WHAT IS ROSACEA?

Rosacea (pronounced Rose AY Sha) is a chronic (long term), inflammatory skin disorder. It occurs in both men and women and may begin as early as the teenage years. The most common symptoms include:

• Facial redness of the nose, cheeks, chin and forehead
• Visibly damaged blood vessels (telangiectasia)
• Small red inflammatory papules

The condition develops gradually as mild episodes of facial blushing or flushing which can lead to a permanent red face. Individuals with fair skin, particularly those of Scottish, Irish or Celtic descent are more predisposed to Rosacea. This condition is commonly known as “The curse of the Celts” although people with darker skins also suffer from Rosacea.

Symptoms

Some sufferers may have a tendency to flush or blush easily and may notice that these are sometimes triggered, for example by a hot drink, a spicy food, an emotion or alcohol. Many people occasionally flush or blush and this is not unusual, however if it persists over a prolonged period of time, the redness can become persistent or permanent with pimples and visible blood vessels in the center of the face (the cheeks, forehead, chin and nose). Other areas can also be affected and these include the scalp, neck, ears, chest and back.

In the past it has often been ignored as it has sometimes been confused with other skin conditions such as acne and sunburn.

In the 90’s there was a greater awareness of rosacea, and this was perhaps helped by a recognition that some celebrities suffered from the condition, for example the Bill Clinton - former President of the United States.

In 1992, the National Rosacea Society was formed and helped raise awareness and education and it was subsequently realised that there were perhaps 14 million rosacea sufferers just in the United States.

There are various forms of the condition, and in 2002 an article was published in the Journal of the American Academy of dermatology which defined the classification of rosacea and identified 4 subtypes.

Subtype 1: Erythematotelangiectatic rosacea

Mainly characterised by flushing and persistent central facial redness of the skin. Stinging and burning sensations, and roughness or scaling may also be reported. A history of flushing is common among these patients.

Subtype 2: Papulopustular rosacea

Characterised by persistent central facial redness of the skin with transient papules or pustules (or both) in a central facial distribution.

However, papules and pustules also may occur around the mouth, nose and eyes. Burning and stinging sensations may be reported and it has often been seen after or in combination with subtype 1, which may be obscured by persistent erythema, papules, or pustules, and so subtype 1 may become more visible after successful treatment of masking components of subtype 2.

Subtype 3: Phymatous rosacea

This includes thickening skin, irregular surface nodularities, and enlargement. Rhinophyma (a large, bulbous, ruddy appearance of the nose) is the most common observation, it can be seen elsewhere, for example the chin, forehead, cheeks, and ears. Subtype 1 may also be present and subtype 3 has frequently been seen after or in combination with subtypes 1 or 2.

Subtype 4: Ocular rosacea

This should be considered when a patient's eyes have one or more of the following signs and symptoms: watery or bloodshot appearance, foreign body sensation, burning or stinging, dryness, itching, light sensitivity, blurred vision, telangiectases of the conjunctiva and lid margin, or lid and periocular erythema.

Ocular rosacea is most frequently seen together with signs and symptoms of rosacea on the patients skin. However, these signs and symptoms are not a necessary pre-requisite and ocular rosacea may occur in up to 20% of patients before symptoms are seen on the skin.

Who is likely to get Rosacea?

Many of those affected are often (but not always) adults aged between 30 and 50. Many (but not all) have a lighter skin colour, blonde or fair hair and perhaps blue or light coloured eyes. It can affect children and people of any skin colour. For women with rosacea, increased flushing and blushing that occurs around and during menopause may make the condition more noticeable.

What causes Rosacea?

The exact cause has not been defined, however it is believed that hereditary and environmental factors are significant.

There are many theories and a lot of research has been carried out. Mites that live in hair follicles have been identified. The immune system has been considered.

It is realised that triggers (typically in the diet) which cause flushing and blushing play a significant role in making the symptoms more visible. Many of these triggers have been identified, however while a particular trigger may affect one person, it may not affect another, and triggers (and diet) vary from person to person.

Psychological Effects and the benefits of a free first consultation

Slightly over 40% of sufferers say it has caused them to avoid or cancel some public engagements/meetings. Nearly 70% of sufferers said it lowered self esteem and self confidence.

Early consultation and diagnosis at a specialist clinic is highly recommended, especially if the clinic offers a free first consultation, as it is becoming increasingly recognised that the social and emotional effects of Rosacea are significant, and sometimes worse than the physical symptoms.

STAGES OF ROSACEA?

Prior to 2002, Rosacea was identified as occuring in different stages and the following information is for reference purposes only.

Pre-Rosacea

This stage is characterized by frequent bouts of transient facial flushing, which appear as quickly as it dissipate. They are difficult to control, and may come in the most inappropriate moments like at the start of a very important meeting.

Rosacea

The intermediate stage of rosacea is characterized by facial redness (with prominent dilated blood vessels), and by swelling that may persist for weeks or months and become permanent on the nose and cheeks. During bad flares, patients may experience pulsating facial pain and discomfort that lasts for days, disrupting their normal everyday life. Inflammatory outbreaks of papules and pustules are a frequent occurrence at this stage. A most distressing symptom is the intolerance to topical preparations. The skin becomes red, it stings and burns upon application of certain products, particularly acne preparations, cleansers, sunscreens and cosmetics.

Rynophyma

It is the most advanced stage as manifested by a bulbous enlargement of the nose.

Rosacea may also affect the eyes with symptoms including irritation, dryness, foreign body sensation, swelling of eyelids, conjunctivitis and light sensitivity.

WHAT ARE THE POTENTIAL TRIGGERS?

Potential triggers for flushing can be external or internal in origin. Common external triggers include:

External:

• Environmental: sun, wind, hot environments, cold environments
• Vasodilator medications
• Physical irritation
• Irritating acne products, sunscreens, cosmetics or skin care products
• Foods or beverages (thermally-hot or spicy foods, and alcoholic beverages)

Internal:

• Stress, anxiety, strong emotions
• Hormone-related conditions (i.e., menstrual-, menopausal- and Disease-mediated)
• Exercise-induced overheating

WHAT DOES THE MEDICAL PROFESSION SAY?

The current medical view is that the basic defect in rosacea is due to facial vascular hyper-responsiveness or dysfunction. Recurrent facial flushing or blushing is believed to be one of the major causative factors. Anything that triggers a facial flush or blush (an increase in blood flow through the facial blood vessels) can worsen rosacea symptoms.

WHAT IS THE DOCTOR'S APPROACH?

Most doctors recommend a combination of oral and topical antibiotics to treat rosacea patients. Antibiotics may be effective in treating the mild cases, and in decreasing papule and pustule formation in the more severe cases. However, it is only minimally effective on facial erythema and it rarely affects the telangiectasia or the flushing aspects of the disorder. While on this treatment, most patients have to continue to avoid all of their individual triggers. These triggers are not uncommon in rosacea sufferers most of whom are very unhappy with their current treatment and severely limited list of what they can do or eat. This may require such life changes as to result in decreased job productivity, and a generalized feeling of hopelessness and depression. Oral and topical antibiotic therapy along with the avoidance of all these triggers is not a very satisfying treatment strategy!

WHAT IS OUR APPROACH?

We believe in a holistic approach where we can give our patients the tools to help themselves keep their condition under control. We will have a first consultation where we will have a look at you as to be able to tell you what is the level of your condition and how we can help. We will also provide you with information as to how you can help yourself to maintain your rosacea at bay.

Our treatment follows three steps. One is the application of IPL (Intense Pulse Light). As opposed to what other clinicians might think suffice, we will calibrate our equipment to suit the specifics of every patient we treat, as different levels of rosacea and types of skin will require different levels of light.

The second step is the recommendation of Vitamins and supplements to help your skin to stay healthy.

The third step is to provide you with information so you can make changes in your diet and lifestyle that will help keep your condition under control.

Rosacea Awareness Month in the USA is April

Rosacea Awareness Month helps increase  awareness of this chronic skin condition.
Rosacea affects an estimated 16 million Americans, many are unaware that they are developing the condition.
Anyone can ask for a free first consultation at the Pulselightclinic

The National Rosacea Society has named April as National Rosacea Awareness Month in the USA, with the aim of alerting the public to the warning signs of rosacea and the importance of early diagnosis and treatment.
A Gallup poll found  78% of Americans had insufficient knowledge of rosacea with less than 10% of those who had rosacea, receiving treatment.

Therefore to help increase knowledge of Rosacea, an A to Z of Rosacea is being constructed