In Canada, it is estimated that 2 million people (about 7% of the population) have the red face of Rosacea. The highest incidence is in white women between the ages of 30 to 50 years.

The red flushing of topical rosacea is confined to the cheeks, nose and central forehead. The skin becomes dry and flaky skin and reacts to most medicines, lotions and creams. Red pimple-like bumps often develop in the affected skin. While Rosacea is common and most sufferers consult their MDs for treatment, there has been little progress in understanding or managing this disorder.

Chronic Rosacea  Skin capillaries dilate with heat, causing flushing, and grow slowly to form permanent reddening  Papules, nodules, and pustules can develop.  Pustules are small (<1mm) and tend to occur on the apex of  papule. Telangiectasias are clusters of capillaries that overgrow and leave the skin permanently red. When  the capillaries grow, they leak fluid and deliver immune cells to the skin.

Significant cosmetic disfigurement may occur in the most severe Rosacea with skin swelling and enlargement. This is more common in men - the red face and bulbous nose of a chronic alcoholic is the classic presentation of the chronic, severe version of the disease. Sebaceous glands enlarge with skin edema that disfigure the nose, forehead, eyelids, ears, and chin. Rhinophyma is an enlarged nose; metophyma is a cushion-like swelling of the forehead, blepharophyma is swelling of the eyelids related to marked sebaceous gland hyperplasia, otophyma a cauliflower-like swelling of the ear lobes and gnathophyma is swelling of the chin.

The Rosacea diagnosis includes a range of inflammatory events in facial skin. The range is so broad that it is reasonable to ask if Rosacea  is too fuzzy a term that can apply to diverse immune-mediated events in the skin with different causes. 

The reader can recall our understanding of the skin as a meeting place for many characters in an ecological drama that unfolds every day. There is some evidence that the microbes and little animals who live on the skin participate in the Rosacea drama. It is also reasonable to suggest that sun exposure to the face damages the skin sufficiently that inflammatory events are more frequent and prolonged. Facial flushing is a normal response to heat, embarrassment and to some food and drinks such as coffee, tea, alcohol and hot spices. The sebaceous glands in the affected skin are often involved and may enlarge. Exposure to sun and all forms of heat causes exacerbations.

The oil glands in the skin of the nose and adjacent cheeks are prone to plugging with sebum that dries and stops flowing. The surface sebum turns black. The sebum plugs are good homes for bacteria and fungi and may contribute to skin inflammation.

Seborrhea is a related condition that involves the hair-bearing skin of the scalp and face, all expressions of infection with the  fungus, pityriasis ovale.  Seborrhea can involve the central forehead, skin under the eyebrows and beard and may contribute to or be confused with Rosacea.

Problems can arrive in the skin from the blood stream. When immune cells enter skin, they often take over with an inflammatory response that causes the skin to swell, itch, burn, and turn red. The red face and bulbous nose of chronic Rosacea has been associated with high living and heavy drinking; however, most people with Rosacea are not overindulgent hedonists.

A food connection has also been implicated and standard Rosacea advice has included abstinence from alcohol, coffee, tea, and spices that cause flushing. Delayed pattern food allergy may be a factor. Complete diet revision is advisable if other  symptoms of food allergy are present.

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