Suffering from rosacea, a chronic often progressive skin condition that causes acne-like redness on the face, is socially crippling for many who suffer from the medical condition.
Even more frustrating is that while there are treatments to manage it, there is still no known cause or cure for rosacea.
Steven R. Feldman, MD, PhD, a professor of dermatology, pathology and public health sciences at Wake Forest Baptist Medical Center, said there are many thoughts about what might cause the condition, but still no known cause.
April has been designated Rosacea Awareness Month by the National Rosacea Society, and while a cure might not be around the corner, better treatments are available to treat the more than 16 million Americans estimated to suffer from the condition.
No cause, no cure
While medical professionals haven't pinned down a cause for rosacea, there are many theories about it. Clinical trials have brought more understanding and better treatments, but ultimately not the underlying reason.
"Bacteria in the skin may be involved. The immune system may be involved, or it may relate to blood vessel dilation," Dr. Feldman said. "We just don't know. It could be genetics, but we presume bacteria is important in the disease."
There is currently no evidence to suggest it is hereditary though the National Rosacea Society suggests that up to 40 percent of those who suffer from the condition can name a relative who suffers from the same condition.
Despite the lack of a cause or a cure, many patients have success through the use of oral antibiotics that aid with inflammation or topical treatments that can be applied to the affected areas. Often, it's a combination of both therapies that provide the most success for patients. Over the counter eye drops, such as Visine, also can help reduce eye redness.
Interestingly, another drug that has proved successful in treating patients is Oracea (doxycycline) in low doses. The medication is prescribed primarily to treat bacterial infections, though it has other uses such as for the treatment of acne and Lyme disease.
"We use a low dose of Oracea -- so low it doesn't affect bacteria so it must work on inflammation," Dr. Feldman mused.
Types of rosacea
Unlike skin condition such as psoriasis, patients with rosacea aren't at a heightened risk of inflammatory disease or heart attacks. In fact there is no data to suggest that rosacea causes problems outside the visibly pesky red facial skin.
There is no laboratory test used to diagnose the condition. Doctors diagnose the condition by inspecting the skin for signs of redness, flushing, bumps or pimples, swelling, and burning, itching or stinging. About half of those with rosacea also suffer from dry skin, and small visible blood vessels may be apparent in many cases.
It primarily occurs in adults between the ages of 30 and 60, but children and teenagers could suffer from a variety of the condition that involves styes on the eyelids.
Another type, ocular rosacea, affects the eyes and may leave them watery and bloodshot. Many patients with this type report a burning, itchy or gritty feeling. Light sensitivity can be problematic for some with this form.
In some patients rosacea also can cause enlargement of the nose, which occurs from excess tissue and skin thickening. However, the vast majority of rosacea patients suffer facial redness, bumps and pimples, or a combination of the two. Pain and discomfort can also be a part of rosacea, regardless of the type.
Like other chronic conditions, there may be periods where the skin condition is noticeably better or worse. A variety of sources can trigger flare ups. Most common triggers include: sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, heavy exercise, hot baths, heated beverages and certain skin care products.
Figuring out what personal triggers could help you avoid them, potentially noticeably cutting flare ups. According to the National Rosacea Society, 96 percent of patients that took part in a survey reported they believed they could reduce flare ups by identifying and avoiding triggers.
A large percentage of rosacea sufferers report suffering flare ups due to emotional stress. But it may be the physical effects of the condition that afflict a large emotional toll.
"It would be hard to invent a more embarrassing disease than rosacea," said Dr. Ted Grossbart, a psychologist at Harvard Medical School. "It affects the one part of the body that cannot be hidden - the face - and tends to strike people at a time in life when they may be increasingly self-conscious about changes in their appearance. Moreover, especially because this condition is not widely understood, it can leave its victims feeling isolated and even alienated from society."
The National Rosacea Society reports that a survey of 1,200 patients revealed that 76 percent said that the symptoms had lowered their self esteem or self confidence, and 69 percent said the disorder caused them embarrassment.
An additional 63 percent said the condition made it difficult to establish new relationships, and 88 percent said it had affected professional interactions.
In addition they can be haunted by misconceptions such as their red face and nose may indicate that they drink heavily, or that they have poor hygiene.
"Emotional stress frequently exacerbates or induces rosacea symptoms, creating a tailspin for many patients," said Dr. Richard Granstein, chairman of dermatology at Cornell University. "Combine this with the physical discomforts and the social impact of the disorder, and there are many aspects of rosacea that go well beyond its effects on personal appearance alone."
"While rosacea is a long-term disorder and there is no cure, the good news is that it can be effectively controlled with medical therapy and lifestyle modifications," Dr. Granstein said. "This can substantially improve the quality of people's lives."