Rosacea

1.    What is Rosacea?

Rosacea (pronounced roh-ZAY-sha) is a chronic disorder similar to acne involving prolonged redness, pimples, and thickening of the skin.  If left untreated, rosacea tends to be progressive, which means it gets worse over time. However, in most people rosacea is cyclic. Rosacea mainly affects the skin of the face.  Rosacea is caused by a combination of factors such as genetics, involvement of the microscopic Demodex skin mites, and hyper-reactive superficial blood vessels that respond to heat and cause flushing.  Rosacea may also lead to enlargement of the nose and other facial features, and can be a significant cause of cosmetic disfigurement.  Ocular rosacea is a variant of rosacea that may appear as red, itchy eyes not improving with eye drops.

2.    What Does Rosacea Look Like?

Rosacea involves frequent redness of the skin (flushing), excessive spider veins, and tiny pimples and nodules, with the absence of blackheads or whiteheads.  Most affected areas are central to the face, forehead, nose and front of cheeks.  As the disease progresses, chronic sebaceous gland enlargement and inflammation may cause thickening, swollenness, and disfigurement of the nose, forehead, eyelids, chin, or ears.  Rosacea tends to worsen with age unless treated.

3.    Who Does Rosacea Affect?

Rosacea is most common between ages 40 and 50.  While it predominates among females, the characteristic swelling and disfigurement of the nose is mostly seen among males.  Rosacea affects individuals of skin phototype I and II (very light-skinned) such as celtic persons and southern Italians, and is less frequent among darker-skinned individuals.  People with rosacea often have a history of blushing easily from changes in skin temperature, spicy foods, alcohol, or other factors. A less common, but potentially serious form of rosacea affects the eyes (“ocular rosacea”) and ranges from minor irritation, dryness, and blurry vision to potentially severe ocular surface disruption and inflammatory keratitis.  Eyelid crusting and swelling (blepharitis) often occurs as well.  Ocular rosacea that is not painful or worsening can be treated simply with gentle cleansing, warm compresses and artificial tears.  For progressive cases, oral antibiotics (i.e. tetracycline) are recommended.

4.    What Causes Rosacea?

Recent studies have shown rosacea to be a multi-factoral condition caused by a combination of genetics, inflammatory reactions of superficial blood vessels, and infestation of microscopic skin mites.  Although the exact mechanism of rosacea is not yet understood, it is believed that the progression to full rosacea begins in certain individuals having a genetic predisposition to a rapid expansion in superficial blood vessels.  This, in addition to a favorable environment and temperature of the face, may enable the skin mites Demodex follicolorum and Demodex brevis to thrive on the facial skin. These parasites of the epidermis live among hair follicles (folliculorum) and sebaceous glands (brevis), and are thought to further trigger an inflammatory reaction, which is manifested in rosacea’s tiny bumps, redness, and skin thickening.  Thus, physical changes or life events that cause an initial blood vessel expansion may induce the progression of rosacea.  Although rosacea does involve pimples of the hair follicles, it is not believed that bacterial growth in these areas is a significant factor causing the skin disorder, as in acne vulgaris.  However, recent studies have shown that a high percent of individuals with rosacea also have H. pylori, the causative bacterial agent in gastric ulcers. 

5.    What Triggers Rosacea?

Patients with rosacea claim a number of possible triggering factors for this skin condition.  Heat, heavy exercise, spicy foods, alcohol, sunlight, menopause, or events that cause flushing of the skin may be exacerbating factors.  In addition, high levels of emotional stress have shown to be significant in contributing to rosacea.

6.    How Can My Rosacea Be Treated? 

Rosacea may be managed with the right combination of treatments.  Photodynamic Therapy (PDT) has proven to be a successful treatment for rosacea.  During PDT, a medication is applied and the affected area is treated with blue light for 5-10 minutes. PDT is performed 1-2 times per month until the rosacea subsides.  Photofacial-Intense Pulsed Light treatment is also effective in treating rosacea, as well as V-Beam Pulse Dye Laser (PDL).  PDL involves a relatively painless laser treatment causing short-term bruising to the face. Performed once every four to six months, this procedure successfully clears rosacea and prevents further disfigurement of the nose or other facial features.  In addition to these procedures, topical antibiotics and anti-fungal creams may help to limit the amount of pimples caused by secondary infection.  Finally, elimination of alcohol, hot beverages, and other exacerbating factors from the diet and lifestyle may significantly help control rosacea in affected individuals.   For more information on available treatments for rosacea, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

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