Rosacea Overview

osacea

Rosacea is a common but often misunderstood condition that is estimated to affect over

million

people worldwide. It affects fair-skinned people of mostly north-western European

descent, and

has been nicknamed the 'curse of the Celts' by some in Ireland. It begins as

erythema (flushing

and redness) on the central face and across the cheeks, nose, or forehead

but can also less

commonly affect the neck and chest. As rosacea progresses, other symptoms

can develop such

as semi-permanent erythema, telangiectasia (dilation of superficial blood

vessels on the face), red

domed papules (small bumps) and pustules, red gritty eyes, burning

and stinging sensations, and

in some advanced cases, a red lobulated nose (rhinophyma). The

disorder can be confused and

co-exist with acne vulgaris and/or seborrheic dermatitis. Rosacea

affects both sexes, but is almost

three times more common in women, and has a peak age of

onset between 30 and 60. The

presence of rash on the scalp or ears suggests a different or

co-existing diagnosis, as rosacea

is primarily a facial diagnosis.

Rosacea -

xamining the Different Types

There are four identified rosacea

types

and it is possible to have more than one type

simultaneously

Erythematotelangiectatic rosacea:

Permanent redness (erythema) with a tendency to flush and

blush easily. It is also common to have small blood vessels visible near the surface of the skin

(telangiectasias) and possibly burning or itching sensations.

Papulopustular rosacea:

Some permanent redness with red bumps (papules) with some pus filled

(pustules) (which typically last 1-4 days); this subtype can be easily confused with acne.

Phymatous rosacea: This subtype is most commonly associated with rhinophyma, an enlargenent

of the nose. Symptoms include thickening skin, irregular surface nodularities, and enlargement.

Phymatous rosacea

can also on the chin (gnatophyma), forehead (metophyma), cheeks, eyelids

(blepharophyma), and ears (otophyma). Small blood vessels visible near the surface of the skin

(telangiectasias) may be present.

Ocular rosacea:

Red, dry and irritated eyes and eyelids. Some other symptoms include foreign

body sensations, itching and burning.

There have been other descriptive terms applied to

describe

rosacea, but these are

not formally accepted as

types

of rosacea

Granulomatous rosacea

The rare and severely scarring Rosacea fulminans (pyoderma faciale) occurring exclusively

in women after adolescence and most commonly in their early 20s

Perioral dermatitis, which is better described as periorificial dermatitis, but similarly treated
with topical metronidazole

Persisting redness and oedema of the upper half of the face has been termed Morbihan
disease.

Rosacea sufferers often report periods of depression stemming from cosmetic disfigurement,

painful burning sensations, and decreases in quality of life.

Potential Causes

The precise

ause

of rosacea still remains

mostly

unknown, but

any

experts believe that

rosacea is a

disorder where the blood vessels become damaged when repeatedly dilated by

stimuli. The damage

causes the vessels to dilate too easily and stay dilated for longer periods

of time or remain permanently

dilated, resulting in flushing and redness. Immune cells and

inflammatory mediators can leak from the

microvascular bed causing inflammatory pustules and

papules, especially with those with papulopustular

rosacea.

Rosacea

an be

hereditary and those that are fair-skinned of European or Celtic ancestry

have

a higher genetic predisposition to developing it. Women are more commonly affected but when

men

develop rosacea it tends to be more severe. People of all ages can

get rosacea but there

is a higher

instance in the 30-50 age group. The first signs of rosacea

are said to be persisting

redness due to

exercise, changes in temperature, and cleansing.

Triggers that cause episodes of flushing and blushing play a part in the development of rosacea.

Exposure to temperature extremes can cause the face to become flushed as well as strenuous

exercise,

heat from sunlight, severe

sunburn, stress, anxiety, cold wind, moving to a warm or hot

environment from

a cold one such as heated shops and offices during the winter. There are also

some foods and drinks

that can trigger flushing, these include alcohol, foods and beverages

containing caffeine (especially, hot

tea and coffee), foods high in histamines and spicy food.

Certain medications and topical irritants can quickly progress rosacea. If redness persists after

using a

treatment then it should be stopped immediately. Some acne and wrinkle treatments that

have been

reported to cause rosacea include microdermabrasion, chemical peels, high dosages

of isotretinoin,

benzoyl peroxide and tretinoin. Steroid induced rosacea is the term given to

rosacea caused by the use

of topical or nasal steroids. These steroids are often prescribed for

seborrheic dermatitis. Dosage should

be slowly decreased and not immediately stopped to avoid

a flare up.

Studies of rosacea and demodex mites have revealed that some people with rosacea have

increased

numbers of the mite, especially those with steroid induced rosacea.

When large

numbers are present

they may play a role along with other triggers. On other occasions

Demodicidosis (Mange) is a separate

condition that may have "rosacea-like" appearances.

It has also been suggested that rosacea might be a neurological disorder resulting from

hypersensitization of sensory neurons following activation of the plasma kallikrein-kinin

system by

exposure to intestinal bacteria in the digestive tract.

s Rosacea more Common in Certain Skin

Types?

Yes, Rosacea often manifests itself in Caucasian and very fair skin, often

with those that have

skin commonly called Porcelain. This type is skin is

often highly sensitive to heat, wind, cold

and especially the sun. Years of

exposure to these elements often manifests into more severe

cases of

Rosacea later in life like Rhinophyma, yet many are genetically predisposed

to having

Rosacea at any age. The severity, however, increases as you

age and hence managing your

condition is of the utmost importance.

What Are The Four Stages Of

Facial

Rosacea?

Pre-Rosacea

: the first cardinal sign of Rosacea: blood vessels dilate

to more

stimuli, open

wider and stay open for longer periods of time

compared to normal

persons. No visible damage

can normally be seen.

Mild Rosacea

: begins when the facial redness induced by flushing

persists for

an abnormal

length of time - usually 1/2 an hour or more after

a trigger. Those

who have frequent

pre-Rosacea flushing are highly

susceptible to progressing to

mild Rosacea. Some of the

common

triggers for a facial flush are heat, cold,

emotions, exercise, topical irritants

and

allergic reactions.

Moderate Rosacea

as facial flushing becomes more frequent and

intense,

vascular damage

occurs. This can result in long lasting redness,

swelling and

inflammatory papules and pustules.

Telangiectasia (damaged

micro blood

vessels, often visible on the surface of the skin) may be

noticed

in the areas

where flushing is worst.

Severe Rosacea

: characterised by intense bouts of facial flushing,

severe

inflammation, facial

pain, swelling and burning sensations.

Sufferers may develop

intolerance to products they were

able to use

before.

Also inflammatory papules,

pustules and nodules may be

present.

Some

experience a bulbous enlargement

of the nose, known as

rhinophyma. This is just a guide,

you may of course

experience

ymptoms outside these ranges.

Managing Skin with Rosacea

The key to managing skin with Rosacea is recognizing that the skin is

suffering an inflammatory

response. Absolutely no way should harsh

cleansers and toners be used. The natural oils on

the skin must be

regulated to allow the skin to form it’s own defenses against any harmful

bacteria or environmental distress. We recommend the following regime

as a starting point

for treatment.

Daily Tips For All Rosacea Sufferers:

Wash with water that is lukewarm, not hot.

Use our gentle (non-abrasive) cleansers applied with the fingers,

not a

cloth.

Blot dry, but do not rub, with a thick-pile cotton towel

Wait for the skin to dry completely. Try waiting at least one minute before

applying

products.

If you wear makeup, choose only oil-free and/or non-comedogenic products.

Always apply

light layers of makeup as many foundations

and

concealers act

almost

as a “mask” that

traps in bacteria and oil

inside the

pores.

When you have a flare up, treat it sooner than later to prevent long-term damage.

Apply at least an SPF 8 sunscreen everyday to prevent UV induced symptoms.

The sun is

often the #1 reason for flare-ups.

		Monitor your diet daily. By avoiding alcohol, hot beverages and/or spicy foods you
		can greatly reduce the number and severity of Rosacea flare-ups.