The human skin contains numerous tiny capillaries that are normally narrow and not visible to the naked eye. However, under the influence of various factors such as stress, fear, cold, or heat, they can freely constrict or dilate. In some cases, the capillary walls lose their elasticity, deteriorate rapidly, and are unable to narrow. Consequently, persistent redness and the appearance of a vascular network on the face, known as rosacea, occur.

Rosacea affects individuals differently, with most people only experiencing a subset of its symptoms. The pattern of these symptoms can vary greatly from person to person. Although rosacea is a chronic condition, it often follows a cycle of flare-ups and periods of remission, providing some relief from its symptoms.

The symptoms of rosacea include:

• Facial redness. Experience a gradual shift from occasional flushing or blushing to a persistent redness that lingers for extended periods. This persistent redness may be accompanied by a tingling or burning sensation, while the affected skin may become rough and scaly over time.
• Rash. Acne-like red spots on the face can turn into red, pus-filled bumps and pimples.
• Visible blood vessels. These typically appear as thin red lines on the cheeks and nose. It’s known as telangiectasia.
• Skin thickening. Particularly on the nose, the skin may thicken, giving the nose an inflated, bulbous appearance. Men are primarily affected by this symptom, which is one of the more severe ones.
• Eye irritation. In what is termed ocular rosacea, the eyes become sore, red, itchy, watery, or dry. They may feel gritty or as if there is something in them, such as an eyelash. The eyelids may swell and become red at the base of the eyelashes. Styes may develop. It is important to see a health care provider if you have eye symptoms because if left untreated, eye damage and loss of vision can result.

Rosacea can occasionally progress in stages, starting with brief flushing of the cheeks and nose and continuing for a longer time before developing into a rash and tiny blood vessels visible beneath the skin. Untreated skin can thicken and swell, resulting in firm, red pimples, particularly on the nose.
The middle of the face is typically affected, but in rare instances, it can spread to the sides of the face, the ears, the neck, the scalp, and the chest.

The dermal layer of the skin houses the blood vessels, which are composed of a superficial and deep network of arterioles, venules, and capillaries. Maintaining healthy blood vessels and microcirculation is crucial for maintaining youthful and healthy skin. Healthy capillaries play a vital role in supplying oxygen and nutrients to the skin cells, while also eliminating metabolic waste. This essential process ensures that the skin fully supports all its functions. The skin can experience aesthetic problems as we age, which can be attributed to inadequate blood circulation in the affected area. Excessive dilation of the blood vessels in the skin can have a negative impact on the local blood circulation, which in turn affects the health of the skin cells.

Couperose is often accompanied by dry skin and peeling. The blood in the capillaries becomes stagnant, leading to a lack of oxygen and nutrients for the skin cells. This also hinders the removal of metabolic waste from the cells. Consequently, the skin cells divide at a slower rate, resulting in thinning and drying of the upper layer of the skin. Premature wrinkles may appear, and the complexion may take on a pale grayish hue. This overall accelerates the aging process of the skin. Additionally, skin prone to couperose is frequently sensitive. Interestingly, even if the skin was not initially hypersensitive, it can quickly develop sensitivity and become a constant companion to couperose. It is worth noting that thin, dry, and light skin is particularly susceptible to becoming hypersensitive and displaying signs of rosacea.

The susceptibility to the disease is often inherited and linked to a genetic predisposition that weakens the walls of blood vessels. This weakness causes the vessels to easily deform and expand when exposed to external factors, which is commonly observed among close relatives and typically manifests with age. The reduced elasticity of capillaries can also be attributed to significant internal pathologies, such as autoimmune diseases, sclerotic changes, hypertension, hormonal imbalances, and heart failure. The condition of internal organs and the gastrointestinal tract also plays a crucial role, as chronic diseases affecting these areas can disrupt the absorption of nutrients and negatively impact the overall state of the vessels and the entire body. Endocrine disorders, hormonal fluctuations, stress, and prolonged exposure to direct sunlight can also affect the elasticity of blood vessels and damage the walls of capillaries. In winter, cold air can have a negative impact on sensitive facial skin, making it more susceptible to damage.

Three primary stages of rosacea have been identified by dermatologists, each with a unique set of bothersome symptoms. During the first phase, called erythrosis, people may momentarily become red in the chin, nose, and cheeks. This redness usually lasts a few days or for a brief amount of time and can happen for no apparent reason. In addition to the redness, some patients report hot flashes, tingling, itching, and skin irritation, as well as increased sensitivity.

As the second stage progresses, the face begins to show signs of a vascular network known as telangiectasia. The dilatation of capillaries that are unable to constrict and return to their normal state is known as telangiectasia. This leads to chronic redness in specific facial areas and the formation of tiny vascular nodules under the skin that result in a web of reddish-purple veins.

Lastly, the third stage is distinguished by inflammatory processes, insufficient skin nourishment, early skin aging, and the beginning of skin withering. Chronic interruptions in blood microcirculation are also characteristics of this stage. The skin may continue to hurt at this point and exhibit particular symptoms associated with these underlying problems. It is crucial to treat rosacea to halt the progression of the disease.

Treating rosacea solely by targeting the inflammatory process is not enough. The primary approach to combat couperose or telangiectasia involves strengthening the blood vessel walls and restoring their tone and function. Photo-facials and ablative radiofrequency treatments can effectively eliminate the capillaries that contribute to inflammation in the soft tissue of the skin. Since capillaries have a delicate structure, it is important to handle them with care throughout skincare. Preventing the formation of new elements is also crucial to avoid the development of nodules and fims on the skin. Additionally, addressing various somatic disorders of the digestive tract, central nervous system, vascular reactions, and eliminating predisposing and provoking factors, along with dietary adjustments and photoprotection, should be considered.