Understanding Rosacea Papules

Rosacea Papules are a small, red solid elevated inflammatory skin lesion without pus that is minor when the size is of a small measles lesion, moderate when about the size of a pencil eraser and severe when the papule is the size of a small currency coin or the tip of the little finger. The top of the papule may be flat, pointed, or rounded. Rosacea papules should not be mistaken for acne papules, which are common lesions in acne. Rosacea papules do not contain pus, while acne papules do contain pus.

Rosacea papules are small, red solid elevated inflammatory skin lesions without pus that are considered minor when the size of a small measles lesion, moderate when smaller than the size of a pencil eraser, and severe when the rosacea papule is the size of a small currency coin. Rosacea papules may open when scratched, becoming crusty and infected. A group of very small rosacea papules and microcomedones may be almost invisible but have a sandpaper feel to the touch.

Vascular flushing is a primary cause of rosacea papules. Over time, flushing results in leakage of inflammatory cells out of the blood vessels and into the skin. These inflammatory cells then migrate toward the surface of the skin, resulting in inflammatory papules. Bacteria or demodex mites do not cause facial papules.

Usually observed in stage two rosacea, inflammatory papules may crop up and persist for weeks. Rosacea papules show a small pustule at the apex, justifying the term papulopustular. The lesions are always follicular in origin, mainly in sebaceous follicles but also in the smaller and more numerous vellus follicles. Comedones do not occur. The deeper inflammatory lesions may heal with scarring, but scars are inconspicuous and tend to be shallow. Facial pores become larger and prominent. If there has been much solar exposure over decades, one may observe the appearance of photo-damaged skin in a yellowed, leathered skin (elastosis), wrinkles and solar comedones. The papulopustular attacks becomes more and more frequent. Finally, rosacea may extend over the entire face and even spread to the scalp, especially if the patient is balding. Itchy follicular papules of the scalp are typical. Eventually, the sides of the neck as well may be affected.

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THE CONTROVERSY OVER ORAL ANTIBIOTIC THERAPY AND ROSACEA

Antibiotics are used to reduce the symptoms of rosacea, including redness, pimples, and red lines on the face (telangiectasia), and thick bumps on the nose (rhinophyma), and to reduce the symptoms that accompany eye involvement in rosacea. Antibiotics may reduce overall inflammation that occur with rosacea. Antibiotics also reduce the number of acne pimples and the amount of facial redness around pimples.

In the treatment of rosacea, a typical course of antibiotics would begin with an oral antibiotic, such as tetracycline. Oral antibiotics are usually tapered off after the rosacea symptoms improve because long-term use of oral antibiotics is associated with side effects. Bacteria build immunity to topical and oral antibiotics within 3 to 5 months; therefore they lose their effectiveness. It is important to note that a possible side effect of oral antibiotics is facial redness, photo or sun sensitivity and skin irritation.

Public health experts are concerned about antibiotic resistance, a problem that can develop when antibiotics are overused. Over time, bacteria develop new defenses against antibiotics that once were effective against them. Bacteria reproduce quickly; these defenses can be rapidly passed on through generations of bacteria until almost all are immune to the effects of a particular antibiotic. The process happens faster than new antibiotics can be developed. To help control the problem, many experts advise people to use antibiotics only for short periods, and only as directed. An antibiotic that works for one person with rosacea may not work for another.

A new term called "SuperBugs" was coined a few years ago as bacteria mutated to become immune to antibiotics. The first antibiotics were developed post World War II and have been considered miracle drugs until recently as bacteria mutations into antibiotic resistant strains have made them less effective. As the antibiotic fails to kill all the bacteria, the few remaining stains mutate to become resistant to that particular antibiotic. So a different and stronger antibiotic is used, but the mutations or genetic advancement allows the bacteria to tolerate the more stringent antibiotic and the cycle continues.

Want to learn more about oral antibiotic rosacea treatment? We recommend you visit the rosacea learning pages below:
www.internationalrosaceafoundation.org/antibiotics.php4
www.rosacea-ltd.com/redman.php3
www.rosacea-ltd.com/antibiotic_resistance_4.php3