Rosacea is a chronic skin disease characterized by redness and swelling which is primarily localized on the face. Other areas that can be affected are the scalp, neck, ears, chest and back. Studies show that those afflicted with rosacea may first notice a tendency to flush or blush easily. This condition can occur over a long period of time and it often progresses to a persistent redness, pimples and visible blood vessels in the center of the face that can eventually involve the cheeks, forehead, chin and nose. Diagnosis of rosacea presents a big problem because it is easily confused with other skin conditions, such as acne and sunburn or seborrheic dermatitis. Rosacea sufferers often report periods of depression stemming from cosmetic disfigurement, painful burning sensations, and decreases in quality of life.Incidence
Approximately 14 million people in the United States have rosacea. It most often affects adults between the ages of 30 and 60. According to some recent studies conducted on more than 2,000 rosacea sufferers, 44 percent reported that their symptoms had first appeared in their 30s and 40s, and 43 percent first experienced rosacea after age 50. Research has also found that only 27 percent of Americans had heard of rosacea. Because of its alarming, acne-like effect on personal appearance, it can cause devastating psychological and social problems.
Types of rosacea
There are four identified rosacea subtypes and patients may have more than one subtype present.
%26bull; Erythematotelangiectatic rosacea
This type of rosacea is characterized by permanent redness with a tendency to flush and blush easily. It is also common to have small blood vessels visible near the surface of the skin and possibly burning or itching sensations.
This phase may sometimes be referred to as pre-rosacea.
%26bull; Papulopustular rosacea
Unlike the previous type, Papulopustular rosacea is characterized by some permanent redness with red bumps filled with pus. These skin changes typically last 1-4 days. This subtype can be easily confused with acne. Rosacea may also be accompanied by oily skin and dandruff.
%26bull; Phymatous rosacea
This subtype is most commonly associated with rhinophyma, an enlargement of the nose. Symptoms include skin thickening, irregular surface nodules, and enlargement. Phymatous rosacea appears on the nose, chin, forehead, cheeks, and ears.
%26bull; Ocular rosacea
The most common symptoms of ocular rosacea are red, dry and irritated eyes and eyelids. Some other symptoms include foreign body sensations, itching and burning. Rosacea may cause the inner skin of the eyelids to become inflamed or appear scaly, a condition known as conjunctivitis.
Causes
The precise pathogenesis of rosacea still remains unknown.
%26bull; Blood vessels damage
Most experts believe that rosacea is a disorder where the blood vessels become damaged when repeatedly dilated. The damage causes the vessels to dilate too easily and stay dilated for longer periods of time, sometimes even permanently.
%26bull; Heredity
Research has shown that rosacea also has a hereditary component. Those that are fair-skinned have a higher genetic predisposition for developing this condition. Women are more commonly affected but when men develop rosacea it tends to be more severe.
%26bull; Infective etiology
Some experts are saying that the cause of rosacea could be a chronic bacterial infection in the gastrointestinal system caused by the Helicobacter pylori. Some other claim that it has something to do with infection with tiny mites (Demodex folliculorum) living in human hair follicles. They may play a role by clogging up sebaceous gland openings. None of these theories have been conclusively proved.
Alcohol does not cause rosacea, although it may worsen it.
Triggers of rosacea
There are several possible triggers of rosacea and some of the most common are:
%26bull; exposure to temperature extremes
%26bull; strenuous exercise
%26bull; heat from sunlight
%26bull; severe sunburn
%26bull; stress
%26bull; cold wind
%26bull; hot baths, saunas
%26bull; moving to a warm or hot environment from a cold one
%26bull; some foods and drinks such as alcohol, foods high in histamine and spicy food
%26bull; certain medications and topical irritants
%26bull; some acne and wrinkle treatments that include microdermabrasion, chemical peels, high dosages of Isotretinoin, benzoyl peroxide and Tretinoin
%26bull; use of topical or nasal steroids
Psychological Effects
Experts believe that the social and emotional effects of rosacea are worse than the physical symptoms. In fact, a controlled study on this subject has shown that:
%26bull; nearly 70 percent of rosacea patients said it lowered their self-confidence and self-esteem
%26bull; 41 percent said the condition caused them to avoid public contact or cancel social engagements
Prognosis if left untreated
If left untreated, rosacea tends to be progressive, which means it gets worse over time. However, in most people rosacea is cyclic, which means it may flare up for a period of weeks to months and then signs and symptoms lessen for a while before rosacea flares up again. The rouble is that rosacea may advance to a third stage, in which the spread of excess facial tissue called fibroplasia may develop. It may also distort facial features enough to cause the so-called lionization.
In some cases, the eyes may also be affected by rosacea, resulting in a gritty feeling and bloodshot appearance which can even affect the vision.
Treatment of rosacea
Unfortunately, there is still no way to eliminate rosacea altogether. However, several treatments are available for relieving signs and symptoms of rosacea. The treatment most often this requires a combination of prescription medications and certain self-care measures. The key to successful management of rosacea is early diagnosis.
Medications
Doctors often prescribe topical antibiotics to treat rosacea. Although this could be confusing because no bacteria are involved, these antibiotics are being used more for their anti-inflammatory properties than to kill bacteria. The most common topical antibiotic prescribed is Metronidazole. It could be also combined with another prescription medication such as azelaic acid.
Oral antibiotics are also prescribed because they tend to work faster than topical ones.
Some of the most common prescription oral antibiotics include:
%26bull; Tetracycline
%26bull; Minocycline
%26bull; Doxycycline
%26bull; Erythromycin
Isotretinoin is a powerful medication sometimes used for more severe cases of inflammatory rosacea. Although it is usually prescribed for cystic acne because it works to inhibit the production of oil by sebaceous glands, it can be really helpful in rosacea treatment. Unfortunately Isotretinoin also has some side effects and is known to cause severe birth defects.
Surgical solutions
Enlarged blood vessels, redness and changes due to rhinophyma often become permanent. In these cases, surgical methods such as laser surgery and electro-surgery, may reduce the symptoms. Dermatological vascular laser or Intense Pulsed Light machines offer one of the best treatments for rosacea. They use light to penetrate the epidermis to target the capillaries in the dermis layer of the skin.
CO2 lasers can be used to remove excess tissue caused by Phymatous rosacea.
They reduce the visibility of blood vessels, remove tissue buildup around the nose and generally improve appearance.
Self-care
One of the most important things a patient can do if he or she has rosacea is to minimize the exposure to anything that causes a flare-up.
Suggestions for preventing flare-ups:
%26bull; Exercise in a cool environment. Don't overheat
%26bull; Use products that are labeled as non-comedogenic. These won't clog your oil and sweat gland openings as much
%26bull; When using moisturizer with a topical medication, apply the moisturizer after the medication has dried
%26bull; Patients should wear sunscreen with a sun protection factor of 15 or higher to protect face from the sun
%26bull; Avoid irritating your facial skin by rubbing or touching it too much
%26bull; Avoid facial products that contain alcohol or other skin irritants
%26bull; Avoid overheating
%26bull; Avoid alcohol
%26bull; Avoid hot drinks, spicy foods and caffeine.
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