Rosacea is often mistaken for broken capillaries, and an enlarged nose for alcohol abuse. This hurtful stereotype makes it harder for people to seek help. In dermatology the condition is called rosacea, and its most visible form, the enlargement of the nose, is known as rhinophyma. As promised in our previous post on couperose skin, we explain how this disease differs and why it needs a doctor.
Rosacea is a chronic inflammatory skin disease that mainly affects the central part of the face: the cheeks, nose, forehead and chin. Despite its Polish name, which translates as "pink acne", it has little in common with ordinary acne, because it does not cause blackheads. It most often affects people with fair skin between the ages of 30 and 50. It runs in cycles of flare-ups and calmer periods, and in some people it gradually worsens over time.
The first sign is often sudden facial flushing with a feeling of heat, followed by persistent redness and dilated capillaries. At this stage it is easy to confuse rosacea with couperose skin. The difference becomes clear when bumps and pustules without blackheads appear, along with burning, stinging and sensitivity to cosmetics. In some people the disease also affects the eyes, which become dry and sore, and then a consultation with an ophthalmologist is needed.
The causes are not fully understood. We know that family predisposition plays an important role, along with an abnormal response of the blood vessels and the skin's immune system, and an excessive number of Demodex mites, which naturally live in hair follicles. Symptoms are made worse by triggers: sun, heat and frost, hot drinks, spicy food, alcohol, stress and physical exertion. The list is slightly different for everyone, so it is worth noticing what makes your own redness worse.
The most hurtful myth concerns the nose. Rhinophyma is a form of rosacea in which the sebaceous glands and connective tissue gradually overgrow. The nose becomes larger, the skin thickens and turns uneven and bumpy, and the openings of the glands are clearly enlarged. These changes develop over many years and are far more common in men.
For decades such a nose was commonly called a drinker's nose, and the stereotype is still alive today. Yet alcohol is not the cause of rhinophyma. It can intensify redness in people with rosacea, just like hot tea or spicy food, but rhinophyma also develops in people who do not drink alcohol at all. People with this condition often hear unkind remarks, feel ashamed and put off seeing a doctor for years, even though early treatment can slow down the changes.
During my work on a dermatology ward and over years of teaching dermatology, I have seen many times how much unnecessary shame this stereotype causes.
Rosacea is treated by a dermatologist. Depending on its form, topical medicines are used, for example with metronidazole, ivermectin or azelaic acid at a therapeutic concentration, and in more severe cases oral treatment as well. Established rhinophyma is corrected with procedures, including ablative laser or surgery. It is very important not to use steroid ointments on your own, because they may calm the redness for a while and then make the skin noticeably worse.
A cosmetology clinic does not replace medical treatment, but it can support it wisely. During calmer periods, in agreement with the dermatologist, we use gentle acids such as azelaic or lactobionic acid, which soothe without overloading the skin. During a flare-up, when there are bumps and pustules on the face, we postpone treatments and focus on skincare. Strong peels, warming treatments and mechanical exfoliation are not suitable for this skin.
Home care is similar to that for couperose skin, but requires even more caution. Short ingredient lists, gentle cleansing with lukewarm water and a barrier-strengthening cream work well, without alcohol, menthol, essential oils or scrubs with particles. Because UV radiation is one of the most common triggers, daily sun protection is particularly important for rosacea.
Rosacea is a disease, not a matter of hygiene or lifestyle, and no one should feel ashamed of it. If you notice these symptoms, start with a dermatologist, and once treatment has calmed your skin, we invite you for a consultation at our clinic at ul. Botaniczna 5 in Osielsko. Bydgoszcz is only about fifteen minutes away by car.
Is rosacea contagious? No. It is an inflammatory disease that cannot be caught from another person.
Does rhinophyma mean someone drinks too much? No. Alcohol can intensify redness, but it is not the cause of nose enlargement, which also occurs in people who do not drink.
Can a cosmetologist treat rosacea? No, treatment is the role of a dermatologist. A cosmetologist can support the skin during calmer periods with suitable treatments and well-chosen skincare.
Katarzyna Gwizdal, MSc, cosmetologist, Skin Laser