ROSACEA
Rosacea is a common condition characterized by symptoms of facial flushing and a spectrum of clinical signs, including redness, spider veins, coarseness of skin, and acne like pustular eruptions. There are also some indications that persons with rosacea are disproportionately of fair-skinned European and Celtic origin. The National Rosacea Society has an excellent website http://www.rosacea.org.
What causes Rosacea?
Who gets Rosacea?
What are the signs and symptoms of Rosacea?
What should I do if I suspect I have Rosacea?
What are the types of Rosacea?
How can I prevent Rosacea?
What are the Rosacea Triggers?
What are the treatments for Rosacea?
What causes Rosacea?
The cause of rosacea is not known. Several factors such your inherited vasculature, climatic exposures, skin degeneration and abnormalities, chemicals and ingested agents and bacteria play a role in its development. There are also some types of rosacea that is likely determined by a patient's unique sensitivity to triggers in the environment. There is little doubt that certain foods seem to trigger rosacea in some people.
It is estimated that about 14 million Americans have rosacea, and many do not even know it. Anyone can get rosacea, but individuals with fair skin who tend to flush or blush easily are believed to be at a greater risk. Rosacea is most common in adults between the ages of 30 and 60, and women are affected almost twice as often as men. Men however tend to have the most severe symptoms.
What are the signs and symptoms of Rosacea?
The following are the common rosacea symptoms. The face is the most common area involved but rosacea can occur on the ears, scalp, neck, back or chest.
Persistent Redness – this is the most common rosacea symptom. It is like having a sunburn that will not go away. This may be more noticeable when smiling, frowning, or squinting.
Blushing - frequent blushing is sometimes the first sign of this disease and is a common rosacea symptom. This facial redness may come and go.
Bumps and Pimples - Bumps or pimples on the skin, either small and solid or pus-filled . This may resemble acne though blackheads are absent. Burning or stinging may occur. This is commonly referred to as acne rosacea.
Visible Blood Vessels – Spider veins in the face caused by enlarged blood vessels is also common.
Eye Irritation - Many people suffer from ocular rosacea where the eyes are irritated and appear watery and bloodshot. The eyelids typically get red and swollen and sties are common.
Dry Appearance – The facial skin is rough and looks dry.
Plaques - Raised red patches may develop in the affected skin.
Stinging or Burning – This usually happens on the face. Tightness may also develop.
Swelling – Edema is the term used to describe swelling of the face. For many people, this is a common rosacea symptom and may only affect the area around the eyes.
Thickening of the Skin – The skin can thicken and enlarge. This condition on the nose is called rhinophyma.
What should I do if I suspect I have Rosacea?
Rosacea should be diagnosed and treated by a dermatologist or other knowledgeable physician before the signs and symptoms become increasingly severe. A qualified physician needs to exclude other disease states that mimic the clinical presentation of rosacea. For example your doctor must exclude polycythemia vera, connective tissue diseases like lupus erythematous, dermatomyositis or mixed connective tissue disease, photosensitivity, carcinoid mastocytosis, long-term application of topical steroids, contact dermatitis, and photosensitivity before making the diagnosis of rosacea. A skin biopsy may be necessary to determine this.
What are the types of Rosacea?
There are four types of rosacea.
Erythematotelangiectatic Rosacea is the most common type. It is characterized by flushing and persistent redness, and may also include visible blood vessels. When people ask what is rosacea, this is what they typically think of. The central facial flushing is often accompanied by burning or stinging and is the predominant sign in this type of rosacea. The redness usually spares the skin around the eyes. Patients also report that the burning or stinging may become worse when topical agents are applied. It type of rosacea can get worse without proper treatment.
Papulopustular Rosacea is often called acne rosacea, is characterized by persistent redness with transient bumps and pimples.
Phymatous Rosacea typically causes skin thickening, often resulting in an enlargement of the nose, rhinopyma. The actor W.C. Fields had this type of rosacea.
Ocular Rosacea patients typically have dry eyes, tearing and burning, swollen eyelids, recurrent sties and potential of vision loss from corneal damage.
There is no cure for rosacea but you can minimize symptoms and outbreaks by avoiding triggers and by protecting your skin with sunscreen.
The use of daily broad-spectrum sunscreen is recommended for all patients with rosacea. A sunscreen that protects against both ultraviolet A and ultraviolet B light should be chosen. Physical blockers such as titanium dioxide and zinc oxide are well tolerated. Also, the sunscreen should contain protective silicones such as dimethicone or cyclomethicone. Green tinted sunscreens can provide coverage of the erythema.
What are the Rosacea Triggers?
Anything that causes an increase of circulation to the face and neck can cause the condition to worsen. The following list of foods, activities and medications have all been implicated in causing symptoms to become worse. Before the initiation of any therapy, the triggering factors that exacerbate the patient's rosacea should be identified and avoided if possible. Once you determine which of these triggers an outbreak, you can avoid it. These factors may be unique to each individual patient.
The list of foods and beverages that are triggers for rosacea is quit extensive and include hot foods or beverages, spicy foods, caffeine withdrawal although caffeine itself isn't a factor, alcohol,
pasta, greasy foods and yes chocolates.
Meats that exacerbate rosacea include lamb, liver, lobster, prawns and meat marinades.
Dairy products include yogurt, sour cream and cheese.
Implicated fruits and vegetables include citrus fruits and related juices, bananas, red plums, raisins, figs, eggplant, avocados, spinach, broad-leaf beans and pods, including lima beans, navy beans and peas, peppers and tomatoes.
Seasonings and food additives like MSG, Aspartame and NutraSweet, any spicy seasoning, hot sauces, vanilla, soy sauce, vinegars, black pepper, yeast extract, food-colorings and preservatives have all been suspect.
Environmental triggers include sunlight, stress, anger, embarrassment, strenuous exercise, hot baths and showers, saunas, cold or hot weather and wind.
Some medications are triggers such as topical steroids, nasal steroids, high doses of vitamins B-6 and B-12, drugs that dilate blood vessels and certain skin care products.
What are the treatments for Rosacea?
If you have rosacea you should be evaluated and followed by a dermatologist because signs and symptoms become increasingly more severe with time. The various treatments available are beyond the scope of this presentation.
Dermatologic Lasers that we use in our practice are useful in treating the redness and spider veins of Erythematotelangiectatic Rosacea. The Laser is effective against rosacea by remodeling of the dermal connective tissue and improving the epidermal barrier. This is not covered by insurance and usually requires 1-3 treatments separated by 4-8 weeks to achieve the best results.
Surgical Care, dermabrasion, face peels or surgical Laser may be required in severe cases of rosacea particularly for rhinophyma.