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Rosacea

  • Rosacea - An Overview

    Mar 14 2014 10:51 AM

    The word Rosacea is from the Latin rosaceus meaning “pink like”.

    Rosacea is a chronic microcirculation disorder that can be quite troubling for the sufferer. While there is currently no “cure” for rosacea, it can be treated with proper skincare, avoidance of triggers, professional treatments and lifestyle changes. Once under control, rosacea is considered to be in remission.

    Rosacea will most likely require continued treatment, as it can flare or relapse. Rosacea is progressive and without treatment may evolve into advanced stages and lead to permanent skin damage.


    Symptoms of Rosacea

    Symptoms of rosacea can include flushing or blushing or persistent redness and/or red patches, visible blood vessels (dilated capillaries), skin heat, red pimple-like bumps (papules and pustules) dryness, flakiness and roughness.

    Rosacea is usually seen in the center of the face - t-zone (nose, forehead, chin) and cheeks but can also affect the neck, upper chest, scalp, and ears.

    Skin affected by rosacea is generally hypersensitive with sensations of itching, burning, stinging, sensitivity, tightness, pain and tenderness. Skin can feel warm or hot to the touch, which increases when rosacea sufferers flush or blush.

    Red eyes and skin thickening, swelling and enlargement of nose from excess tissue are additional rosacea signs.

    If you are still having trouble picturing exactly what rosacea looks like just think of celebrities like Bill Clinton, Cameron Diaz, Cynthia Nixon, Princess Diana, Renee Zellweger, Rosie O’Donnell and newcomer Bruce from Swamp People.

    Who Suffers from Rosacea?
    Approximately 16 million Americans and 45 million people or almost 10% of people worldwide are afflicted with rosacea.

    Caucasians or people primarily descended from north Western Europe (Celtic descent) are genetically predisposed to rosacea. In general, fair skinned individuals are more likely to get rosacea than people with darker complexions.

    If your skin sunburns easily or you have a family member with rosacea, it is likely that you will develop rosacea.

    Symptoms may occur during teen years but most people experience the onset of rosacea in their 30s, 40s and 50s.

    Rosacea affects both men and women. Rosacea is about 3 times more frequent in women while the men who have this disorder experience more extreme symptoms.

    In women, rosacea is usually seen on their cheeks and chin, while men exhibit it more along with swelling on the nose. Rosacea can also affect the chest, ears, neck and scalp.

    Some sources say that the redness must be persistent and present for 3 months for it to be deemed rosacea.

    Some sources indicate that migraine sufferers are 3 times more likely to have rosacea.


    Grades of Rosacea

    Rosacea can be classified into 4 Rosacea Subtypes/Grades that can range from pre-rosacea with just redness and sensitivity to full blown rosacea with bumps, pimples, swelling, etc.

    Rosacea Grade 1 or Rosacea Subtype 1 or Prerosacea includes pink or red skin with flushing or blushing that comes and goes initially and becomes persistent as time goes on.

    Rosacea Grade 1 can include visible blood vessels that contribute to the appearance of redness along with stinging, burning, swelling and inflammation. Roughness, scaling or flaking, sensitivity and dryness of the skin may also occur with Rosacea Grade 1.

    Rosacea Grade 2 or Rosacea Subtype 2 is also called Acne Rosacea as redness is now persistent and accompanied by possible bumps and pimples in the nose and cheek area, red patches, roughness and/or scaling.

    Note: Even though this grade is frequently called Acne Rosacea, rosacea and acne are not the same disorder. However, someone may have both conditions. Rosacea does not include blackheads or whiteheads as a symptom while acne does.

    Rosacea Grade 3 or Rosacea Subtype 3 or Phymatous Rosacea manifests in thickening of the skin, irregular surface bumps on up to enlargement of the nose from excess tissue. Rosacea Grade 3 more often occurs in men but women can get this type of rosacea as well.

    W.C. Fields was an actor from days of yore famous for his red, swollen nose. Former president Bill Clinton is a current notable with this type rosacea. Laser and plastic surgery are required to treat this grade of rosacea.

    Rosacea Grade 4 or Subtype 4 or Ocular Rosacea involves the eye area. All stages of rosacea may have eye involvement with about 50% of rosacea sufferers having eye symptoms.

    Rosacea triggers cause the blood vessels of the eye to dilate and the following symptoms:

    • Red or bloodshot eyes, dry or watery eyes prone to tearing
    • Swollen or chronically inflamed eyelids and styes
    • Sensitivity to light
    • Irritation, burning/stinging, gritty or scratching sensation on up to intense pain
    • Inflammation of the thin tissue that cover the whites of the eye and the front part of the eye (corneal ulceration)
    • In extreme cases, blood vessels may invade the colored part of the eye and see through covering over it and the pupil which causes scarring, blurry vision and potential vision loss from corneal damage.
    • Mucus with or without infection (conjunctivitis or ”pink” eye)

    Rare Forms of Rosacea

    Rare and severe complications of rosacea include facial abscesses and hard round bumps such as with rosacea conglobata and rosacea fulminans.

    Rosacea Conglobata is a disfiguring form of rosacea that includes tender, pink to deep red, swollen and bleeding pus filled sores, and hardened raised, solid flat-topped lesions. Rosacea conglobata occurs mainly in females and is progressive and chronic.

    Rosacea Fulminans is rare and mimics severe cystic acne with bumps and pimples that appear suddenly and develop into hard round bumps, draining tracks that connect the cysts, abscesses and ulcers. Facial swelling with a blue-red color and possible scarring are also symptoms of rosacea fulminans.

    Note, this is not acne rosacea and there is no flushing or eye involvement.

    Rosacea Fulminans affects the faces of women after adolescence between the ages of 20 and 40 who may have never had acne. Unlike acne, there are no comedones with this severe form of rosacea and it lasts about one year without recurring.

    The cause of both forms of rosacea is unknown but may be due to issues with the immune system, hormones or vascular system. Some sources link it with Crohn’s disease, Hepatitis C therapy and even high doses of vitamins B6 and B12.

    Some sources state that greasy scales with possible yellow patches and itching (seborrhea or seborrheic dermatitis) are present before this condition develops.

    Treatment of these rare forms of rosacea include 3-6 months of oral and or topical corticosteroids to calm the inflammation, Accutane (isotretinoin), oral antibiotics, and oral contraceptives with antiandrogens. Note: Accutane must be accompanied by birth control and may aggravate ocular rosacea. A doctor may perform cortisone injections into the bumps or cut them out.

    Some sources list yet another type of rosacea, “neck rosacea” which appears on the sides of the neck in a v shape and includes dilated capillaries with brownish/reddish color changes. It also exhibits a bumpy texture and appearance. This form of rosacea is a direct result of UV overexposure and accompanying damage to the outer and deeper layers of skin (epidermis and dermis) except the skin immediately around hair follicles.

    (For detailed scientific information see Grades of Rosacea Article)


    What Causes Rosacea?

    The exact cause of rosacea is unknown. While there is an ongoing debate over whether rosacea triggers actually cause rosacea, research has proven that there are many factors involved in the development or rosacea.

    High Levels of Microscopic Skin Mite Environmental Cumulative overexposure to the sun & repeated sunburns Abrupt Changes in Temperature - Extremes of heat or cold Vascular/Circulation System Disorder Medical Conditions Gastrointestinal Tract Disorders Endocrine/Hormonal Disorders (pregnancy, menstrual cycle, PCOS, menopause) Liver Disease Stress and Stress Related Conditions Topical irritants, medications and skin treatments Diet - Spicy foods Alcoholic beverages Hot Liquids - beverages and soup Caffeine Histamine and histamine producing foods Inflammation causing foods Acid forming foods High glycemic foods Trans fats Vitamin Deficiency Acidic blood Strenuous Exercise and Heavy Lifting Obesity Free Radical Damage Aging Inflammation and Overactive Immune System

    (For more details see Unraveling the Causes of Rosacea, Rosacea and Diet, and Inflammation and Rosacea)


    Treating Rosacea

    While rosacea can’t be cured, there are a number of ways to control flare-ups. Choosing and using the right skincare products and ingredients, avoiding sun exposure and dietary triggers, as well as managing stress are key ways to control rosacea. Seeing an esthetician, doctor or dermatologist for medications or light or laser treatments can be beneficial for treating rosacea as well.

    Ingredient and Product Solutions for Rosacea

    Rosacea sufferers should choose products that will cool and reduce skin heat, soothe, reduce redness, heal, hydrate, strengthen and constrict capillaries and even reduce allergies.

    Products that are gentle and free of irritating or controversial ingredients, like sulfates, alcohol and mineral oil are also key for controlling rosacea redness. The best ingredients to do this are green tea (camellia sinensis), chamomile (anthemis nobilis), frankincense (olibanum or boswellia carterii), licorice (dipotassium glycyrrhizate) French rose, guarana, allantoin and panthenol. In addition to the right ingredient, the concentration and formulation are what sets apart one product from another. Seek out products that contain high concentrations of the key active ingredients and that are formulated to penetrate deeply for maximum results. (For details see Best Ingredients to Treat Rosacea, Best Products to Treat Rosacea, Redness Relief Line)

    Follow an appropriate skincare regimen that includes a cleanser, toner, serum and moisturizer to be used morning and evening, daily. Treating your skin gently (no rubbing or scrubbing) and using lukewarm (not hot!) water are musts for rosacea skincare.


    Lifestyle Solutions for Rosacea:

    Consult a Doctor if you suspect you have rosacea. Dermatologists can diagnose rosacea and prescribe topical or oral medications like antibiotics, metronidazole, finacea, and skinoren, sulfacetamide sulfur or low doses of isotretinoin for persistent papules and pustules.

    *Note: References to medication in this article is not to be considered a recommendation of any of the above medications. It is vitally important to inform your doctor of all medical conditions before taking any medications and educate yourself on the contraindications before starting therapy.

    Laser, Intense Pulsed Light or Photorejuvenation Treatments might also be used to reduce facial redness and other rosacea symptoms. CO2 (Carbon Dioxide) resurfacing lasers is used to treat phymatous rosacea.

    General Physicians can assess and treat any of the medical conditions associated with rosacea. To inhibit rosacea flushing they may prescribe oral medication such as clonidine, beta-blockers (nadolol and propranolol), mirtazapine (remeron), antidepressants or anti-anxiety drugs, aspirin and antihistamines.

    Manage Stress - Since stress is a rosacea trigger, engaging in stress reducing activities like deep breathing, massage, yoga, meditation and walking (but not hot baths or jacuzzis!)

    Get your zzzs! Get plenty of sleep as poor sleep is linked with inflammation.

    Avoid sun exposure to prevent rosacea flares. When planning to be outdoors, apply a naturally sourced sunscreen with a SPF of 30 and reapply every two hours. Wear a wide brimmed hat and sunglasses (the bigger the better) and use an umbrella when possible.

    Avoid heat and abrupt temperature changes, key rosacea triggers

    Where possible, find alternatives to medications, which are known to trigger rosacea.

    For ocular or eye infections, some sources suggest cleansing the eyelids with diluted baby shampoo or eyelid cleaner and using warm compresses several times a day,

    Dietary Modifications for Rosacea

    Limit intake of rosacea dietary triggers: spicy foods, alcohol, hot and/or caffeinated beverages, foods that contain histamine or cause a histamine response, trans fats, foods with high glycemic index, foods and ingredients linked to obesity and acid forming foods.

    Consume Alkaline Foods and Beverages: alkaline water and most fruits and vegetables

    Choose foods that reduce inflammation to combat rosacea. Iced green tea is an ideal choice for rosacea sufferers.

    Increase intake of foods rich in the following or supplement (Consult a physician before taking supplements): Vitamins: A, B Complex, D3, E, and K Essential Fatty Acids (Omega 3s and Omega 6s) Minerals: calcium, copper, iodine, iron, magnesium, MSM, phosphorous, potassium chloride, silymarin, sodium chloride, selenium and zinc Digestive Aids: Enzymes, fiber and probiotics Exercise in moderation

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  • What Rosacea Isn’t

    Mar 13 2014 3:52 PM

    There are a number of medical conditions and disorders that affect the skin with symptoms that are similar to the visible symptoms to rosacea. Not only are these other disorders unrelated to rosacea, some can be quite serious. This is why it is vital to consult a physician. A dermatologist or a doctor can analyze your skin, make a medical diagnosis and rule out other possibilities.

    Estheticians cannot officially diagnose rosacea and make it a practice to refer to dermatologists for confirmation or treatment of more advanced stages.

    However, estheticians are well versed in treating rosacea and recommending homecare that can complement dermatologist prescribed treatments as well.

    Note: the following discussions are not meant to diagnose nor rule out any skin condition. Pevonia Spa Clinica recommends that customers visit a physician for a medical diagnosis.

    Skin Disorders

    Sensitive Skin Sensitivity and redness are often associated with a condition known as rosacea. However, sensitive skin and skin affected by rosacea are not the same. They do have many similar symptoms and solutions.

    Not all fair skinned individuals with redness, itchiness, flaking and skin warmth have rosacea. These symptoms can be an indication of sensitive or sensitized skin as well.

    Acne

    While both acne and rosacea have similar looking papules and pustules, it is the differences in terms of causes, other symptoms and age of onset that separates acne from rosacea.

    Acne begins in the hair follicle due to thick, sticky excessive sebum, accumulation of dead skin cells (retention hyperkeratosis) and p. acnes bacteria. These factors can result in comedones (whiteheads, blackheads) or papules or pustules. Acne usually has an adolescent onset and can include scarring.

    In contrast, rosacea is primarily a disease of inflammation that includes a microscopic skin mite or parasite and while it can also include papules and pustules it usually will not have the scarring associated with acne. Rosacea has a later onset usually appearing between ages 30 -50. Also, rosacea may have ocular involvement.

    In general, the presence of comedones, ocular involvement and scarring are the key ways to differentiate acne from rosacea. If there are no comedones present, it is most likely rosacea. (Note that acne and rosacea can coexist as well.)

    Unfortunately, people often misdiagnose or mistake rosacea papules or pustules with acne. They then become bewildered or frustrated after using acne products to treat what they believed to be “acne” which usually exacerbates rosacea.

    Perioral Dermatitis

    Perioral dermatitis with red papules usually seen around the nostrils and mouth, or the eyes in women aged 20-45 some might mistake for rosacea but it is actually related to acne vulgaris. Fluoride toothpastes or fluorinated topical glucocorticoid steroids cause it.

    Roseola

    Roseola may look or even sound a little like the word rosacea but is actually a viral infection seen in young children under age 3. Symptoms typically begin with high fever, fatigue and issues with respiration followed by pink or red rash with spots on the torso. It is caused by human herpes virus type 6 or 7.

    Mange (Demodicidosis)

    The fact that rosacea is associated with demodex folliculorum does not make it the same as demodicidosis (mange) which is a separate condition, albeit similar in appearance to rosacea.

    Seborrheic Dermatitis

    Seborrhea, or seborrheic dermatitis, is often seen with rosacea but is a separate condition. Symptoms include fine, white flakes like dandruff or thick, oily, yellow scales along with a red or yellow tone and are believed to precede Rosacea Fulminans.

    Other conditions of mistaken rosacea identity include staph infection, allergy or eczema.

    Poikiloderma

    Poikiloderma can be mistaken for rosacea since it includes prominent blood vessels. The difference is that poikiloderma also includes both increased and decreased pigmentation as well as skin thinning.

    Systemic Disorders

    Lupus Erythematosus

    Lupus Erythematosus is similar in appearance with a rash of round or disk shaped bumps, red, raised patches with adherent scales that lend a whitish appearance. It is usually accompanied by plugged hair follicles and often occurs in a “butterfly rash” or malar rash. It also appears on the nose. Other common symptoms can include chest pain when taking a deep breath, fatigue, fever with no other cause, feeling of discomfort or malaise, hair loss, mouth sores, sensitivity to sunlight and swollen lymph nodes. Other symptoms like headaches, numbness, tingling, seizures, vision problems, personality changes, abdominal pain, nausea vomiting, abnormal heart rhythms, coughing up blood, difficulty breathing, patchy skin color, and fingers that change color when cold (Raynaud’s).

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