Christman Dermatology

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Did You Know that Rosacea Can Affect Your Eyes?

Over half of patients with facial rosacea may have eye inflammation
and other symptoms of a condition known as ocular rosacea.

Symptoms of Ocular Rosacea

  • Gritty feeling in eyes
  • Eyes may burn, sting, or itch
  • Eyes look bloodshot
  • Vision may be blurry
  • Eyelids may be red and inflamed
  • Cysts or sties
  • Eyes may tear
  • May experience light sensitivity

ocular rosacea - red, inflamed, gritty eyes may burn and sting - 50% of people with rosacea have issues with their eyesThe exact relationship between facial rosacea and ocular rosecea is unclear. Rosacea skin and eye symptoms do not necessarily follow the same course.  The diagnosis is often missed as the symptoms are not specific to rosacea and there is no specific test to prove that the patient definitely has ocular rosacea.There is often eye irritation and a gritty sensation in the eyes. These symptoms may also be seen in other conditions with eyelid oil gland dysfunction and in conditions with decreased tear production.If the condition is identified it can often be treated so that the inflammation is controlled and irritation and discomfort are reduced.  For mild disease topical treatment including eyelid scrubs, warm soaks, and eye lubricants are helpful.  Oral antibiotics such as doxycycline may be helpful as well.For people experiencing issues with their eyes and have already been diagnosed with rosacea of the skin, discuss the possibility of ocular rosacea with your ophthalmologist.

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Acne or Rosacea – Which is it?

  • Acne

  • Teenagers and adults
  • Face and trunk
  • Clogged pores
  • Red bumps
  • Less redness
  • Lack of eye symptoms

  • Rosacea

  • Primarily adults
  • Central face
  • Absence of clogged pores
  • Red bumps
  • Central facial redness
  • Often eye symptoms

Acne (acne vulgaris) often has its onset around puberty, may be very active in teenagers, and may persist or develop in adults — especially women.  Lesions consist of clogged pores (blackheads and whiteheads), pustules, red bumps (papules) and tender deeper cysts.  Acne vulgaris occurs on the face, neck, shoulders, and trunk. Underlying mechanisms include hormonal changes leading to increased oil production, and bacteria leading to inflammation and clogged pores. Together, these result in acne lesions.  There is a strong genetic component to acne vulgaris. Adult onset acne most often affects women between the ages of 20 and 50. They often experience hormonally based lesions, particularly pink papules and painful cysts along the jaw line and lower face.

Acne rosacea is most common in adults between the ages of 30 and 60, and is more common in women.  It primarily involves the central face and consists of four stages:  flushing; redness/small vessels; red bumps and pustules; and less commonly, skin swelling/thickening. It is most common in fair-skinned individuals.  The underlying cause of rosacea is not well understood. Recently, it has been thought to be a combination of dysregulation in the skin’s nervous and blood vessel systems and localized immune system dysfunction that leads to inflammation, redness, and subsequent lesions.  Risk factors include sun exposure, family history, possibly Demodex mites and/or Helicobacter pylori.  Additional factors that aggravate the redness of rosacea include alcohol, caffeine, heat exposure, and smoking.

To distinguish between acne and rosacea, it is helpful to consider the following information: age; the location and type of lesions; and the degree of underlying redness.  Teen years, clogged pores/blackheads, and trunk involvement are seen primarily in acne vulgaris. Central facial redness with or without pink bumps and pustules are more suggestive of acne rosacea.

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What’s New in Pediatric Acne?

Pediatric acne affects children ages 7-12.The first evidence-based pediatric acne guidelines were developed this year by the American Acne and Rosacea Society (AARS), and endorsed by the American Academy of Pediatrics (AAP).  The guidelines were developed by a panel of pediatric dermatologists, pediatricians, and dermatologists with acne expertise.

There is a trend of acne appearing at an earlier age. It is thought to be related to the earlier onset of puberty.  It is also likely that the early onset of acne may indicate more severe acne in the teen years.

Acne in children ages 7-12 usually consist of clogged pores and small bumps that are often successfully managed with over the counter and/or prescription topical products.  Twice a day gentle cleansing and the use of products that don’t clog pores (non-comedogenic) need to be incorporated into a daily program.   Parents and children should realize that it often takes several months of consistent therapy to see improvement. The program will need to be maintained to prevent relapse.  As hormones change moving into adolescence, the therapy may need adjustments.

Visit the American Academy of Pediatrics to read more about the new Pediatric Acne Guidelines.