As dermatology became established in the early 19th century, rosacea was one of the first skin disorders described in medical texts.  The Journal of the American Academy of Dermatology recently published an overview of early illustrations of rosacea, showing how far medicine has come in its recognition of the disorder and highlighting how important visual cues are to its diagnosis.¹

While the signs and symptoms of rosacea appear in paintings as early as the 1400s, their association with a specific disorder was not understood.  One of the earliest images of rosacea dates to the 1817 edition of On Cutaneous Diseases by Dr. Robert Willan, as hand-colored illustrations in medical textbooks were used to aid physicians in diagnosing diseases and distinguishing one condition from another.  The illustration, which appears alongside depictions of moderate and severe acne, shows redness on the nose and cheeks, as well as the tiny blood vessels (telangiectasia) and bumps and pimples (papules and pustules) of rosacea.

In the early 1800s, medical illustrations frequently exaggerated the features of rosacea skin in order to differentiate the condition from acne. Bumps and pimples were often given a blue or purple tint, while telangiectasia sometimes appeared almost like cracks in the skin. Because no treatments yet existed for the disorder, symptoms often progressed to their most severe state.  In particular, rhinophyma, the overgrowth of tissue around the nose, was often shown as a grotesque disfigurement, rather than the less severe bulbousness seen in the actor W.C. Fields.  The patients who sat for the illustrations were visibly unhappy or upset by their appearance.

However, as the century progressed, more realistic depictions of rosacea were created, including illustrations based on wax casts of patients.  The disorder was also increasingly recognized as different from acne.  With the advent of photography, representations of rosacea began to move away from artists' interpretations and exaggerations – although illustrations continued to be common well into the 20th century.

As dermatologists worked toward increased understanding of rosacea, a more modern picture of rosacea has emerged.  In 2002, the “Standard classification of rosacea” was published by the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea,² which also published a standard grading system for the disorder.  And thankfully treatments now exist that help patients effectively manage their condition through medical therapy as well as lifestyle changes – allowing them to avoid the extremes known by sufferers in centuries past.

References:
1.  Cribier B.  Medical history of the representation of rosacea in the 19th century.  J Am Acad Dermatol 2013;69:S2-14.  doi: 10.1016/j.jaad.2013.04/046.
2.  Wilkin J, Dahl M, Detmar M, Drake L, et al.  Standard classification of rosacea:  Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea.  J Am Acad Dermatol 2002;46:584-587.