune system reactions: Increased activity of pro-inflammatory cytokines, such as interleukins and tumour necrosis factor, has been observed in skin affected by rosacea. This may indicate that autoimmune or overactive immune responses play a role in the development of the disease.
• Environmental factors: UV exposure, hot or cold weather, wind and changes in humidity are known potential triggers of rosacea flare-ups. UV rays can damage the skin barrier and trigger inflammation, while extreme weather can irritate the skin and cause redness.
• Diet and lifestyle factors: Spicy food, alcohol and caffeine are considered factors that can trigger or worsen rosacea symptoms. Stress is also known to be an important factor that can influence the course of the disease, as it can promote an inflammatory response in the body.

Immunological aspects

It is important to stress that rosacea is not just a surface skin problem. Research shows that certain immune system components, such as neutrophils and macrophages, may be activated in rosacea and contribute to inflammation and skin damage. In addition, microscopic skin mites (Demodex folliculorum), which naturally live on human skin, can trigger an overactive immune response in rosacea.

Possible consequences of the disease

Long-term uncontrolled rosacea inflammation can cause changes in the structure and appearance of the skin, such as skin thickening or rhinophyma. In addition, some patients experience emotional and psychological difficulties because of their skin condition, which can significantly affect their quality of life.

Each type of rosacea requires an individual approach to treatment, focused on controlling symptoms and improving quality of life. Treatment may include topical preparations, systemic therapy, lifestyle changes and sometimes surgical procedures.

Lifestyle adjustments

For people with facial rosacea, it is important to recognise and avoid triggers that can worsen symptoms. This includes:

• Avoiding spicy food and alcohol, which can cause facial redness and a feeling of heat.
• Protecting the face from the sun with hats and high-SPF sunscreens, as UV rays can cause flare-ups.
• Managing stress, as emotional tension can trigger or worsen rosacea flare-ups. Techniques such as deep breathing, yoga or meditation can help reduce the effects of stress.
• Choosing gentle skin care and avoiding irritating ingredients and products that can cause skin sensitivity or irritation.

Our recommendation. For redness-prone, sensitive facial skin, choose Eubos Cool & Calm CC cream with SPF 50 – it visibly conceals redness and protects against the sun.

Information sources

1. National Rosacea Society
2. Mayo Clinic
3. American Academy of Dermatology

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