The Four Stages of Rosacea

Rosacea is a progressive vascular disorder that affects the face and the eyes. Frequent dilation of blood vessels leads to vascular hyper-responsiveness and structural damage.

It progresses in stages known as pre-rosacea, mild rosacea, moderate rosacea and severe rosacea and has periods of exacerbation and remission. It most commonly occurs in adults between ages thirty and fifty (but not exclusively), and women are affected about three times as often as men, although men have a greater tendency to develop stage four rosacea.

Stage 1 Pre-Rosacea: generally people who are prone to frequent bouts of flushing and blushing are in stage 1. The facial redness that occurs with the flushing or blushing is rather transient and disappears soon after the cause or trigger is over. Some common triggers at this stage are:

An increase in the local temperature (be it a room or weather-related)

Exercise that produces body heat

Hot foods and drinks

Spicy foods

Facial cleansing

Embarrassing situations.

At this stage a functional change can occur where the blood vessels start to dilate to more stimuli than before, they start to open wider than before and begin to stay open for longer periods of time. At this stage there are no physical signs of damage to blood vessel walls.

Stage 2 Mild Rosacea: this stage is the first ‘true’ form of rosacea; it begins when the facial redness induced by flushing continues for an abnormal length of time after the trigger is over due to facial blood vessels remaining open. It usually continues for half an hour or more. The skin is often described as rosy or as having a healthy looking glow. Minor structural damage may be also be visible at this stage.

Stage 3 Moderate Rosacea: this stage begins when the facial redness persists for days or even weeks. In some instances there is a semi-permanent redness in the central area covering the nose and cheeks. The face is often described as having a sun-burned or wind-burned look. In most cases there are prominent areas of telangiectasia (chronic dilation of groups of capillaries) in the areas where flushing is worse. Some sufferers of moderate rosacea also report the following:

· Swelling and/or burning sensations

· Outbreaks of inflammatory papules (a small, solid, usually inflammatory elevation of the skin)

· Outbreaks of pustules (pus filled papules)

At this stage facial blood vessels can show different levels of structural damage. Some can still function normally, while others function very differently to normal blood vessels, and may be beyond repair. Blood vessels that have become severely damaged and are permanently dilated allow large volumes of blood to flow through them, which can lead to chronic inflammation. These changes can stimulate the growth of new blood vessels and the fusion of existing damaged vessels.

These severely damaged blood vessels contribute to facial swelling as fluid and proteins leak out of the broken vessels into the skin. The papules are a result of inflammatory substances escaping from damaged vessels and migrating to the superficial layers of the skin.

Stage 4 Severe Rosacea: a small portion of rosacea sufferers progress to the severe form. At this stage there are intense episodes of facial flushing, severe inflammation, swelling, facial pain and debilitating burning sensations.

On top of this inflammation there are often crops of inflammatory papules, pustules and nodules, and some people develop rhinophyma (a bulbous enlargement of the nose). This stage is a result of uncontrolled facial flushing over an extended period of time. The major changes that have occurred by this stage are:

· Widespread damage to facial blood vessels

· Extreme hyper-reactivity of the remaining blood vessels

· Significant leakage from damaged blood vessel walls

· Adverse changes to facial skin structure

At this stage permanent damage has been done and it is very difficult to treat.

Treatments available:

There is no known cure for rosacea. However, progression has been successfully brought into remission in many instances using Intense Pulsed Light Therapy to address existing damaged vessels, in combination with Nutritional therapy that addresses digestive function, diet and lifestyle factors that may be contributing to flushing, and which prescribes a comprehensive programme to support any areas of concern for the individual.

It is often found that there are many differences between one rosacea sufferer and the next, and therefore an individualised programme is essential.

In some instances antibiotic therapy can be used to help reduce inflammation, but this is a short term remedy as the inflammation often returns some time after antibiotic therapy has discontinued.

When antibiotics are used it is essential to replace the beneficial bacteria that are depleted by antibiotics because the health of the digestive system is strongly associated with rosacea. 70% of the immune system is located in or around the digestive system and a lack of beneficial bacteria can lead to a condition called leaky gut which can over-stimulates the immune system. An over-active immune system often releases inflammatory chemicals that exacerbate rosacea.

It is advisable to seek professionals for both therapies that have experience in treating rosacea.

There are some treatments available that claim to help rosacea, and many of these have been found to make matters much worse. Any treatment not listed here is not endorsed by me and should be carefully and fully investigated before pursuing.

Bibliography:

· Lipski E. M.S., C.C.N. Digestive Wellness. Updated 2nd Edition Keats 2000.

· Murray & Pizzorno Encyclopedia of Natural Medicine Prima Health 1998.

· Nase G PhD. Beating Rosacea: Vascular, Ocular & Acne Forms. Nase Publications 2001.

· Savona Holford Solve Your Skin Problems Judy Piatkus Ltd, London 2001.

Lisa is a qualified Nutritional Therapist. She has been practising nutrition for 12 years across a broad spectrum of health conditions. She has a special interest in Rosacea, and her research, together with handson experience, led to the writing of her thesis entitled “The Nutritional Management of Rosacea”.