Rosacea

Rosacea is a chronic inflammatory skin condition that affects over three million Canadians. Rosacea features can vary from one person to another as can severity. There is no known cure, but it can be managed with appropriate treatment and lifestyle changes. The central face is the most commonly affected area.

Rosacea usually develops in young adults and presents between ages 30 and 50. It affects both men and women and is most easily visible in those with fair skin, such as people of northern and eastern European descent (e.g. Irish, English, Scottish), although rosacea can develop in people with any skin color.

The first sign may be intermittent redness or blushing. Over time, the redness may become persistent and more visible along with small blood vessels. The most common sites affected are the cheeks, nose, chin and forehead. Red small bumps and pus-filled pimples can also appear, giving skin a rough, uneven appearance.

Thickened, swollen, and bumpy skin can also develop, called phyma. Rhinophyma (when it affects the nose) is the most common presentation. This feature is due to prominence of oil-producing glands and thickening of surrounding connective tissues. Rhinophyma develops in some men who have rosacea, and rarely in women.

Rosacea can affect the eyes as well, and include bloodshot eyes that feel gritty or dry. Eyelids may also be itchy and flaky. More than half of rosacea sufferers may experience eye symptoms.

The features of rosacea can include any of the following:

• flushing on cheeks, nose, chin, forehead
• persistent facial redness
• red lines, due to enlarged blood vessels
• pimplelike bumps and pustules without blackheads or whiteheads
• skin swelling and thickening
• dry skin
• burning, stinging or itching

Experts are not sure about specific causes of rosacea but they believe it is due to both genetic and environmental factors. There is evidence that the immune system is hyperactive in response to usual environmental stimuli in those with rosacea.

Diagnosing rosacea: Rosacea is classified based on different features (phenotypes). These are the observable, presenting features of the individual patient.

Having one (1) of two (2) distinct signs of rosacea is sufficient to make a diagnosis:

• Persistent facial redness of the forehead, cheeks, nose, chin

OR

• Thickening of the skin on the nose, ears or chin (phymatous changes)

OR any two (2) of the following:

• • papules and pustules (pimples)
  • flushing (transient redness with burning or hot sensation)
  • small broken blood vessels (telangiectasia)
  • eye and eyelid problems

Secondary signs can also support a rosacea diagnosis but are not diagnostic: skin burning or stinging, facial redness that comes and goes; and dry, rough skin.

Several lifestyle factors may cause rosacea to flare. Triggers vary from person to person, so it is both important and helpful to find out which ones make your own symptoms flare up. This knowledge can help you better manage your condition, because you’re able to avoid factors that may aggravate rosacea.

Food and beverages: What you eat and drink can affect rosacea symptoms. Watch for the following, and track when you eat these trigger foods/drinks to determine which ones affect you:

• hot beverages such as soup, hot chocolate
• caffeinated beverages such as tea, coffee
• spicy seasonings such as white or black pepper
• paprika, red pepper, cayenne
• alcohol, especially red wine

Sun exposure: Exposure to UV light seems to make rosacea worse, so rosacea sufferers are advised to wear hats and use sunblock with a minimum SPF of 30 daily. Try to avoid the sun at peak times, primarily between 11 am and 3 pm.

Temperature extremes: Extremely hot or cold temperatures, very dry or humid air, wind and indoor heat exposure can be triggers. The key is to stay cool in hot weather, cover skin and moisturize when it is cold outdoors, and avoid hot baths, saunas and other environments that raise your body temperature.

Intense exercise: High-intensity workouts overheat the body, which can trigger flushing and worsen facial redness. Avoid vigorous exercise or divide it into shorter sessions. You can also find ways to stay cool while exercising, such as exercising outdoors during cooler weather, or exercising indoors in an air-conditioned space when it’s hot outside.

Stress: Stress is one of the most common triggers associated with rosacea flare-ups. If this is a trigger for you, seek out ways to manage emotional upset — such as getting enough sleep, deep breathing and stretching, exercising regularly and eating a healthy diet.

Medications: Extended use of prescription-strength cortisone creams on the face can precipitate rosacea flares (steroid rosacea) and worsen rosacea symptoms. Topical acne treatments may also increase dryness and irritation, exacerbating rosacea.

Certain blood pressure medications that cause enlarged blood vessels and flushing can also prompt flare-ups. Consult your physician if you think your medication plays a role in rosacea flares.

Cosmetic products: Products with fragrance, alcohol, abrasives, or other irritating ingredients can aggravate rosacea symptoms. Remember that rosacea-prone skin is sensitive and dry, so choose only mild products.

Rosacea does not resolve on its own and untreated rosacea can worsen over time. Unlike acne, self-treating with over-the-counter acne products may irritate skin more — causing more redness and bumps. Your family doctor or dermatologist can prescribe various treatments and recommend appropriate skin care products and cosmetics. While there is no cure, it can be managed with appropriate treatment and lifestyle changes.

Sticking with your recommended treatment will can improve signs and symptoms within a few weeks.

Topical
Topical Metronidazole: This topical agent, which has anti-inflammatory and antimicrobial effects, is considered a standard treatment for the pimples of rosacea. It can be used long-term and is available in gel, cream or lotion form.

Azelaic Acid: Azelaic acid is a naturally occurring dicarboxylic acid possessing antibacterial activity. It is
as effective as metronidazole for the pimples of rosacea. While some studies have shown azelaic acid to be slightly superior to metronidazole, it may not be as well tolerated.

Ivermectin: Topical ivermectin is a prescription cream for treating the pimples of rosacea. The drug is thought to have anti-inflammatory and anti-mite activity.

Brimonidine Tartrate: Used once daily as a gel, brimonidine tartrate can temporarily reduce the redness (erythema) associated with rosacea by temporarily shrinking blood vessels.

Tretinoin cream: This topical agent may be prescribed for mild rosacea. It can irritate skin and should be used with caution.

Sodium sulfacetamide and sulphur: Sodium sulfacetamide and sulphur are older medicines occasionally used to treat pimples of rosacea.

Topical Antibiotics: Topical antibiotics are used for milder forms of rosacea, while oral medication is reserved for moderate or severe rosacea.

Oral
Antibiotics: Rosacea can be treated with antibiotics pills such as tetracycline or doxycycline as these have anti-inflammatory effects.

Isotretinoin: This oral agent may be prescribed if rosacea is severe, or if pimples and inflammation do not respond to antibiotics. Pregnancy precautions are mandatory if used in women of childbearing potential.

Other Treatments
Laser Therapy and other Surgery: Laser treatment involves using light energy to treat visible blood vessels and redness in rosacea that does not respond to other types of therapy. Laser resurfacing, dermabrasion or surgery may be used to reduce the tissue overgrowth associated with rhinophyma.

Makeup: In addition to treating rosacea symptoms, many patients feel better about their condition if they can cover the visible redness and bumps. Corrective camouflage makeup is available to help conceal rosacea symptoms.

Rosacea can lead to feelings of self-consciousness and embarrassment due to the redness and bumps on visible areas, such as the face. There are also common misconceptions about rosacea, for example, that it is a sign of alcohol abuse or poor hygiene. It can persist for many years, so it can lead to stigmatization, impacting patients’ quality of life.

Nearly three-quarters of rosacea patients have reported low self-esteem. Similar numbers have reported that they feel the rosacea negatively affects their career opportunities. Because of the social and psychological impact, it is important to be diagnosed and treated for this chronic skin condition. Successfully controlling rosacea through treatment has been shown to improve the mental and emotional well-being of patients.

Good skin health tips

• The key to caring for skin affected by rosacea is to treat it gently:
• Choose products that are non-drying, and free of alcohol or astringents
• Use a mild cleanser; don’t rub or scrub skin
• Make a habit of using sunscreen (SPF 30 or higher) every day
• Moisturize your skin, especially during colder months when the air is dry

Five myths about rosacea
It is a form of acne — Don’t try acne creams to treat confirmed rosacea; they may dry out and irritate your skin even more.

It is because of a drinking problem — Excess alcohol consumption does not cause rosacea. Alcohol is a known trigger, so it can worsen features of rosacea.

It is due to high blood pressure — It’s a common misconception that high blood pressure produces facial flushing.

It is due to poor hygiene — Rosacea isn’t caused by not washing enough. In fact, because rosacea skin tends to be dry and sensitive over-washing it can make symptoms worse.

It is a bad sunburn or a frost bite— Because of the redness that characterizes rosacea, people may incorrectly assume that it is caused by exposure to sun or cold.