What is rosacea?

     pronunciation = rose-ay-shah
     synonyms = "adult acne", "acne rosacea"
Rosacea is a common inflammatory skin disease of unknown cause. It primarily affects the skin of the face , but may also be seen on the scalp , neck  and upper chest. 

The skin of the face appears oily and red  and it may be streaked with telangiectasias*  and dotted with papules and pustules . The condition was originally called acne rosacea, but acne and rosacea are not related to each other. They may easily be confused with each other because they look alike with similar red bumps and pus bumps  and at times may even occur simultaneously in the same person.

Because changes are gradual, it may be hard to recognize rosacea in its early stage. Many people mistake rosacea for a sunburn, a complexion change, or acne. The identifying features of rosacea are:

  •      a diffuse transient redness of the skin of the face and neck caused either by emotion (blush) or physical
external stimuli (flush) such as drinking hot liquids, or eating spicy foods.  
  •      increased oiliness of the skin  
  •      blemishes/pimples - papules and pustules  
  •      enlargement of the small blood vessels of the face (telangiectasias)*  
  •      increased pore size  
  •      edema of the skin, especially of the nose (rhinophyma)*  
  •      eye involvement - blepharitis*, conjunctivitis*, iritis*, keratitis *.
Who gets rosacea?
Rosacea is usually seen in adults between 20-70 years of age. It seems to affect fair-skinned people more often, though it can affect any skin type. Most people who get rosacea have a history of flushing or blushing more easily and more often than the average person (they are sometimes described as having "peaches and cream" complexions). While it occurs more commonly in women, men tend to develop the more severe form, rhinophyma. The image of one famous sufferer, W.C. Fields, helped to mistakenly link rosacea with alcoholism. Although drinking alcohol can make rosacea worse, even people who never drink alcohol can develop rosacea.

How does rosacea develop? 
Rosacea usually begins with brief episodes of redness (flushing/blushing) of the face, particularly of the cheeks and nose , . This is caused by distention of the blood vessels in the skin and looks like a sunburn. Because the blood vessels do not go back down to their normal size after multiple episodes of flushing/blushing the face takes on the appearance of "broken" blood vessels known as telangiectasias* . Rosacea is a chronic condition. In most people symptoms come and go in cycles. These "flare-ups" are common. Although the condition may improve (go into remission) for a while without treatment, it is often followed by a worsening of symptoms (redness, pimples, red lines, or swollen skin of the nose) that progresses upon its return.
Over time, the redness of dilated blood vessels becomes permanent and papules* and pustules surface. In addition, fluid collects in the skin, especially the nose of men, to produce the large, red, swollen nose of rhinophyma.
The eyes may become involved with the redness of inflammation affecting the eyelid
margins blepharitis  and the tissues lining the eye socket (conjunctiva) . Even the cornea of the eye can be affected resulting possibly in keratitis, scarring of the cornea, and blindness in the worse cases.

Whenever there is concern that the eye might be affected in any manner by rosacea you should consult your ophthalmologist. 

What causes rosacea?
The cause of rosacea is unknown. There are many theories but none have been proven. Various factors have been suggested, such as: bacteria, mites, certain types of foods, malfunction of the tissue under the skin, gastrointestinal disease or psychological stress. It is most likely that there is no single cause of rosacea and that it occurs in persons who are susceptible to a number of factors such as heredity, skin type, skin color, skin structure, environmental conditions, etc. 

What aggravates rosacea?
Facial flushing can make symptoms worse. It can even cause flare-ups in patients whose rosacea is under control with medication. Flushing can be triggered by many things ... strenuous exercise, menopause or some medicines. The most common triggers are:

sunlight,emotional stress, extreme heat or cold, alcohol, spicy foods, hot drinks

You should do your best to avoid anything that causes flushing. But what bothers one person may not cause a problem in another. You will need to find out what things affect you and decide if you want to change your habits to avoid them. Just remember, flushing may adversely affect your success in controlling rosacea. 

What treatments are used for rosacea?

Rosacea cannot be cured, but it can be controlled. 

Treatment includes changes in behavior. Hot liquids such as coffee and tea, spicy foods, temperature extremes, alcohol, excessive and prolonged sunlight, and emotional stress may aggravate rosacea by exacerbating flushing through blood vessel dilation. Therefore, these factors should be avoided if possible. Rosacea patients should also avoid harsh deodorant soaps, which may irritate the skin and induce dryness.
Because rosacea is a chronic condition, long-term detox therapy is necessary.
How should I care for my skin?
How and what you use to cleanse your face are very important when you have rosacea. Following a regular cleansing routine will make treatment easier and more successful.
You should be careful about what products you use with rosacea. Only very mild products should be used on the face. A non-soap cleanser is best. Avoid deodorant soaps and products that contain alcohol. If you have dry facial skin, apply a quality moisturizer. A SPF 15 or higher  sunscreen should be used everyday on all sun exposed surfaces 365 days a year. In general, it helps to choose professional facial products that won’t clog pores . Do not use products that contain significant amounts of alcohol (check hair spray labels), acetone, or oil. 
Rosacea sufferers should avoid rough washcloths and tugging or pulling at the skin. Instead, a gentle cleanser that is not grainy or abrasive should be spread with the fingertips. Lukewarm water should be used to rinse, and a thick cotton towel may blot the face dry. Also, avoid skin-care products with ingredients that may sting or irritate the facial skin, such as alcohol, menthol, peppermint, eucalyptus oil, clove oil, witch hazel or certain fragrances. 
 What results can be expected?
Whether you see improvement - and how much - depends on how far the disease had progressed, when treatment started and how carefully and faithfully you have followed the directions for your treatment. Following instructions carefully and having patience will improve the odds of success. Certainly, avoiding as many trigger factors as possible will also help to improve your condition. Rosacea is a treatable and controllable condition.

Surgical Procedures for telangiectasias*: 
PhotoDerm safely treats unattractive veins and other lesions without injections, surgery or anesthesia. PhotoDerm generates intense pulsed light which gently destroys visible veins so they fade and slowly disappear. Since a light source is used for treatment, rather than an injection or incision, discomfort is minimal. Patients typically describe the feeling as similar to a pinch or the snap of an elastic band. Local anesthesia or pain medication is not required. Immediately following treatment, blood vessels are lighter  in color and much less prominent or have disappeared. A  slight pink color lasting a few hours may be noticed. Only  in rare circumstances have we observed a temporary  bruise, which clears in a few short days. This is in contrast  to the bruising that almost always occurs with pulsed  “dye” lasers.  Within one to two weeks you will see the  very natural looking final results! 

Rosacea Triggers
This is a list of things that can aggravate your rosacea symptoms. It is unlikely that you will react to everything on this list, but by being observant and using the checklist, you can discover which ones apply to you and avoid flare-ups in the future:
  • Weather: Sun, wind, cold, humidity.
  • Emotional Influence: stress,anxiety. 
  • Temperature-related: saunas, hot baths, simple overheating.
  • Excessively warm environments: physical exertion, exercise, "Lift and load" jobs.
  • Beverages: alcohol, especially red wine, beer, bourbon, gin, vodka or champagne.
  • Hot drinks: hot cider, hot chocolate, coffee or tea. 
  • Foods: Hot and spicy foods, liver, yogurt, sour cream, and some cheeses, chocolate, vanilla, soy sauce, vinegars. 
  • Vegetables: eggplant, tomatoes, spinach, lima, navy beans, and peas 
  • Fruits: avocados, bananas, red plums, raisins, figs, and citrus fruits 
  • Skin care products: some cosmetics and hair sprays, especially those containing alcohol, witch hazel, or fragrances. 
  • Topical steroids: Any substance that causes redness or stinging .
Term Explanation:

  • TELANGIECTASIA (tell an jek taze yah): Enlarged visible superficial blood vessels
  • PAPULE (PAP yule): A small, solid, elevated skin lesion less than 0.5 cm in diameter.
The top of the papule can be flat, pointed, or rounded. Papules are common lesions in
  • PUSTULE (PUS tyule): Vesicle filled with cloudy or purulent fluid such as pus.
  • ACNE: A common inflammatory disease of the facial skin seen most frequently
between the ages of 10 and 25 years and characterized by blackheads, whiteheads and
blemishes composed of papules and pustules. Follow these links for further
information about acne and our acne products.: A collection of white blood cells in tissue fluid, it may be either a sign of infection
or inflammation
  • EDEMA/EDEMATOUS: swelling/swollen..
  • BLEPHARITIS (BLEF ah RYE tis): Inflammation of the eyelids.
  • CONJUNCTIVITIS: Redness and irritation of the white part of the eyeball and the
lining of the eye socket
  • IRITIS (eye RYE tis): Inflammation of the iris of the eye.
  • KERATITIS (ker ah TIE tis): Inflammation of the cornea of the eye
  • RHINOPHYMA (RYE no FYE muh): Hypertrophy of the soft tissue of the nose.
Occurs in men with severe rosacea.
  • ISOTRETINOIN (EYE so TRET ih no in ): 13-cis-retinoic acid. Marketed under the
tradename Accutane®. A systemic retinoid used in the treatment of severe
recalcitrant cystic acne.
  • NONCOMEDOGENIC (non coh mee dough jen ic): Literally it means "does not cause
comedones (whiteheads/blackheads)"(ir uh THEE muh): Inflammatory redness of the skin.
  • NON-ACNEOGENIC (non ack knee o jen ic): Literally it means "does not cause acne"

Date: ________________

Did you experience any of the following?

 ____ Hot sun or extreme weather
                           Describe: _________________________________
 ____ Emotional stress
                           Describe: _________________________________
 ____ Physical exertion
                           Describe: _________________________________
 ____ Other
                           Describe: _________________________________

What did you eat and drink?

 ____ Spicy foods
                        List: _________________________________
 ____ Fruits and vegetables
                        List: _________________________________
 ____ Dairy products
                        List: _________________________________
 ____ Beverages (hot, alcohol)
                        List: _________________________________
 ____ Drugs
                        List: _________________________________
 ____ Other
                        List: _________________________________

What personal and household products did you use?

 ____ Cosmetics or skin care products
                              List: _________________________________
 ____ Soap or shampoos
                              List: _________________________________
 ____ Perfume or aftershave
                              List: _________________________________
 ____ Other
                              List: _________________________________
What is the condition of your rosacea today?

____ No flare-up        ____ Mild flare-up          ____ Severe flare-up