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Around 2001, I started noticing some issues on my nose, particularly around the creases, an issue I still experience today. It normally starts with a stinging feeling, an indication I’m about to experience some sort of inflammation. What eventually happens is something which looks like a ‘whitehead’ which I now know to be a ‘pustule’. Sometimes there are multiples, and most are not normally bigger than 2mm, mostly smaller. These pustules nearly always disappear within a short period of time, normally after washing/showering, but they tend to leave reddish marks which eventually fade. Very infrequently, these pustules would appear on my chin. My nose is slightly discoloured and more reddish than the rest of my face since the issue started.
Shortly after I started experiencing this issue, a doctor diagnosed me with ‘mild rosacea‘. If this is a correct diagnosis, then I would appear to mainly have Subtype 2 or papulopustular (acne) rosacea (see breakdown of types below). I also have the minor irritation of a recurrent mild eczema inside my right outer ear which has run parallel to this issue (…. spookily).
For around two years, I was treated with a mixture of low dose oral antibiotics (tetracycline) and a skin medication known as metronidazole. This did clear up the issue, but it always returned, and I stopped the medication opting instead for a commercial product which I find works better. It doesn’t clear it 100% but I’ve learned to live with it as a long-term chronic condition. I looked at many Rosacea sites online and none of the pictures seemed to apply to me and I agree with my diagnosing doctor in terms of a ‘mild’ version.
I worked out early on the triggers were stress, when ‘run down’, and too long in the sun. There were possibly others. Stress was part and parcel of the work I was involved in, and it was at a time when I left my life in the military after 29 years and started a second career in industry (often I think in hindsight, I may have been overly stressed at the life change without realising it). Without any medical input, I decided to try to make sure I got sufficient vitamins and I now appear to get less coughs and colds then I used to. I now try to stay out of the direct sun. Other common triggers are listed on reputable sites and include alcohol, hot and cold weather, exercise, hot baths and spicy foods but I have to say some of these activities will cause many people who do not have rosacea to turn red-faced for a short time. I guess they mean it’s exacerbated in those with Rosacea.
What is Rosacea
A common skin condition, usually occurring on the face, which predominantly affects fair-skinned but may affect all skin types in people aged 40 to 60 years old. It is more common in women but when affecting men, it may be more severe. It is a chronic condition, and can persist for a long time and, in any individual, the severity tends to fluctuate. Rosacea tends to affect the cheeks, forehead, chin and nose, and is characterised by persistent redness caused by dilated blood vessels, small bumps and pus-filled spots similar to acne. There may also be uncomfortable inflammation of the surface of the eyes and eyelids. I found this site to be a very useful Rosacea reference.
Rosacea is sometimes classified into 4 subtypes that may overlap:
- Subtype one, known as erythematotelangiectatic rosacea (ETR), is associated with facial redness, flushing, and visible blood vessels.
- Subtype two, papulopustular (or acne) rosacea, is associated with acne-like breakouts, and often affects middle-aged women.
- Subtype three, known as rhinophyma, is a rare form associated with the thickening of the skin on your nose. It usually affects men and is often accompanied by another subtype of rosacea.
- Subtype four is known as the ocular rosacea, and its symptoms are centred on the eye area.
I would say I have overlapping subtypes one and two but, in the latter, only due to some small bits of visible blood vessels (telangiesctasia) with zero facial redness and flushing.
What causes rosacea?
The cause of rosacea is not fully understood. Your genetics, immune system factors, and environmental factors may all play a part. Factors that trigger rosacea cause the blood vessels in the skin of the face to enlarge (dilate). The theory that rosacea is due to bacteria on the skin or in the gut has not been proven. However, antibiotics have proven helpful to treat rosacea. This is because of their anti-inflammatory effect. Rosacea is not contagious.
Why is rosacea sometimes linked to NETs?
On certain sites and in certain texts about NETs, you will see mention of Rosacea, clearly as a misdiagnosis of someone who presents with flushing. I started experiencing the sensation of NET related flushing in late 2009/early 2010 and I can honestly say this was a totally different experience to what I had with my mild rosacea. However, I don’t have the ‘blushing’ type of rosacea and I can see the presentational similarities.
Another issue commonly reported in both conditions is small visible blood vessels on the face, known formally as Telangiectasia or informally as ‘spider veins’ or ‘broken capillary veins’. This is quite common with erythematotelangiectatic rosacea (subtype 1). I actually have at least two of these showing and this appears to be something I’ve only noticed since the NET diagnosis and only in the last few years. Interesting, it says this is something normally caused by “chronic flushing” but I wouldn’t have labelled my flushing in that way. I have not felt any flushing since late 2010 after surgery and the commencement of long-acting somatostatin analogues. Unless there has been something ‘sub-clinical’ going on, I’ve veered my minor issue towards long-term but mild rosacea as the cause rather than NETs. Telangiectasia is mentioned in many NET texts including my own article “Neuroendocrine Cancer: A Witch’s Brew of Signs and Symptoms“
Histamine if often linked to both conditions. Read about NET related to histamine here and Rosacea histamine issues here.
BUT ….. the only real link with substance is the fact that many NET flushing episodes may be thought to have been rosacea.
Rosacea has similarities to many other skin conditions. In fact, skin issues seem to be pretty common with NET patients, I guess many are pretty much normal comorbidities which we all get but some might be linked to vitamin deficiencies or side effects of treatment. Some skin issues are actually directly linked to NETs including Merkel Cell Carcinoma, pellagra (linked to extreme cases of Carcinoid Syndrome) and Sweet’s syndrome (linked to Glucagonoma).
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