Rosacea Fulminans

What is Rosacea Fulminans?

Rosacea fulminans is far and away the most extreme variant of rosacea. It is considered the ‘worst’, if judged objectively, and this is an easy judgment to understand. Acne fulminans presents with severe nodules and abscesses absent from other, more mundane forms of rosacea. It almost inevitably causes scarring, bleeding, and can be described as nothing but ‘disfiguring’. It strikes very rapidly, progressing over the course of days or, at most, weeks; this contrasts heavily with rosacea, which develops over the course of decades.

Rosacea fulminans, naturally, includes the signature erythmia, or redness of rosacea. Rosacea fulminans is a condition distinct from rosacea. However, it still shares at least this similarity in addition to its own unique, painful flavor. This is, however, where the similarities end; rosacea fulminans is otherwise dissimilar to rosacea, and its other symptoms detract from the severity of the shared erythmia.

Who gets Rosacea Fulminans?

Rosacea fulminans affects women exclusively, a trait unique to rosacea conditions. Most forms of rosacea affect men and women equally or carry a bias (generally related to hormones), but no other form of rosacea is exclusive to a single sex. It is not clear if this is chromosomal or hormonal. However, the lack of any reported male cases makes this impossible to study. There is no data with respect to acne fulminans cases appearing in intersexed individuals or transsexuals (who may have chromosomal and hormonal development in opposition to one another).

Rosacea fulminans only affects women that have progressed through adolescence. While rosacea tends to manifest in middle age or later, and progress over the course of decades into the afflicted’s old age, rosacea fulminans presents itself much earlier in life, generally in a subject’s 20s or 30s. The disease progresses over the course of days or weeks, not years.

None of the usual predisposing conditions apply to rosacea fulminans. Whereas rosacea can be triggered to break out by heat, ultraviolet exposure or any number of other conditions, rosacea fulminans is effectively spontaneous, and very rapid. Thus, there are no genetic sensitivities that come into play, although individuals of caucasian descent are almost certainly more likely to suffer from rosacea fulminans, as they are more likely to suffer from many other skin conditions.

What causes Rosacea Fulminans?

The cause of rosacea fulminans is unknown. It is not an acneiform condition. It does not follow the same rules as rosacea, rosacea conglobata or any other rosacea condition. It does not follow any of the patterns for other dermatitis conditions. Rosacea fulminans is not sebaceous in origin, related to the oiliness of the skin, nor does it seem to have an environmental trigger. This lack of an apparent cause coupled with its very rapid spread makes it quite alarming for most patients.

Perhaps most notably, rosacea fulminans is not a bacterial condition. The abscessing nature of rosacea fulminans means it is frequently identified with bacterial infection. However, it is not bacterial in origin. Likewise, rosacea fulminans is not viral in origin.

Rosacea fulminans is not contagious and cannot be shared between any two individuals, no matter what degree of contact they might share. There is no viral or bacterial component to make rosacea fulminans a contagious condition.

What does Rosacea Fulminans cause?

Rosacea fulminans can cause a number of individual conditions, none of them pleasant. First and foremost, rosacea fulminans causes the outbreak of nodules and painful lesions. These will bleed and almost certainly scar once rosacea fulminans has run its course. These scars have a tendency to be composed of thick tissue, owing to the lesions that rosacea fulminans can form.

Infection is a very prevalent issue for patients suffering from rosacea fulminans. While rosacea fulminans does not have a viral or bacterial component identified with its cause, it does involve open sores, which necessarily opens one’s skin and internals to the possibility of infection, especially bacterial infection. This is further exacerbated by the presence of abscesses, which are extremely prone to infection (and are frequently identified with it-while an ‘abscess’ is nothing more than an empty space, just a sinus that shouldn’t exist, they are usually made medically relevant by their capacity to incubate bacteria). Individuals suffering from rosacea fulminans must take care to prevent unnecessary exposure and should avoid touching their face for this reason, be mindful of their pillow cases, and generally go through the same motions they might have gone through as teenagers dealing with acne.

Rosacea fulminans is quite irritating and painful. While rosacea fulminans is not linked to the sebaceous glands and how oily the skin is, the inflammation can trigger outbreaks of acne in individuals that are prone to it. Individuals suffering from rosacea that subsequently contract rosacea fulminans will almost certainly deal with a rosacea outbreak in response to rosacea fulminans, even though they are functionally very different aside from the signature erythmia (redness). Any skin condition that may respond to inflammation will almost certainly respond to rosacea fulminans.

Rosacea fulminans is disfiguring. It is inevitable that individuals suffering from rosacea fulminans will encounter some sort of social consequence for their difficulties, as the lesions and redness are nearly impossible to ignore, discounting the very real possibility of active bleeding occurring. This carries with it a very strong potential for heavy psychological impact. It is very difficult to suffer such a dramatic and uncontrollable change of appearance for the worse, with discomfort, with the potentiality for permanent scarring, without losing one’s wits at least a little, no matter how stoic they might be to begin with.

How serious is Rosacea Fulminans?

Rosacea fulminans is a very serious skin condition. Its effects are quite disfiguring, especially without medical intervention. It is impossible to ignore or downplay. It is effectively impossible to mitigate its effects without professional medical intervention; while acne is a skin disease for which medical intervention is frequently ignored in favor of over-the-counter treatment and home remedies, and even rosacea is left untouched, rosacea fulminans demands attention.

Rosacea fulminans, while very serious, has a decent prognosis. This is its ‘saving grace’, if it can be said to have that. Unlike most forms of rosacea, there is a single identifiable treatment that carries with it real and effective results. While this does little to aid any permanent scarring that the damage from the abscesses and lesions may have caused, it does end the disease and prevent any further damage from occurring.

What does Rosacea Fulminans treatment look like?

Rosacea fulminans treatment consists of injected isotreitonin, also known as Accutane. Steroids of injected or topical varieties may also be prescribed; pregnant individuals who cannot use isotreitonin will likely be prescribed these instead. Rosacea fulminans treatment is effective and can take the wind out of rosacea fulminans’ sails very quickly. However, treatment must be swift and decisive. Rosacea fulminans cannot be ignored and treatment must be delivered.

While it may superficially resemble an acneiform condition, no acne treatments will have any impact on rosacea fulminans. It is a very different disease with a distinct (if ill-understood) origin and limited recourse. However, it still comes out on top of other ailments, including rosacea-type ailments, with respect to treatability. While rosacea fulminans may resemble an infection, it is not; antibiotics will have no relevant effect. Any secondary infections made possible by acne fulminans may still be treated by antibiotics but the disease itself will not show any impact for this treatment’s usage.

How do I know if I have Rosacea Fulminans?

Rosacea fulminans can easily be diagnosed by its sudden onset and very rapid spread. Rosacea fulminans is destructive, painful and difficult to mistake. It is characterized by initial erythmia (redness) followed by nodules, followed by hemorrhaging, followed by abscess. The presentation of the nodules is usually enough to identify it as rosacea fulminans and any bleeding that should subsequently occur can deflate all doubt.

As with any disease, self-diagnosis is not reliable to any extent that it should be used to the exclusion of legitimate, considered medical advice from a trained medical professional. Further, the nature of rosacea fulminans means that treatment must happen as quickly as possible. ANY sign of rosacea fulminans should be met with the examination by, consideration of and treatment from a trained medical professional. The sooner rosacea fulminans can be treated, the sooner it can be kicked to the curb.

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