Rosacea (rose-AY-sha) is a chronic (long-term) skin disease It is estimated to affect over 45 million people worldwide. It causes redness and pimples. Rosacea occurs in both men and women and, and although it may occur at any age, onset usually begins after the age of 30. It affects fair-skinned people of mostly north-western European descent, and has been nicknamed the ‘curse of the Celts’ by some in Ireland. Rosacea is sometimes called acne rosacea, which is misleading because rosacea and acne are two totally different conditions, although they can appear together. 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. There are four identified rosacea subtypes. Ocular rosacea: Red, dry and irritated eyes and eyelids. Some other symptoms include foreign body sensations, itching and burning. 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 is most commonly associated with rhinophyma, an enlargement of the nose. Erythematotelangiectatic rosacea is 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.
Frst signs of rosacea are said to be persisting redness due to exercise, changes in temperature, and cleansing. It’s also a misconception that this red-faced condition is caused by drinking alcoholic beverages. It usually starts between age 30 and 60. Rosacea may be aggravated by facial creams or oils, and especially by topical steroids. Rosacea can affect all segments of the population, particularly those with fair skin who tend to flush or blush easily. The disorder may be somewhat more common in women, but is often more severe in men — perhaps because men tend to delay seeking medical help until the condition reaches advanced stages. There are several theories regarding the origin of overactive facial blood vessels and inflammation, including genetic, environmental, vascular, inflammatory factors. Some believe the social and emotional effects of rosacea are worse than the physical symptoms. In one survey, 1 nearly 70 percent of rosacea patients said it lowered their self-confidence and self-esteem. Forty-one percent said the condition caused them to avoid public contact or cancel social engagements. In some cases, the eyes may also be affected by rosacea, resulting in a gritty feeling and bloodshot appearance. As the severity advances, the symptoms may include swollen blood vessels in the eyes, and in rare cases small hard bumps may develop on the eyelids and vision may be affected.
Rosacea and demodex mites have revealed that some people with rosacea have increased numbers of the mite, especially those with steroid induced rosacea. Helicobacter pylori, which causes intestinal infection of rosacea. Certain medications and topical irritants can quickly progress rosacea. The immune system also has been implicated as playing a role in rosacea’s development. Tiny blood vessels under the skin of the face enlarge and dilate. These blood vessels may become hyper- sensitive to certain triggers. 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. As rosacea affects the face, it can be associated with anxiety and lack of confidence and may lead to psychological problems and depression. Treating rosacea varies from patient to patient depending on severity and subtypes. Dermatologists are recommended to take a subtype-directed approach to treating rosacea patients.
Rosacea Treatment and Prevention Tips
1.Protection from the sun is important and daily use of a sunscreen of at least SPF 15 containing a physical blocker such as zinc oxide or titanium dioxide is advised.
2.Oral tetracycline antibiotics (tetracycline, doxycycline, minocycline) and topical antibiotics such as metronidazole are usually the first line of defence prescribed by doctors to relieve papules, pustules, inflammation and some redness
3.The treatment of flushing and blushing has been attempted by means of the centrally acting a-2 agonist clonidine, but there is no evidence whatsoever that this is of any benefit.
4.People who develop infections of the eyelids must practice frequent eyelid hygiene. Daily scrubbing the eyelids gently with diluted baby shampoo or an over-the-counter eyelid cleaner and applying warm (but not hot) compresses several times a day is recommended.
5.Dermatological vascular laser (single wavelength) or Intense Pulsed Light (broad spectrum) machines offer one of the best treatments for rosacea.
6.CO2 lasers can be used to remove excess tissue caused by phymatous rosacea. CO2 lasers emit a wavelength that is absorbed directly by the skin. The laser beam can be focused into a thin beam and used as a scalpel or defocused and used to vaporise tissue. Low level light therapies have also been used to treat rosacea.
7.Rhinophyma can be treated successfully by reshaping the nose surgically or with carbon dioxide laser by a dermatologic or plastic surgeon.
8.One alternative skin treatment, fashionable in the Victorian and Edwardian eras, was Sulphur. Recently Sulphur has re-gained some credibility as a safe alternative to steroids and coal tar
9.Isotretinoin (Accutane) is a powerful medication sometimes used for more severe cases of inflammatory rosacea.
10.Keeping a diary over a few weeks can help to identify foods and other triggers that appear to make the flushing worse so they can be avoided wherever possible.