A Portrait of Rosacea

Rosacea is one of the most devastating conditions for men and women in today's society, affecting the look, feel, and texture of our skin. Although it characteristically attacks the facial skin, it is also found on other areas of the body as well. These areas are sometimes ignored since the blushing or flushing symptom is only found on the face.   
 
Rosacea often starts in the eyes as an inflammatory eye problem and is overlooked. Blepharitis and Conjunctivitis are the most common infections. All Rosacea patients should be seen by an ophthalmologist on a regular basis.
 
Rosacea has very well defined characteristics which include redness or flushing, blushing to the facial area, a copper-like hue which the French define as couperose, pallor on areas not affected, as well as small papules, slight scaling, and erythematous papules.  
 
The onset of Rosacea usually appears in the 30s, 40s, and 50's as redness on the cheeks, nose, chin, or forehead. Rosacea is a relatively common disease in fair-skinned individuals and is more rare in darker skinned individuals. Rosacea is more common in women than in men.  It is common in all skins in sunny countries. Sun damage early in life has a damaging effect on Rosacea.   
 
At the onset these conditions appear and disappear like a sunburn or allergic reaction. When Rosacea is left untreated the redness will become more prominent and papules will start appearing along with swelling and irritation.   
 
Many factors affect Rosacea including flushing or blushing, harsh irritating products, alcoholic beverages, embarrassment, stress, anxiety, hot drinks, spicy foods, heat and humidity, physical exercise, and very cold weather.  
 
One of the best tools to treat Rosacea is knowledge and education, so lets start with these:
 
STAGES

There are 3 very defined stages of Rosacea on the face:
 

Stage One: Flushing and or blushing with a copper red hue to the skin. There are many fine tielangiectasia and occasional papules forming sprays on the nose or chin, nasolabial folds, and cheeks. If the erythema lasts only a few minutes then it is not Rosacea. Many complain of sensitive skin that burns, itches, or stings after applying cosmetics, especially ones with fragrance or alcohol. The skin may be especially sensitive to peeling or abrasive agents.
 
 
Stage Two: Papules and pustules on the center of the face including forehead, nose, cheeks, and chin as well as a copper hue to the skin with tielangiectasia.
 
 
 
Stage Three: Inflamed skin on the entire face with papules and deep-seated painful nodules. This is a severe form of Rosacea.
 
ADDITIONAL SYMPTOMS OF ROSACEA
 
Rhinophyma (Rhinos, Greek = nose) is the ultimate disfigurement from Rosacea causing the face to look malformed. This occurs exclusively in men. This disfigurement is not caused by alcohol, as is commonly thought. Only a few Rosacea patients develop this condition. This (bulbous nose) develops over many years as a result of progressive disease and increase in the connective tissue, sebaceous gland hyperplasia and chronic deep inflammation.
 
Gnathophyma  (Gnathos, Greek = jaw) shows up as swelling of the jaw.
 
Otophyma (Ota, Greek = ear) is a cauliflower like swelling of the earlobes

Blepharophyma  (Blepharon, Greek = lid) is a chronic swelling of the eyelids, mostly from sebaceous gland hyperplasia.

Red Eyes Many individuals start out with red eyes before any other symptoms occur. This symptom starts before flushing and blushing and can mark the onset of Rosacea.

When dealing and treating Rosacea it is important to remember that exacerbating factors do affect everyone, however the degree of effect is different for each individual. Therefore, please chart the things you are exposed to, do and eat or drink during the day so you will know what ultimately affects your Rosacea and how your skin responds to these factors.
 
SOLUTIONS

Choosing a Physician:
Arm yourself with Knowledge. If you think you have Rosacea see a physician and find out what treatment options are available to you. Consider seeing an ophthalmologist as well if you have any redness or irritation in or around your eyes. If you are already seeing a doctor and are unhappy or confused about your results check with you local hospital and find out who they recommend that specializes in Rosacea or find out who the Dean Of Research for dermatology at your hospital is. Many physicians book special time for individuals who want a longer consultation and you must specify this when booking your appointment.

Once you have chosen a physician compile a list of what you think exacerbates your condition, how long you have noticed it, what if anything, you have used for treatment and the results, if any, you had. Be very diligent when compiling this list as every little detail counts for treatment and results.
 
Medication:
There are many medications available that are successful in the treatment of Rosacea both topically and systemically. They include, but are not limited to, noritate, metro gel (Metronidazole), and metrocream. Metronidazole does not reduce erythema, telangiectases or flushing, however it does help with papular and pustular Rosacea. Erythromycin in a non-alcoholic base, tetracycline, retina (tretinoin) and acutane (isotretinoin in a bland cream) which helps reduce inflammatory lesions in stage 1 and 2 Rosacea. Nizoral is also used. Systemic drugs may be used with success and Rosacea responds well to these. Tetracycline, HCI, oxytetracylcine, doxycycline and minocycline are effective in treating papulopustular Rosacea and in reducing erythema. These medications need to be monitored closely and doses varied as the disease has ups and downs or flares and remissions. Remember that medication, lifestyle changes, proper usage of SPF 25 and diligence are the keys to successful treatment. Some of these medications may exacerbate Rosacea and the accompanying acne so read labels, check for comedogenic ingredients and check contra indications as well as specific dose instructions. One medication that is not good for Rosacea is topical steroids. These medications cause thinning of the skin, which leads to lines, wrinkles, discoloration, photo sensitivity, and exacerbate acne as well. Although the skin responds at first, thinning of the skin occurs with prolonged use, and there is a marked increase in telangiectases. The complexion becomes dark red with a couperouse or copper-like hue. The skin then becomes studded with papulopustules, firm nodules, scaling and cysts. This type of medication also causes problems since many individuals discontinue them as soon as the "symptoms" disappear and unfortunately this causes more flaring.
 
Skin Care Products:
Due to advances in science and education it is now possible to treat Rosacea and have beautiful skin with or without medication. I am not implying that you will not need medication depending on the severity of your Rosacea, but instead that you have additional tools to treat your skin with so it is healthy and glowing. We know that harsh products containing alcohol, some alpha-hydroxy preparations, exfoliants made from seeds and pits which scratch the skin and astringents should be avoided. However, the same rules for healthy skin apply to an individual with Rosacea. You may exfoliate, cleanse, and wear SPF as well as using BHA's and moisturizers that are safe as long as they are gentle and non-comedogenic. Salicylic acid, BHA (which is not to be confused with the BHA preservative) works on irritated, dry, flaky skin that can also be oily and covered with grades one and two acne. Salicylic acid will remove the red or "couperouse"bronze color that many have with Rosacea.
 
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Barbara Strickland 1998-2016. This information is published and may not be reprinted.