Affecting more than 415 million people globally, rosacea is a common skin condition, although a poorly understood one. The face and eyes are primarily affected, and the condition is often mistaken for being an 'adult acne'. According to a National Rosacea Society survey, close to 95% of patients know next to nothing about the signs just before being diagnosed. So, what are the types of rosacea and how different are they from acne? And, what's the role of your DNA in all of this?

The basics of rosacea

Dating back to the 14th century, Rosacea was first called 'goutresse’, by a French doctor because of the facial redness it caused. The condition is now known to be chronic and inflammatory. There are different types of rosacea, most often accompanied by swollen red bumps and small visible blood vessels.

Since the condition mostly affects the face, they’re often mistaken for acne, eczema, or allergy. It predominantly known to affect females, especially when they are between 30 and 50 years of age. Those of European ancestry are also at a higher risk for the condition.

Types of rosacea: Just how many are there?

Rosacea is kind of an umbrella term that covers the four different subtypes:

Erythematotelangiectatic rosacea (ETR)
Symptoms:  Facial redness, flushing, and visible blood vessels.
Papulopustular (or acne) rosacea
Symptoms: Acne-like breakouts, swelling, and redness.
Phymatous/Rhinophyma rosacea
Symptoms: Thickening and redness, mostly on the nose. Often co-exists with other types.
Ocular rosacea
Symptoms: Redness in the eye, along with irritation and swollen eyelids.

Symptoms: The giveaways of rosacea

  1. Facial redness: A persistent redness on the face, especially around the central part. Small blood vessels become visible. 
  2. Swollen, red bumps: Pimples are seen across the face, and the swollen bumps may also contain pus. 
  3. Eye problems: Mainly seen if a person has ocular rosacea. This results in swollen, often irritated and dry eyes.
  4. Swollen nose: Associated with rhinophyma rosacea, the skin under the nose thickens and starts to swell. This is more seen in men than in women.

Rosacea: What are the triggers?

Before taking up a certain course of treatment, dermatologists often look for common triggers that cause a rosacea flare-up. The common triggers are:

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Genetics and rosacea

Genetic factors have been shown to play a role in increasing the risk of the condition. Since the most apparent symptoms are redness and inflammation of the skin, rosacea could be caused by genes associated with blood vessel abnormalities and immune reactions. Rosacea is caused by mutations in two gene families:

Human leukocyte antigen (HLA) complex:

The HLA genes, primarily involved in immune function, help the body in distinguishing foreign proteins from the body’s own. Variations in these genes have also been linked to rosacea symptoms - when the immune system misdirects the response, causing inflammation of the blood vessels.

Glutathione-S-transferases:

The proteins encoded by the GSL gene family help in protecting cells from oxidative damage - for example, the ones caused by exposure to sunlight and UV rays. Mutations in this gene complex could affect its efficiency in protecting skin cells, leading to rosacea.

Effects of gene variants

A genome-wide study that analyzed over 20,000 individuals with European descent was able to set forth a genetic basis to Rosacea. In this preliminary study, volunteers who were in the ‘cases’ group having answered yes to rosacea symptoms, were tested for genetic variation. One variant was found to be associated with disease occurrence, and this is located between two genes - HLA-DRA and BTNL2. The variant was found to influence the inflammatory response associated with rosacea.

A coincidental finding of this study was that variations in the HLA gene were also related to symptoms of diabetes and celiac disease, giving a suggestive link that rosacea may act as a visual cue to another underlying disease.

Rosacea and acne: What’s their relation? 

It is easy to misdiagnose rosacea for acne, but there are several subtle differences:

TriggerOrgans affectedRisk groupTreatment
Rosacea- Stress
- Sunlight
- Exercise
- Spicy food
- Alcohol
- Eyes
- Eyelids
- Cheeks
- Nose
- Forehead
- 30+ years
- Women 
- Men (severe form)
- Topical solutions
- Retinoids
- Laser therapy
- Antibiotics
Ance- Hormonal imbalances
- Medications
- Stress
- Diet
- Face
- Chest
- Back
- Shoulders
- Teenagers
- Young adults
- Topical solution
- Retinoids
- Chemical peels
- Antibiotics

Getting the diagnosis right

There is no direct diagnosis for this condition. The main indicator of rosacea is that the redness is contained to the face or the presence of enlarged blood vessels on the face. 

I. Preliminary diagnosis:

The preliminary diagnosis occurs with a physical examination of the face. If there is scarring elsewhere (like on the scalp), or if the doctor suspects another medical condition, like lupus, blood tests would be ordered. 

II. Clinical tests:

Other clinical tests would also be performed to rule out other confounding conditions like psoriasis or eczema. If the symptoms include the eyes, consultation with an ophtlamologist may be required.

Fighting different types of rosacea with dietary changes 

What should you avoid?

Several foods could trigger flare-ups. It is preferred that these are limited or avoided:

  1. Alcohol - Even a tiny amount of alcohol (champagne, vodka, beer, gin, and bourbon) has resulted in flareups in a majority of patients.
  2. Hot beverages - Drinking hot beverages can cause the vessels on the face to dilate, causing a blushed appearance.
  3. Spicy foods - Most spicy foods contain the chemical ‘capsaicin’. Eating foods that contain this chemical, can worsen symptoms. Avoid jalapenos, chilies, or tabasco peppers.
  4. Dairy - Common culprits are milk, sour cream, yogurt, and cheese.
  5. It is also recommended to avoid foods that contain high amounts of histamine and cinnamaldehyde, like chocolate, nuts, cinnamon, and foods pickled with vinegar.

What should you add?

Foods that reduce inflammation, healthy fats, probiotics, and fiber-rich foods may be able to help or reduce the severity of some rosacea symptoms. These include:

  1. Whole foods like oatmeal and brown rice
  2. Nuts, fatty fish, rich in omega-3 fatty acids
  3. Berries, rich in antioxidants
  4. Yogurt, sauerkraut, miso are probiotic foods
  5. Fiber-rich foods like bananas, onions, leeks, garlic, and whole grains

Skincare: When too much becomes too little 

People with rosacea may develop really sensitive skin, that could be easily irritated by the wrong choice of cleansers, creams, and makeup. Some common triggers:

Treatment: How effective are they? 

Rosacea could become severe if left untreated. However, most treatment practices help in managing symptoms. The course of treatment usually differ based on the types of rosacea.

  1. Medications: Azelaic acid clears up the bumps and swellings. Antibiotics help in clearing bacteria, reducing swelling too.
  2. Gels: Brimonidine is a gel that helps in tightening blood vessels on the face, reducing the redness.
  3. Alternate treatments: Lasers and light treatment help in tightening blood vessels in extreme cases. Dermabrasion can also be done if recommended by the physician

It is important to note that rosacea is a chronic condition and so these treatments only help in reducing the intensity of the symptoms.

The power of home remedies 

There are a lot of DIY/home remedies to manage rosacea:

Summary

In all, the many types of rosacea are chronic and inflammatory that requires intensive care and a strict diet and skincare regime. The exact cause of this condition is unknown, and maybe there could be a link between rosacea and other underlying diseases, but that can only be determined through more studies. Currently, there is no treatment, however, symptoms can be managed.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434179/
  2. https://www.mayoclinic.org/diseases-conditions/rosacea/diagnosis-treatment/drc-20353820

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