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 Celt’s” although people with darker skins also suffer from Rosacea.
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 centre 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 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 occurring in different stages and the following information is for reference purposes only.
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.
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.
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:
- Environmental: sun, wind, hot environments, cold environments
- Physical irritation
- Irritating acne products, sunscreens, cosmetics or skin care products
- Foods or beverages (thermally-hot or spicy foods, and alcoholic beverages)
- 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.
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!
New Rosacea Research
The Pulse Light Clinic is always at the forefront of the latest research into Rosacea; its holistic approach ensures that this knowledge is incorporated into every treatment for every patient, which is therefore always optimised.
It is widely recognised that is no one single cause of rosacea, occasionally new research identifies a cause that affects some sufferers more than others; this should be identified before any action is taken.
Recent research shows that in some sufferers, the cause can be tiny mites on the face that are not visible and are so small they cannot be felt.
It appears the mites which are in glands that produce sweat and sebum contain a type of bacteria that is released when they die, and this spills out into the glands; unfortunately because the mites do not excrete while they are alive, all the bacteria are released at once when they die.
For most people this is not a problem, however in some people, if there is a heavy infestation of these tiny mites, which can trigger rosacea.
At night, the mites leave the glands, often in search of a mate, and so if they die during the night, it is not a problem, because the Bactria are not in a confined space. The mite Demodex folliculorum has been identified as the most likely culprit.
It is thought that this explains why antibiotics are only effective as a temporary solution, because they kill the bacteria inside the mites, which produce the toxins. Once the treatment stops, new mites (perhaps from relatives or friends) are infected with the bacteria.
One rosacea sufferer who read about the new research treated her face with a shampoo that kills mites, and then washed it with alcohol.
The next day, her face was even more red. Therefore any person who is considering any kind of treatment should always consider a free first consultation as offered by certain specialist rosacea treatment clinics.
One of the key researchers suggests simply dietary changes such as avoiding high fat foods should be a precursor to any treatment, this has always been the practice of the Pulse Light Clinic.
As mentioned the dermodex spends the day inside the glands that produce sweat and sebum , and they feed on the oily substance released by sebaceous glands; therefore dietary changes can reduce population numbers to numbers that are insufficient to trigger rosacea, or to numbers which no longer constitute and infestation.
The study’s lead author Kevin Kavanagh, a researcher at the National University of Ireland, says:
“Recent work has shown that the sebum in rosacea patients is different from that in controls,” therefore a change in diet may lead to the appearance of more ‘normal’ sebum,’ that might prevent Dermodex from proliferating.”