Here, from the National Rosacea Society (NRS), is what you need to know about the condition:

Rosacea typically begins at any time after age 30 as an intermittently appearing, flushing or redness on the cheeks, nose, chin or forehead. Over time, the redness tends to become ruddier and more persistent, and small blood vessels may appear in the affected area. Without treatment, bumps and pimples often develop, and in severe cases the nose may become swollen from excess tissue. In around half of patients, the organization says, the eyes are also affected. They can feel irritated and appear watery or bloodshot.

But sophisticated new therapies designed to target rosacea’s disease processes, combined with treatment plans tailored to patients’ specific cases, have made it easier than ever for people to achieve clear skin.

“Rosacea may feel like an uphill battle – left untreated, the disease is a moving target, with varying signs and symptoms that may improve but often get worse, both in response to triggers and over time,” said Dr. Hilary Baldwin, associate professor of dermatology at Rutgers Robert Wood Johnson Medical School. “The good news is that there are more treatment options available than ever before, allowing physicians and patients to work together to find the most effective treatment for each individual case.”

While once conventionally divided into four subtypes, rosacea is now understood as a single disease with a wide variety of appearances. Although its clinical features, or phenotypes, may appear at different times and in varying combinations, scientific research indicates they may all be manifestations of the same underlying inflammatory continuum. For example, one study noted that combining topical brimonidine with ivermectin from the start of treatment resulted in clearer skin than using brimonidine onl.

Moreover, optimal therapy may also keep the disease from progressing further over the long term, Baldwin noted. Though more studies are needed, some medications appeared to improve baseline redness over time, and may possibly help inhibit progression as well as help maintain remission.

The best results are achieved when patients and their doctors work together to identify appropriate therapy and monitor its progress, Dr. Baldwin said. In initially designing a treatment plan, she recommended that physicians take a comprehensive history of the patient’s experiences with rosacea, including its signs and symptoms over time, as well as its social, emotional and psychological effects. Doctors should also offer advice on trigger factors, as well as information on skin care and sun protection.

As therapies progresses, physicians may wish to offer additional strategies. For example, oxymetazoline and brimonidine are topical treatments that act on different receptors in different ways, Baldwin said. With the patient’s observation of its effects, physicians may suggest adjustments, such as application in different amounts at different times of day, to achieve the best result.

“Managing rosacea isn’t a single visit to the doctor, but an ongoing process, and for some patients it may take weeks or months to see improvement,” Baldwin said. “But patients are not alone. Fortunately, with today’s increasingly sophisticated tools, individuals partnering with their physicians can lead normal lives not negatively impacted by rosacea.”

The NRS maintains a website (click here).  The site contains news, information and patient materials, including “Understanding Rosacea,” an educational booklet that provides an overview of the disorder, its potential causes and treatment; “Recognizing Redness,” a pamphlet that includes a redness register to allow patients to gauge relative redness before and after flare-ups or treatment; Rosacea Review, a newsletter for rosacea patients; a “Rosacea Diary” to help patients identify and avoid lifestyle and environmental factors that may trigger flare-ups in their individual cases; and other booklets to help patients understand, manage and cope with their condition.

According to the not-for-profit National Rosacea Society, about 16 million people in the United States suffer from rosacea, a chronic skin condition that typically starts as occasional facial flushing but can progress to permanently reddened and damaged skin.

Overall, most rosacea patients are adult women. But with rhinophyma, far more men are affected.

Researchers continue to explore the causes of rosacea, which appears to be a misfire of the body’s neurovascular and immune systems.

Over time, the frequency of blushing or facial flushing can increase, and the redness can become permanent. Some patients’ skin may become more sensitive. Others may experience changes that include acne-like breakouts, swelling, or visible blood vessels.

And in cases of ‘phyma, it progresses to thickening skin, which becomes bumpy and oily. Most often, this occurs on the nose, hence the name “rhinophyma”.

Left untreated, those afflicted with rosacea can face serious challenges. The National Rosacea Society reports that seventy percent say the condition negatively impacts their personal and professional lives, contributing to depression, anxiety, and low self-esteem.

In particular, states rhinophyma can carry a toll, as it has been inaccurately linked with alcoholism. W.C. Fields’ hard-drinking persona may have contributed to that misperception – which is incorrect and can further distress patients. In addition to the emotional and psychological burden of rhinophyma, if left unaddressed, it can interfere with breathing.

Rhinophyma responds well to treatment. And the sooner patients start, the more quickly they can reclaim their appearance, control symptoms – and prevent rosacea from disrupting their lives.

With that in mind, I offers the following tips:

5 Tips to Successfully Treat Rhinophyma:

1. Get a clear diagnosis:

   Rhinophyma is a more advanced form of rosacea, appearing after earlier symptoms, so patients may already have a diagnosis. That said, it’s important that the skin be evaluated for other conditions, including skin cancer, which can co-occur in the affected area.

2. Treat ASAP:

   Early intervention can slow rhinophyma and minimize its appearance. This can reduce the need for more extensive treatment to remove excess skin and reshape the nose.

3. Understand the roles of meds and surgery:

   Once the skin has become thicker, only removal can reduce it. Depending on the extent, dermatologists can remove excess skin with different surgical techniques, including lasers. Medications, in particular isotretinoin, can play an important role in slowing ongoing thickening, and may be prescribed after surgery to help block reoccurrence. With isotretinoin, it’s important patients fully understand potentially serious side effects so they can make an informed decision.

4. Stick with post-treatment “musts”:

   Number one? Always avoid the sun: SPF 30, protective clothing, seeking shade. Next? ID your triggers: Possibilities include temperature extremes, spicy foods, hot beverages, alcohol, certain medications, stress, health and beauty products. These can all spark flares that contribute to reoccurrence. The National Rosacea Society’s website has a diary booklet patients can use to record exposures and identify those they are susceptible to. Your skin specialist can help you evaluate your individual triggers.

5. Make self care skin friendly:

   Your dermatologist, can help you choose health and beauty products that avoid “trigger” ingredients like menthol, camphor, or sodium lauryl sulfate, as well as provide guidance in following a careful skin care routine: Cleansing is important, but it must be gentle. And moisturizing is a must, with a “friendly” cream that steers clear of irritants.

Restorative treatments and supportive care give patients tools to control rhinophyma so that they can feel empowered in their lives.

Christina Smitley, FNP-C, is a family nurse practitioner with Advanced Dermatology pc, is board-certified through the American Academy of Nurse Practitioners.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com

“Rosacea makes the skin extremely sensitive, and as a result, many things — what we call triggers — can make the condition worse,” said board-certified dermatologist Arielle N.B. Kauvar, MD, FAAD. “Although triggers can vary from one person to the next, a good way to help pinpoint your triggers is to keep a journal of the things you eat and drink, the personal care products you use, and the things you’re exposed to that could cause your rosacea to flare. Once you have identified your triggers, it’s important to avoid them to prevent flare-ups.”

If stress causes your rosacea to flare, find a relaxing practice like meditation or tai chi.

Kauvar recommends the following tips, based on common triggers, to help avoid rosacea flare-ups:

Protect your skin from the sun. Sun exposure is one of the most common causes of rosacea flare-ups. Even people with dark skin tones can have a flare-up after being outdoors in the sun. To protect your skin, seek shade and wear protective clothing, including a wide-brimmed hat and sunglasses with UV protection, whenever possible. In addition, apply a broad-spectrum sunscreen with an SPF of 30 or higher to all exposed skin every day you’re going to be outside. Make sure the sunscreen is fragrance-free, and look for the active ingredients zinc oxide and titanium dioxide, as they are least likely to irritate sensitive skin.

Minimize stress. If stress causes your rosacea to flare, find an activity that helps relieve your stress and do it often. Common outlets for stress include exercise, meditation, tai chi or joining a rosacea support group.

Avoid overheating — even during exercise. Take warm baths and showers rather than hot ones, and sit far enough away from fireplaces, heaters and other heat sources so that you don’t feel the direct warmth. If you’re working out, keep supplies with you to help you cool down, such as a cold water bottle, or a towel that you can dip in cold water and drape around your neck. It’s also a good idea to dress in layers so you can remove clothing if you get too warm.

Simplify your skin care routine. Skin care plays an important role in keeping rosacea under control, as many skin care products are too harsh for people with rosacea. When shopping for skin care products, look for mild, gentle formulas made for sensitive skin. Avoid any skin care products that contain menthol, camphor, sodium lauryl sulfate and alcohol, as these can trigger flare-ups. Products that contain retinoids can irritate your skin and may need to be avoided or used less frequently. In addition, be gentle to your skin and do not rub, scrub or massage your face.

Opt for mild foods. Since spicy foods often trigger rosacea symptoms, opt for milder versions of your favorite dishes. If your rosacea still flares, it’s best to avoid spicy foods altogether.

Opt for cold beverages. Studies show that the heat from hot beverages can cause some people’s rosacea to flare. Try iced coffee or tea instead, or let your beverage cool first before drinking it.

Limit alcohol. When it comes to flare-ups from alcohol, red wine may be the biggest culprit. If you choose to drink, consider beverages other than red wine, and limit your intake to one or two drinks with a cold glass of water in between.

Protect your face from wind and cold. Wearing a scarf is a great option for protecting your skin against the elements. Look for scarves made of silk or acrylic, and avoid wool and other rough-feeling fabrics, as these can trigger a flare-up.

“Without treatment, rosacea symptoms can worsen and include permanent redness, visible blood vessels, burning and stinging, and acne-like breakouts,” Kauvar said. “That’s why it’s important to see a dermatologist for treatment, as well as understand what causes your condition to flare and avoid those triggers.”

“Even though signs of rosacea have been documented in art and literature for centuries, virtually all that is understood about this disorder in medical science has been discovered in the last 15 years,” said Dr. Richard Gallo, chairman of dermatology at the University of California – San Diego, who recently headed a committee and review panel of 28 rosacea experts in the development of the new standard diagnostic guidelines. “Unlike the mysteries of the past, dermatologists are now able to identify the various signs and symptoms of rosacea based on a thorough understanding of the disease process.”

Beyond its immediate physical impact, new research has also found that rosacea may be associated with increased risk of a broad range of potentially serious systemic disorders. These include a growing list of cardiovascular, gastrointestinal, neurological and autoimmune diseases, as well as certain cancers.

According to the new standard system, the presence of one of two signs or symptoms known as phenotypes – persistent redness of the facial skin or, less commonly, the thickening of the facial skin, often around the nose – is considered diagnostic of rosacea. Additional major phenotypes, which often appear with the diagnostic features, include bumps and pimples, flushing, visible blood vessels and irritation of the eyes. The presence of two or more major phenotypes independent of the diagnostic features is also considered diagnostic of rosacea. Secondary phenotypes, which must appear with one or more diagnostic or major phenotypes, include burning or stinging, swelling and dry appearance.

Despite its prevalence and damaging consequences, in a recent National Rosacea Society (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 the condition. 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 appearance.

Adding insult to injury is the common myth that rosacea sufferers who have a ruddy complexion or enlarged nose may be heavy drinkers. In fact, while alcohol may aggravate rosacea, these symptoms can be just as severe in a teetotaler. Another common misconception is that rosacea is caused by poor hygiene, when in reality it is unrelated to personal cleanliness – nor is it contagious in any way.

Rosacea typically first strikes any time after age 30, and may initially resemble a simple sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to the cheeks, nose, chin or forehead. Then just when a sufferer starts to feel concerned, the redness disappears.

Unfortunately, it happens again and again, becoming more severe and lasting longer each time, and eventually visible blood vessels may appear. Without treatment, bumps and pimples often develop, growing more extensive over time; burning, itching and stinging are common.

In around half of rosacea patients, the eyes are also affected, including visible blood vessels on the eyelid margin and a bloodshot appearance, as well as inflammation and growth of fibrous tissue. Burning, stinging, light sensitivity and the sensation of a foreign object may also occur, as well as conjunctivitis, inflammation of oil glands at the rim of the eyelids (blepharitis) and crusty accumulations at the base of the eyelashes.

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.

Recent studies have shown that the initial redness appears to be the start of an inflammatory continuum initiated by neurovascular dysregulation and the innate immune system. The role of the innate immune system in rosacea has been the focus of groundbreaking studies funded by the NRS, including the discovery of irregularities of key components known as cathelicidins. Research has further demonstrated that a marked increase in mast cells, located at the interface between the nervous system and vascular system, is a common link in all major presentations of the disorder. Other studies have documented a possible genetic component, as well as the potential role of the human microbiome.

“It’s now well established that a complex but consistent disease process underlies the various physical manifestations of rosacea, and these are now increasingly well understood,” Gallo said. “At the same time, today there is a much wider range of therapeutic options to treat the various potential signs and symptoms, so it makes sense to focus on the individual phenotypes that may be present.”

Although the ultimate 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 and certain skin-care products.

“The good news is that rosacea can be effectively controlled with medical therapy and lifestyle changes,” Gallo said. “Through ongoing progress in medical research, a growing number of medical therapies are now available that can be tailored to each individual case and substantially reduce the impact of rosacea on people’s lives.”

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

People who suspect they may have rosacea can contact the NRS for more information; click here for the society’s website, or call 1-888-NO-BLUSH.

Rosacea, a common skin disease, usually begins with a tendency to blush more easily than other people. It often begins with a tendency to blush or flush more easily than other people.

But it can cause more than redness, according to the AAD. Because there are so many symptoms of the condition, rosacea actually has four subtypes.

The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be red all the time. Here, according to the AAD, are the different types:

Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels

Papulopustular rosacea: Redness, swelling, and acne-like breakouts.

Phymatous rosacea: Skin thickens and has a bumpy texture.

Ocular rosacea: Eyes red and irritated, eyelids can be swollen and what looks like a sty.

Over time, the AAD says, people with rosacea often have permanent redness in the center of their face.

The AAD cites federal government figures as saying that more than 14 million people are living with rosacea. Some risk factors include:

Being between 30 and 50 years old; having fair skin, often with blonde hair and blue eyes; having Celtic or Scandinavian ancestry; a family history; having had severe acne. Although women are likelier than men to get rosacea, men are likelier to get severe rosacea. But people of any age can get it, as can people of any skin color.

As for the cause, that’s still not known. Scientists have found that rosacea runs in families, and that means that there may be a rosacea gene. And the immune system may play a part. Research has revealed that most people with acne-like rosacea react to a bacterium called bacillus oleronius. This reaction causes their immune system to overreact.

Additionally, the AAD says, a bug that causes intestinal infections may be a factor. This bug, H pylori, is common in people who have rosacea, although the link isn’t definitive. And demodex, a mite that live on the skin, may also play a role. The reason: It likes to live on the nose and cheeks, where rosacea often appears. Again, though, the link isn’t definitive.  Cathelicidin, a protein that normally protects the skin from infection, may cause redness and swelling depending on how a person’s body processes the protein.

Diagnosis of rosacea is fairly simply. A dermatologist will examine the skin and eyes and ask the patient questions about their health history.

Once the type of rosacea has been determined via symptoms, a dermatologist will treat it accordingly. While rosacea can’t be cured, the AAD says, it can be managed by taking care of the condition.

Treatments include topical medicine; wearing sunscreen; a skin-repairing emollient; lasers and light treatments; dermabrasion; and antibiotics. As for rosacea that affects the eyelids, the dermatologist will recommend a prescription medicine to wash the eyelids throughout the day.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations, with a membership of more than 18,000 physicians worldwide. For more information, contact the AAD at 1-888-462-DERM (3376) or www.aad.org.