Is your face trying to tell you something?
Although new medical research has discovered the red-faced appearance of rosacea may serve as a potential signal for serious but less visible illnesses, only a small fraction of those suffering from this widespread, often embarrassing disorder are currently being treated. The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month to alert the public to the early warning signs of this chronic and conspicuous facial condition now estimated to affect more than 16 million Americans.
“Although it’s important to note that causal relationships between rosacea and other diseases have not been determined, a growing number of studies have found associations between rosacea and increased risk for a variety of potentially serious systemic disorders – from cardiovascular disease to certain cancers and gastrointestinal disease,” said Dr. Sewon Kang, chairman of dermatology at Johns Hopkins School of Medicine. “Well beyond its negative effects on emotional, social and occupational well being, this provides further reason for people who suspect they may have rosacea to seek diagnosis and appropriate treatment.”
Unfortunately, according to a recent large-population study at the Wake Forest School of Medicine, an estimated 82 percent of people with rosacea are currently untreated.1
Recent studies in the United Kingdom and South Korea have found significant associations between rosacea and inflammatory bowel disease (IBD), and a large retrospective study in Denmark found a higher prevalence in rosacea patients of gastrointestinal disorders, including celiac disease, Crohn’s disease, irritable bowel syndrome and ulcerative colitis.2-4 In a separate Danish assessment of cause-specific mortality in rosacea patients, researchers found a significantly increased risk of death due to gastrointestinal diseases, primarily related to hepatic disease.5
In a large study of more than 33,000 patients with rosacea in Taiwan, researchers found a 41 percent greater risk of high cholesterol (dyslipidemia), a 35 percent higher risk of coronary artery disease and a 17 percent greater risk of high blood pressure (hypertension) than people without rosacea.6 Coronary artery disease remained significantly associated with rosacea even after adjusting for cardiovascular risk factors.
In the well-known “Nurses Health Study II” – an ongoing biennial questionnaire on the medical history of 116,000 nurses since 1989 – the more than 6,000 women diagnosed with rosacea were 1.59 times more likely to have thyroid cancer and 1.5 times more likely to have basal cell carcinoma, a form of skin cancer, than those without rosacea.7 A recent clinical study of 130 individuals with rosacea at Johns Hopkins University also found a significant association between rosacea and allergies, respiratory diseases, gastroesophageal reflux disease (GERD), diabetes, urogenital diseases and female hormone imbalance.8 Other recent studies have found increased risks of Parkinson's disease, Alzheimer's disease and glioma, a form of brain cancer, in people with rosacea.9-11
“While the list of reported associations continues to grow, it's important to note that study parameters have not been uniform, and many confounding factors may affect their accuracy. As with any early research, further study will be needed to clarify their meaning and implications for patients," Dr. Kang said. “That said, until these relationships are fully understood, it’s reasonable for people who suspect they may have rosacea to seek a medical evaluation of their skin and, if appropriate, obtain a general health examination as well.”
What Is Rosacea?
In a recent NRS survey of 1,459 rosacea patients, 47 percent said they had never heard of rosacea prior to their diagnosis, and 95 percent said they had known little or nothing about its signs and symptoms. In other NRS surveys, 90 percent of rosacea patients said rosacea’s effect on personal appearance had lowered their self-esteem and self-confidence, and 52 percent said they had avoided face-to-face contact because of the disorder. Among those with severe symptoms, 51 percent said they had even missed work because of their condition.
Rosacea typically first strikes anytime after age 30, and may initially resemble a simple sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to their cheeks, nose, chin or forehead. Then just when they start to feel concerned, the redness disappears.
Unfortunately, it happens again and again, becoming ruddier and lasting longer each time, and eventually visible blood vessels may appear. Without treatment, bumps and pimples often develop, growing more extensive over time, and burning, itching and stinging are common.
In severe cases, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose. In some people the eyes are also affected, feeling irritated and appearing watery or bloodshot. Severe cases of this condition, known as ocular rosacea, can result in reduced visual acuity.
Among the most famous rosacea sufferers is former President Bill Clinton, whose doctors disclosed that he had this condition in The New York Times. Others reported to have suffered from the disorder include Princess Diana, singer Sam Smith, model Dita Von Teese and comedian Amy Schumer.
Research is now helping to dispel common misconceptions about the disorder by illuminating rosacea’s relationship to various internal and external factors that may be involved in its development. Through its patient-funded research grants program, the NRS has awarded over $1.5 million to support 66 studies that may lead to advances in its treatment and potential prevention or cure.
While the cause of rosacea remains unknown, a vast array of lifestyle and environmental factors has been found to trigger flare-ups of signs and symptoms in various individuals. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin-care products and potentially an overabundance of Demodex mites.
“The good news is that rosacea can be effectively controlled through medical therapy and lifestyle changes,” Dr. Kang said. “As medical research continues to uncover the relationships between the health of the skin and other parts of the body, further insights may also emerge into how to treat rosacea as well as improve overall health.”
Individuals with any of the following warning signs of rosacea are urged to see a dermatologist for diagnosis and appropriate treatment:
Redness on the cheeks, nose, chin or forehead
Small visible blood vessels on the face
Bumps or pimples on the face
Watery or irritated eyes
During April and throughout the year, people who suspect they may have rosacea can contact the NRS for more information.
Comprehensive information and materials on rosacea are available on the NRS website at rosacea.org. The NRS encourages those interested in spreading awareness during the month of April to visit the official Rosacea Awareness Month landing page at rosacea.org/ram and follow the online conversation using the hashtag #RosaceaAwareness. The NRS may also be followed on Facebook, Twitter or Pinterest for up-to-date information and tips on rosacea. Further information may be obtained by writing the National Rosacea Society, 196 James Street, Barrington, Illinois 60010; via email at firstname.lastname@example.org; or by calling its toll-free number at 1-888-NO-BLUSH.
About the National Rosacea Society
The National Rosacea Society is the world’s largest organization dedicated to improving the lives of the estimated 16 million Americans who suffer from this widespread but poorly understood disorder. Its mission is to raise awareness of rosacea, provide public health information on the disorder and support medical research that may lead to improvements in its management, prevention and potential cure.
Wehansen B, Hill DE, Feldman SR. Most people with psoriasis or rosacea are not being treated: a large population study. Dermatol Online J 2016 Jul 15;22 (7):3.
Spoendlin J, Karatas G, Furlano R, et al. Rosacea in patients with ulcerative colitis and Crohn’s disease: a population-based case control study. Inflamm Bowel Dis 2016;22(3):680-687
Kim M, Choi KH, Hwang SW, et al. Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study. J Am Acad Dermatol 2017 Jan;76(1):40-48.
Egeberg A, Weinstock LB, Thyssen EP, et al. Rosacea and gastrointestinal disorders: a population-based cohort study. Br J Dermatol 2017 Jan; 176(1):100-106.
Egeberg A, Fowler JF Jr, Gislason GH, et al. Nationwide assessment of cause-specific mortality in patients with rosacea: a cohort study in Denmark. Am J Clin Dermatol 2016 Dec;17(6):673-679.
Hua TC, Chung PI, Chen YJ, et al. Cardiovascular comorbidities in patients with rosacea: a nationwide case-control study from Taiwan. J Am Acad Dermatol 2015 Aug;73(2):249-254.
Li WQ, Zhang M, Danby FW, et al. Personal history of rosacea and risk of incident cancer among women in the US. Br J Cancer 2015 Jul 28;113(3):520-523.
Rainer BM, Fischer AH, Luz Felipe da Silva D, et al. Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study. J Am Acad Dermatol 2015 Oct;73(4):604-608.
Egeberg A, Hansen PR, Gislason GH, et al. Exploring the association between rosacea and Parkinson disease: a Danish nationwide cohort study. JAMA Neurol 2016 May 1;73(5):529-534.
Egeberg A, Hansen PR, Gislason GH, et al. Patients with rosacea have increased risk of dementia. Ann Neurol 2016 Jun;79(6):921-928.
Egeberg A, Hansen PR, Gislason GH, et al. Association of rosacea with risk of glioma in a Danish nationwide cohort study. JAMA Dermatol 2016 May 1;152(5):541-545.