Fricken long article on Rosacea
What Is Rosacea?
Most people have very little knowledge of rosacea, treatment, symptoms or the cause. Knowing the symptoms and finding the treatment that works for you is the best defense against the social and psychological trauma.
The rosacea classic symptoms are patchy flushing (redness) and inflammation, particularly on the cheeks, nose, forehead, and around the mouth. Rosacea typically appears between the ages of 30 and 50 and affects more women than men. As symptoms emerge slowly, rosacea may initially be mistaken for sunburn, leading to a delay in proper rosacea treatment. Rosacea treatment delayed is 'rosacea treatment denied'.
Rosacea is a hereditary; chronic (long term) skin disorder that most often affects the nose, forehead, cheekbones, and chin (Dr. Berasques). Groups of tiny microvessels (arterioles, capillaries, and venules) close to the surface of the skin become dilated, resulting in blotchy red areas with small papules (a small, red solid elevated inflammatory skin lesion without pus) and pustules (pus-filled inflammatory bumps). The redness can come and go, but eventually it may become permanent. Furthermore, the skin tissue can swell and thicken and may be tender and sensitive to the touch. Pustules are 'not' pimples. Pimples have a bacterial component to their makeup and are also mainly localized in and around the hair follicles while papules are a raised solid red lesion without pus.
Although it may first appear as early as the teen years, rosacea symptoms most frequently begins when rosacea sufferers enter their 30s, 40s or 50s as a flushing or transient redness on the cheeks or nose, and in some cases the chin or forehead. In this earliest stage, some patients may report stinging or burning sensations, including the feeling of dry or tight skin.
"While the incidence of rosacea appears to be rising sharply as more people enter the most susceptible age, many mistakenly think it's just a complexion problem that will go away by itself -- it usually keeps growing worse if left unchecked," said Dr. Joseph Bikowski, assistant clinical professor of dermatology at the University of Pittsburgh. "Of greatest concern is that only a small percentage of rosacea sufferers realize that medical help is available from dermatologists to halt its progression and reverse its symptoms."
Rosacea may be persistent and worsen over time, leading to permanent changes in appearance and affecting self-esteem. The condition is treatable. Most cases can be controlled easily by avoiding factors that trigger flushing, using sun protection, and by keeping the body well hydrated with water.
As the condition progresses, flushing becomes more persistent and noticeable. Small, red, solid bumps (called papules) and pus-filled pimples (called pustules) may appear on the skin. Because these appear similar to acne, it is sometimes called acne rosacea or adult acne. However, unlike acne, there are no blackheads. Though rosacea is sometimes referred to as "adult acne," it is a distinctly different and often more serious condition than acne vulgaris, which most commonly occurs during adolescence. While both conditions can cause pimples, rosacea requires different therapy -- acne treatments can actually make it worse -- and rosacea rarely goes away by itself.
Small, dilated blood vessels may become visible, too. Often when people with rosacea blush, the enlarged blood vessels in their faces can look like thin red lines.
In advanced cases, more of the face is affected. The skin swells, cysts form, and small, knobby bumps develop on the nose, making it appear red and swollen. This condition, called rhinophyma, is relatively uncommon and primarily affects men. It was the cause of the late comedian W.C. Fields' best-known feature -- his trademark bulbous nose.
Ocular Rosacea: It can also cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps. The eyes may become bloodshot and eyelashes sometimes fall out (Dr. Thiboutot). The rosacea ophthalmic signs are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The rosacea ophthalmic complications are independent of the severity of facial rosacea. Rosacea keratitis has an unfavorable prognosis, and in extreme cases can lead to corneal opacity with blindness. The most frequent signs of ocular rosacea, which may never progress, are chronically inflamed margins of the eyelids with scales and crusts, quite similar to seborrheic dermatitis, with which it is often confused. Pain and photophobia may be present. It is instructive to ask rosacea patients how their eyes react to bright sunlight.
Stages - Plewig and Kligman Classification of Rosacea
(Taken from their book, Acne and Rosacea, Second Edition, 1993)
Stage I: The erythema (redness) may persist for hours and days, hence the old term erthema congestivum (redness congestion). Erythema lasting only a few minutes is not early rosacea. Telangiectases becomes progressively prominent, forming sprays on the nose, nasolabial folds, checks, and glabella. Most of these patients complain of sensitive skin that stings, burns, and itches after application of a variety of cosmetics, especially certain fragrances and sunscreens. Trauma from abrasives and peeling agents readily induces long-lasting erythema, thus the facial skin is unusually vulnerable to chemical and physical stimuli.
Stage II: Inflammatory papules and pustules crop up and persist for weeks. Some papules show a small pustule at the apex, justifying the term papulopustular. The lesions are always follicular in origin, mainly in sebaceous follicles but also in the smaller and more numerous vellus follicles. Comedones do not occur. The deeper inflammatory lesions may heal with scarring, but scars are inconspicuous and tend to be shallow. Facial pores become larger and prominent. If there has been much solar exposure over decades, the stigmata of photodamaged skin becomes superimposed, namely yellowed, leathered skin (elastosis), wrinkles and solar comedones. The papulopustular attacks become more and more frequent. Finally, rosacea may extend over the entire face and even spread to the scalp, especially if the patient is balding. Itchy follicular pustules of the scalp are typical. Eventually, the sides of the neck as well as the retroauricular and presternal area may be affected.
Stage III: A small proportion of patients develop more serious expressions of the disease, namely large inflammatory nodules, furunculoid infiltrations, and tissue hyperplasia. These derangements occur particularly on the cheeks and nose, less often on the chin, forehead, or ears. The facial contours gradually become coarse, thickened, and irregular. Curiously, patients may not notice these disfigurements. The deranged appearance becomes evident when photographs from previous years are reviewed. Finally, the patient shows diffusely inflamed, thickened, edematous skin with large pores, resembling the peel of an orange. These coarse features are due to extensively inflammatory infiltration, connective tissue hypertrophy, massive fibrosis and elastosis, diffuse sebaceous gland hyperplasia, and extreme enlargement of individual sebaceous glands forming dozens of yellowish unbilicated papules on the cheeks, forehead, temples, and nose. Thickened folds and ridges may create a grotesque appearance mimicking leonine facies of leprosy or leukemia. The ultimate deformity is the phymas, of which rhinophyma is the prototype.
What Causes Rosacea?
No one knows for certain what causes rosacea. Researchers have suggested several factors that may be related to its development:
A disorder of the blood vessels that causes them to swell, leading to flushing.
A genetic predisposition combined with certain environmental factors that may irritate the skin.
Rosacea seems to affect fair-skinned people more often, though it can affect any skin type. Often several people in a family have the condition, thus it is believed to be at least partly genetic. The disorder may be somewhat more common in women, but is often more severe in men. In some cases, it may be associated with migraine headache, other skin disorders, and certain eye disorders, including blepharitis and keretitis.
Any one of the following warning signs can be a signal to see a rosacea expert for diagnosis and appropriate treatment before the signs and symptoms become increasingly severe:
Redness on the cheeks, nose, chin or forehead.
Small visible blood vessels on the face.
Bumps or pimples on the face.
Watery or irritated eyes.
Rosacea is aggravated by many factors, including sunlight, physical and mental stress, sinus and allergy conditions, hot liquids, spicy foods, extremes in temperature, alcohol (either topically applied or orally consumed) and stress (Drs. McKoewn, Wilkin, Wilkin, Wilkin). But it is important to note that what aggravates one person's rosacea may have no effect on another person's condition (Dr. Wilkin)
Finacea, a new rosacea treatment, has proven effective in reducing redness
Rosacea plagues 14 million Americans with facial redness, bumps, pimples, and visible blood vessels, yet its cause and cure remain elusive. But for now, there's help for the symptoms.
In a trial of 251 rosacea sufferers, azelaic acid gel (Finacea) was the surprising upstart, outlasting the effectiveness of the current top treatment, metronidazole gel (MetroGel). Finacea continued to improve symptoms throughout the 15-week trial, while MetroGel plateaued after just 8 weeks, says researcher Boni Elewski, MD, of the University of Alabama. "It even reduced redness, a difficult symptom."
And the treatment caused no major side effects, and most of the patients who experienced a temporary stinging sensation from the gel found it easy to tolerate.
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~~~~~Megan
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