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I. Definition:

Rosacea is a very common skin condition with prevalence for persons of fair skin type (Fitzpatrick 1 or 2), Celtic or Northern European heredity. However, the condition can be found in dark skinned patients as well.
Is it true Rosacea or simple skin redness or flushing?

II. Rosacea Causes:

It is very important to distinguish true Rosacea from simple skin redness or flushing. Rosacea is a spectrum of presentations ranging from skin redness and sensitivity to sun, alcohol, spicy foods to true Rosacea, with inflammatory skin lesions (which are not adult acne) and the appearance of Rhinophyma (large bulbous, red nose …like W.C. Fields). It is very important not to label the former patient with Rosacea, because it carries certain disease oriented stigmata.

Rosacea is more commonly found in patients of Northern European origin, age usually 30 or beyond as presentation, males and females probably have the same disease ratio; although more women seek medical assistance than men. The disease might be genetic but we have no proof of this and further studies are required. Clearly there are “trigger factors.” Sun is number one trigger factor. Rosacea patients should stay out of the sun, period. Sun blocks are helpful, but clearly ineffective as compared to staying out of the sun. The other minor trigger factors to be avoided are alcohol, spicey foods and hot beverages.

Rosacea is a clinical diagnosis, rather than a microscopic or tissue diagnosis like skin cancer. Yes, there are certain changes in the skin which are found in Rosacea patients. These changes are increased number of capillaries, distortion of the capillaries, increased numbers of inflammatory cells as well as certain bacteria and skin mites. Rather the bacteria or skin mites (found in all skin biopsies) have anything to do with Rosacea is one question researchers are trying to answer. The two most prominent theories as to the cause of Rosacea are the infectious theory and the autoimmune theory. The former postulates that Rosacea is caused by bacteria or an inflammation to the skin by skin mites. The latter, autoimmune theory, postulates that the patient develops antibodies to the skin which results in the “redness and pustule cascade.” Researchers are also looking toward certain inflammatory chemicals in the skin (cytokines, interleukins, nitric acid and others) which might be implicated in the redness, pustules and chronic inflammation which sets apart rosacea from simply flushed skin. Obviously, genetics is also a key

Rosacea does not invariably progress to worsening stages. In fact, anecdotal patient comments indicate that it might even resolve with some treatments. Rosacea patients may need to be treated medically all their adult lives, but they might also get better and not require continued treatment.

III. The Rosacea Enigma:

Know the trigger factors and how to reduce symptoms Rosacea tends to run a much milder course in women, however, with men developing the more disfiguring aspects such as rhinophyma (the red bulbous nose) and disfiguring, difficult to treat acne rosacea. The condition can arise suddenly after an environmental or chemical impact in one prone to having rosacea or slowly, developing over years and never becoming fulminant. The one thing that is common to all cases of Rosacea are that solar irradiation makes it flare and worsens its clinical course and prognosis.

Other environmental factors such as heat, humidity, cold, and dryness have been cited as possible irritating factors as well. The skin may be exquisitely sensitive to fragrance, detergents, emollients and many skincare product ingredients. Drinking hot liquids, eating spicy foods and development of emotional reactions will also stimulate the flushing response, as will alcoholic beverages. The best treatment is to abstain from the initiating factors, which exacerbate the condition.

There is no known cause for Rosacea, although there seems to be a problem with abnormal blood vessel dilation and constriction in the arteries of the face. Rosacea is a disease of the central aspect of the face, localized to the nose, forehead, cheeks, chin and glabella (the area between the eyebrows). A bright red central face, capillary prominence and acneiform eruptions mark full-blown rosacea. acne rosacea differs somewhat from the pustular comedomes of adolescent acne. Many times there are inflammatory eruptions without sebaceous material, although there can be full-blown sebaceous cysts, which will require incision and drainage. Rhinophyma (Greek for "bulbous nose) results from excessive sebaceous activity of the nose with enlarged, scarred sebaceous glands.

In-clinic professional treatments and a good home-care regimen can make a world of difference. Our office carries many products that can address rosacea.

IV. Rosacea Treatment:

Rosacea treatment is based on the infectious disease theory and involves the use of topical and oral antibiotics. Topical antibiotics (metronidazole (Flagyl) and sulfacetimide gels, lotions and creams, are the mainstay of therapy as they reduce the bacterial population of the skin. Oral antibiotics in the tetracycline class (doxycycline, tetracycline, minocycline) or Erythromycin antibiotics are used in more advanced cases. The side effects of Rosacea such as rhinophyma (large bulbous nose) can be successfully treated with surgical shaving or laser surgery, whereas the ophthalmologic complications need specialized care with an ophthalmologist (dry eye, conjunctivitis, red eye syndrome).

What about common skin creams that “fight redness,” or treat Rosacea? There is much anecdotal evidence in the patient community that certain products help the redness and flushing of early Rosacea, but really only topical and oral antibiotics and abstinence from the “trigger factors,” are effective for treatment in advanced cases. I personally believe that some of our skin care products are very helpful early in the course of Rosacea.

While skin care products can help control or lessen some symptoms of rosacea, the best long-term treatment by far is non ablative no down-time laser treatments (Fotofacial)

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