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Common Conditions -
Rosacea
Rosacea is a disorder of the skin affecting 13
million people in the United States
characterized by redness of the central face,
especially the nose. Pimples (acne eruption),
reddening and sensitivity of the eyes and
thickening or enlargement of the nose (rhinophyma)
also may accompany it. The expression of rosacea
can be as mild as a slightly reddish appearing
nose or “rosy cheeks”. It may also become
severe, manifesting itself as a breakout of
large red pimples, frequently infected or
inflamed eyes, a greatly enlarged nose (“WC
Fields” nose) or frequent incapacitating bouts
of flushing.
 
images from
www.rosacea.org
What causes rosacea?
The true cause of rosacea is unknown. In one
theory, bacteria present on the surface of the
skin release chemicals causing blood vessels to
dilate. In another theory a genetic
predisposition to dilated blood vessels occurs,
or a neural (nerve-related) abnormality causes a
heightened flushing reaction. Yet another theory
postulates a connection to the bacterium
(Helicobacter pylori) causing stomach ulcers.
More recent theories center on the primacy of
inflammation. Some believe that a mite on the
surface of the skin called demodex has a role
because it has been demonstrated to be in
increased amount in people with rosacea.
The bacterial theory is supported by the fact
that rosacea is typically treated successfully
with antibiotics. It is criticized because the
bacterium involved has never been identified.
Antibiotics have some inherent anti-inflammatory
tendencies and some people argue this is the
reason they are effective against rosacea. The
association with stomach ulcers is controversial
and not accepted by many rosacea experts.
There are many things that appear to make
rosacea worse. The most common of these flare
factors include alcoholic beverages, hot
beverages or soup, spicy foods, wind, cold,
heat, sun, exercise and emotional stress. In
addition, people with rosacea often have very
sensitive skin, meaning that they are easily
irritated by skin care producst, especially
those containing fragrance.
What is rosacea?
Rosacea is a disorder of the skin affecting 13
million people in the United States.
The symptoms associated with rosacea may include
flushing, blushing, burning, hot or itchy
sensation of the face and occasionally swelling.
Eye symptoms can include a sensation of
something in the eye, dryness, itching, blurred
vision or sensitivity to light. Some people have
no symptoms.
Although rosacea commonly occurs in middle-aged
women and men, it can present as early as the
twenties and as late as the eighties. It is
estimated that rosacea affects 30-40% of women
over 40. Although rosacea is more common in
women, men often have more severe disease. Men
are particularly prone to rhinophyma, an
enlargement or thickening of the nose.
Are there different types of rosacea?
Rosacea has been divided into 4 main types:
• Type I (Erythematotelengiectatic)
consists of redness and dilated blood vessels
only.
• Type II (Papulopustular)
includes acne breakouts, in addition to redness
and dilated blood vessels.
• Type III (Ocular
Rosacea) features reddened eyelids,
conjunctivitis, a “gritty” sensation in the eyes
frequent chalazions (sties).
• Type IV (rhinophyma)
consists of nasal enlargement that appears
bulbous and is more common in men.
 
images from
www.rosacea.org
How can I treat rosacea?
The main treatments for rosacea are topical and
oral antibiotics, anti-inflammatory agents,
azelaic acid derivatives, laser surgery,
avoidance of flare factors and special make-up
techniques. There is no cure for rosacea.
A typical initial treatment course for mild to
moderate rosacea would consist of employing a
topical agent containing metronidazole (the
antibacterial agent in Metrogel and Noritate)
with or without an oral tetracycline derivative
(Dynacin, minocycline, Doryx, doxycycline)
depending on the presenting severity of the
disease. Other topical agents commonly and
successfully used for the treatment of rosacea
include azelaic acid (Finacea and Azelex),
Sulfacetamide with or without Sulfur (Plexion
TS, Rosac AC, Klaron, Ovace, Sulfacet). Second
tier oral antibiotics include erythromycin
derivatives, sulfa derivatives and ampicillin.
Once a good response is achieved with the
combination oral and topical antibiotics, the
oral antibiotics are usually discontinued after
2-4 months. Remissions induced this way last
much longer and are maintained in about twice as
many individuals who remain on topical
metronidazole therapy. Many people with moderate
to severe rosacea are unable to discontinue
their oral medications and stay clear.
Rosacea that is resistant to antibiotics usually
benefits from treatment with oral isotretinoin (Accutane)
. Accutane can be employed in different dosing
strategies for this purpose. Some use a regular
dosage for a few months to induce a remission,
whereas others employ a low-dosage strategy.
Laser treatment has become a mainstream and
important method for controlling rosacea. In
people with rosacea, the blood vessels of the
face dilate more than average and often don’t go
back to their more closed resting state when the
stimulus( such as heat, a glass of wine, the
sun) is gone. Over time, the vessel loses its
ability to constrict or close altogether. This
is when thin red lines on the face appear, often
popularly referred to as “broken blood vessels”.
These cannot be removed by medical therapy.
Another way to approach people who don’t respond
to oral antibiotics is to try laser surgery to
eradicate or reduce the number of dilated blood
vessels on the face. This often reduces the
redness significantly and there is often a
reduction in the flushing episodes and the
breakouts as well. There are many different
vascular lasers that can very effectively treat
this problem. Most of these types of lasers have
extremely low risks involved, although multiple
treatment sessions may be necessary to achieve
the desired results, and maintenance therapy
(1-2 times per year) will probably be necessary.
Is rosacea curable?
Rosacea is a chronic condition and although it
can be put in remission for a significant period
of time, it is not curable. Topical therapy is
generally recommended to maintain and treat this
condition.
Products from skinfo® that are good for people
with rosacea: For Treatment (adjunctive- should
be used in conjunction with a topical
prescription antibiotic) Skinfo® Vital Tea Serum
and Cream- 90% Green Tea Extract Moisturizers:
Kinerase Cream Skinfo® Vita Lite Moisturizer
SkinCeuticals Face Cream Sun Protection: skinfo®
Pure Block SPF 30 skinfo® Morning Security Cream
SPF 30 SkinCeuticals Physical UV Defense SPF 30
Ultra-Dry Skin: Neostrata Biohydrating Cream
Cleanser: skinfo® Clean But Not Dry Cleanser
Kinerase Gentle Cleanser skinfo® Vital Tea
Cleanser SkinCeuticals Foaming Cleanser
SkinCeuticals Gentle Cleanser Acne Breakouts: MD
Forte Glycare Perfection Gel skinfo® Clear Skin
5% Gel.
What does rosacea look like?
People suffering from rosacea can look very
different depending on which type of rosacea
they have.
• Type I (Erythematotelengiectatic) consists of
redness and dilated blood vessels only.
• Type II (Papulopustular)
includes acne breakouts, in addition to redness
and dilated blood vessels.
• Type III (Ocular
Rosacea) features reddened eyelids,
conjunctivitis, a “gritty” sensation in the eyes
frequent chalazions (sties).
• Type IV (rhinophyma)
consists of nasal enlargement that appears
bulbous and is more common in men.
The symptoms associated with rosacea may include
flushing, blushing, burning, hot or itchy
sensation of the face and occasionally swelling.
Eye symptoms can include a sensation of
something in the eye, dryness, itching, blurred
vision or sensitivity to light. Some people have
no symptoms.
 
images
from
www.rosacea.org
How can I find out more?
www.rosacea.org
Where did this information come from?
Szalchcic A, Sliwowski Z, Karczewski E, et al.
Helicobacter pylori and its eradication in
rosacea. J Physiol Pharmacol 1999
Dec;50(5):777-86.
Bamford JT, Tilden RL, Blankush JL, et al.
Effect of treatment of helicobacter pylori
infection on rosacea. Arch Dermatol 1999
Jun;135(6):659-63.
Rosacea treatment. Dahl, MV. Perspectives:
Condensed from a symposium at the American
Academy of Dermatology, July, 1999. Pps. 11-13.
Nikolowski J, Plewig G. Oral treatment of
rosacea with 13-cis-retinoic acid. (Article in
German). Hautarzt 1981 Nov;32(11):575-84.
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