Rosacea is a chronic, acne-like condition that occurs in middle-aged men and women. Rosacea used to be called "acne rosacea" but it is different from acne. The red spots and pustules are dome-shaped rather than pointed and there are no blackheads, whiteheads, deep cysts, or lumps. Rosacea affects the cheeks, nose and forehead – rarely, it involves the trunk and upper limbs.
One survey found that:
The image of one famous sufferer, W. C. Fields, helped to mistakenly link rosacea with alcoholism. Although drinking alcohol can make rosacea worse, even people who never drink alcohol can develop rosacea.
Rosacea is three times more common in women, but usually more severe in men. As at the time of writing (2004) it is thought to affect as many as 13 million Americans.
Rosacea is usually seen in adults in their 30s and 40s. It seems to affect fair-skinned, blue-eyed people more often, though it can affect any skin type. Most people who get rosacea have a history of flushing or blushing more easily and more often than the average person (they are sometimes described as having "peaches and cream" complexions). Women get rosacea a little more often than men, but men are more likely to develop rhinophyma.
The cause of rosacea is unknown, but many factors have been suspected of influencing it: alcoholism, menopausal and other flushing, a tendency towards seborrhea, local infection, B-vitamin deficiencies and gastrointestinal disorders. Most cases are associated with moderate to severe seborrhea, although in many cases sebum production is not increased. Flushing is prevalent, and migraine headaches are three times more common amongst sufferers.
Facial flushing can make symptoms worse and even cause flare-ups in patients whose rosacea had been under control. It is the chronic flushing in rosacea which causes the telangiectasia. Flushing can be triggered by many things, the most common being hot drinks, alcohol, spicy foods, stress, sunlight and extreme heat or cold. Other causes of flushing and telangiectasia include heredity, exercise, emotions, hormones, cortisone medications and other rare skin diseases.
In most people, the first sign of rosacea is rosy cheeks; the face gets red in patches and stays red – eventually redness doesn't go away at all. Rosacea is a chronic condition. In most people symptoms come and go in cycles. These flare-ups are common. Although the condition may improve (go into remission) for a while without treatment, it is often followed by a worsening of symptoms (redness, pimples, red lines or nasal bumps) that progresses over time.
It typically first appears when people reach their 30s and 40s as a flushing or subtle redness on the cheeks, nose, chin or forehead that comes and goes. This early stage is often mistaken for a simple complexion problem or sunburn and ignored. Left untreated, the redness becomes more permanent and tiny blood vessels may become visible.
As the condition progresses, the redness becomes more persistent, bumps and pimples called papules and pustules appear and small dilated blood vessels may become visible. In some cases the eyes also may be affected, causing them to be irritated and bloodshot. In advanced cases. In more advanced cases of rosacea, a condition called rhinophyma may develop. The oil glands enlarge, causing a bulbous, enlarged red nose and puffy cheeks. Thick bumps can develop on the lower half of the nose and near to the cheeks.
Women are more likely to experience symptoms on the cheeks and chin while men are more likely to have swelling of the nose (rhinophyma) associated with advanced rosacea.
Many rosacea patients have only one or two symptoms; here is a detailed list of the most common ones:
Rosacea can not be cured, but its symptoms can be reduced and its progression arrested through medical treatment and lifestyle modifications. Because it is a chronic disorder, research has found that sufferers usually must adhere to long-term medical therapy prescribed by physicians to maintain remission. Another important component to minimizing the effects of rosacea is lifestyle management: moderating or eliminating those lifestyle and environmental factors that may aggravate the condition.
Several medications are available by doctor's prescription. They control redness and reduce the number of papules and pustules. Some are applied to the skin (topically) and others are taken by mouth (orally) – different types can be used in combination. In most cases, it may take several weeks to see results – don't worry. Once symptoms have cleared, patients may need to continue taking medication to keep rosacea under control.
Controlling the causes of flushing and blushing can help prevent rosacea from getting worse and blood vessels from getting larger. But once red lines appear, they can only be covered up by makeup or removed by a surgical method. Surgery can also be used to correct a nose enlarged by rhinophyma.
Keep a diary of flushing episodes and note associated foods, products, activities, medications or other triggering factors.
Statistics from one survey showed that medical therapy improved emotional well-being in 70% of cases, professional interactions in 60% of cases and social life in 57%.
Sun exposure, hot weather, humidity, cold and wind have all been known to aggravate rosacea for many individuals. The following are defense strategies you can use:
Stress ranks high on the list of tripwires for many rosacea sufferers. However, in a survey of rosacea patients affected by stress, most of those using stress management techniques said they had successfully reduced their flare-ups. When feeling overwhelmed, try some of the following stress reducers:
Foods and Beverages
Steaming hot soup or coffee, spicy nachos, a glass of wine – no matter how appetizing they sound, these foods and beverages may be a problem for some rosacea sufferers. Hot liquids may cause flushing. Spicy foods like oriental mustard sauce or salsa can raise a sweat, and alcoholic beverages may trigger flare-ups in many cases. These tips will help you select rosacea-friendly meals:
Avoid "hot" spices such as white and black pepper, paprika, red pepper and cayenne, which are common rosacea tripwires. Try these flavor substitutes:
While exercise may be part of a healthy lifestyle, it could actually be harmful to rosacea sufferers if it causes their condition to flare up. Moderation is the key. And even then, take these precautions:
Bathing and Cleansing
Rosacea sufferers often must modify their approach to cleansing and bathing. The following tips can help you adopt a personal-care routine that soothes and calms your facial redness:
Skin Care Products
Rosacea sufferers can use a variety of skin-care products to their advantage. Moisturizers can reduce flakiness and makeups can camouflage symptoms and improve appearance. You may have to experiment until you find the products that work best for your individual condition. Here are some general guidelines that will help you select products carefully:
Pre-existing Medical Conditions
Physicians have found that some underlying health conditions and temporary ailments can stimulate a flushing response and trigger rosacea flare-ups. The following conditions should be ruled out or treated by your doctor as appropriate to help bring flare-ups under control:
Certain drugs can cause facial flushing, resulting in rosacea flare-ups. If you experience flare-ups as a result of the following drugs, discuss the problem with your doctor:
The conspicuous redness, blemishes and swelling caused by rosacea can take a significant toll on an individual's emotional health. You may find your self-confidence and self-esteem are suffering as a result of your appearance, but you can turn the situation around by taking appropriate action to bring your rosacea symptoms under control.
The first step is to accept that you have a medical condition, rather than denying it. Although rosacea is not life threatening, it is usually a chronic disorder of flare-ups and remissions that becomes increasingly severe without long-term therapy. Although this fact cannot be changed, you can personally take control of your condition and restore your appearance by complying with long-term medical treatment and avoiding those lifestyle factors that aggravate your individual case.
The good news is that emotional health generally returns when rosacea symptoms are successfully addressed. 70% of rosacea sufferers responding to a National Rosacea Society survey said their emotional well-being improved when their rosacea was effectively treated, and most also reported improvement in their professional interactions and social lives.
It also may help you to know that you are not alone. An estimated 13 million or more Americans suffer from rosacea, although many may not be fortunate enough to realize it and seek treatment.
If you find yourself the object of stares or comments during a flare-up, try turning this awkward situation into a positive educational opportunity by openly discussing your rosacea and educating the offender. Recognize that most individuals are unaware of rosacea, so take into account that most reactions are simply caused by curiosity and ignorance of the disease, rather than some negative intent.
Take the initiative for explaining the condition to people you see regularly – especially your employer and co-workers, who may have real concerns about whether the condition will affect your job performance or their own health. Put to rest the common misconceptions that rosacea's symptoms are caused by poor hygiene or excessive drinking, or that the disorder may be contagious. Pass along educational materials on rosacea if appropriate.
Through this approach, you can turn potentially negative situations into constructive opportunities to create understanding.
Living with Rosacea
Millions of people suffer from rosacea, yet increasing numbers of sufferers have achieved substantial control over their disorder. The best defense in conquering rosacea is to comply with long-term medical therapy and minimize lifestyle factors that aggravate your individual condition. Through these strategies, rosacea can be managed successfully.
Without regular treatment, redness and pimples can return. Studies of patients who stopped treatment after their symptoms were successfully cleared show that rosacea came back in many of the patients within a week to 6 months.
Individuals who suspect they may have rosacea are urged to see a dermatologist for diagnosis and treatment. It is easy to mistake skin disorders and doctors know best how to identify and treat rosacea.
Red, sore or 'gritty' eyelids are sometimes caused by rosacea. Ocular manifestations may include many different eye problems and may precede skin involvement, thus delaying the diagnosis of rosacea.
Rosacea may cause the nose to slowly enlarge. When rosacea is not treated, some people – especially men – may eventually get small knobby bumps on the nose. As more bumps appear, the nose looks swollen.
Rosacea is often accompanied by a red face due to flushing. Sometimes the affected skin is swollen and hot.
A high incidence of Helicobacter pylori infection in the stomach has been found amongst rosacea patients.
If you are using or have used steroid drugs, you may have 'steroid rosacea', a rosacea-like condition on the face caused by potent topical steroids. After several weeks of applying a topical steroid to the eyelids, cheeks or chin the affected area becomes red. Small papules (bumps) and pustules appear intermittently, and may be especially severe when the topical steroid cream is discontinued. If the steroid creams are used for months or years, broken capillaries (telangiectasia) may develop.
A similar condition can arise in other areas treated with topical steroids, particularly the groin and genitals where the absorption of the steroid through the skin is higher. Occasionally steroid rosacea is confused with tinea faciei incognito, a fungal infection masked by topical steroids.
Rosacea is now being viewed as an auto-immune disease.
Avoid coffee, alcohol, hot beverages, spicy foods and any other food or drink that causes flushing.
A 2003 survey by the National Rosacea Society has identified a broad range of hot spicy foods that often trigger or aggravate Rosacea. In the survey of more than 500 rosacea patients, published in Rosacea Review, 61% of those affected by spicy foods listed hot peppers as a trigger for their rosacea signs and symptoms; 52% listed Mexican-style foods; 47% chili and 46% salsa.
Rosacea patients often have a reduced secretion of pancreatic lipase, an enzyme which aids in fat digestion. Pancreatic or plant enzyme supplementation, especially when prepared with extra lipase, will improve this digestive weakness.
Gastric analysis of rosacea patients has led to the theory that it may be the result of hypochlorhydria. HCL supplementation results in marked improvement in rosacea patients who have achlorhydria or hypochlorhydria.
Never apply a topical steroid like cortisone to rosacea unless directed to do so by your doctor for a specific reason. Cortisone treatments can worsen rosacea over the long term and make it even more resistant to treatment.
The incidence of migraine headaches and flushing accompanying rosacea points to some form of food intolerance.
Avoid oil-based facial creams. Use a water-based make-up and sunscreen. The skin may be very sensitive to local applications.
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