What do Bill Clinton, W.C. Fields, Santa Claus and Rudolph the Red-Nose Reindeer have in common? A red face, of course, and a red nose–two traits that characterize a chronic skin condition known as rosacea. If President Clinton’s seemed less obvious to you, it was probably because he had access to better and earlier treatment.
Many people with rosacea first notice they are quick to blush. Depending in part on their personality, they may be embarrassed by this trait. And they soon discover that what they have is more than a blush but rather a chronic skin condition, similar to adolescent acne.
Symptoms also include:
• persistent redness of the nose and central face;
• acne-like red bumps and/or pustules or pimples;
• spider-like blood vessels (telangiectasia) on the face and, sometimes,
• a bulbous nose, similar to that of W.C. Fields.
About 50 percent of persons with rosacea also have eye problems–a gritty feeling plus reddening of the eyes and eyelids.
Many observers attribute the red face and bulbous nose to alcohol abuse, and W.C. Fields seemed to welcome this stereotype. In fact, some liver disorders can cause many of the same symptoms, and alcohol is one potential trigger of rosacea. Nevertheless, rosacea can and does occur in persons who do not imbibe.
Fair Skin Is at Risk
Unlike acne which usually appears during the teen years, rosacea is more typically a skin condition of middle aged and older adults, particularly women going through menopause.
The condition is more common among women and among fair-skinned individuals of northern European descent, although persons with darker skin and men can also get rosacea. Thickening of the nose, known as rhinophyma, occurs nearly always in males.
Rosacea is frequently made worse by sun exposure. Other triggers include emotional stress, hot weather, wind, exercise, alcohol consumption, hot baths, spicy foods, and certain skin care products and medications.
Severity of symptoms vary as can the overall effect on the individual. Some persons have few or no symptoms and are not bothered by rosacea. They may even like the ruddy glow of their complexion and accept it as a part of who they are.
Others have moderate symptoms that occur periodically, causing short-term embarrassment. These patients generally find treatments to manage their condition, however, and keep it from interfering in their lives.
Finally, some individuals find rosacea to be extremely bothersome. In the advanced stage, the skin may become a deep shade of red, and the eyes noticeably inflamed. Unsightly broken blood vessels appear on the nose and central face.
Even when symptoms are less severe, rosacea can lead to low self esteem and psychological, social and emotional problems. Some rosacea patients develop depression. Although there is no real cure for rosacea at this time, the skin symptoms can be improved with treatment.
Most persons with rosacea realize fairly early that good skin care is important...but not always easy or successful. Washing the face with a gentle cleanser twice a day is helpful; too much washing, on the other hand, may irritate the skin. Since sun exposure is nearly always a trigger, applying sunscreen lotion, with an SPF of 15 or higher, every morning is also recommended.
The biggest mistake many patients make is to try to treat the problem themselves with common acne therapies or natural remedies. Rosacea-affected skin is very sensitive, and these self treatments, if not well chosen, can cause even greater irritation.
Many common skin cleansers contain ingredients that are potential rosacea triggers–alcohol, witch hazel, peppermint, eucalyptus oil, clove oil, menthol, fragrance or salicylic acid.
Natural remedies that may work include facial soaks two or three times a week with dilute vinegar or green tea. Vinegar is a natural disinfectant, and green tea is believed to have anti-inflammatory qualities.
A better approach, though, is to seek out a dermatologist or a physician experienced in handling skin problems. There are several sub-types of rosacea, and a doctor can help identify what sub-type you have and what treatment works best for you.
Topical antibiotics such as metronidazole (Flagyl) or azelaic acid (Finacea gel 15%) may be used initially to improve the condition of the skin. Applied twice a day, these can be effective at reducing the pustules and bumps.
Other topical treatments include sodium sulfacetamide (Klaron lotion), erythromycin and clindamycin (Cleocin).
Isotretinoin (Accutane), commonly used for the treatment of acne vulgaris, is sometimes used for severe rosacea symptoms, although close physician monitoring and blood testing are necessary to avoid potentially rather severe side effects. Getting pregnant while on this medication is absolutely contraindicated.
For severe cases or for eye problems, oral antibiotics may be prescribed. A doctor may recommend gentle scrubbing of inflamed eyes with diluted baby shampoo and warm (not hot) compresses.
In addition to the antibiotics, doctors may also prescribe skin cleansers. Products such as Cetaphil or Purpose may be less irritating than harsh soaps or lotions.
For the persistent redness and broken blood vessels, many patients are now choosing laser and intense light treatments, even though some of these treatments may not be covered by insurance. Laser treatments may be uncomfortable, and multiple sessions are usually required, but they are generally effective at improving the skin condition without scarring or damage.
Another option is photodynamic therapy, using a topical photosensitizer liquid and a light to activate the sensitizer. This is a treatment primarily designed for acne, but it is often used off-label to improve skin texture of rosacea patients.
For persons who develop an unsightly bumpy, bulbous nose (rinophyma), excess tissue can be removed with a scalpel, laser or electrocautery.
Although the symptoms of rosacea are more bothersome and embarrassing than anything else, they are usually progressive and worsen over time. With early recognition and treatment, most patients can go through life without being known as the “red faced” one.
REFERENCES:
Gary W. Cole, M.D., FAAD, “Rosacea,” MedicineNet.com, 2012.
National Institute of Arthritis and Musculoskeletal and Skin Diseases, “Fast Facts: What is rosacea?”
National Institutes of Health, “Questions and answers about rosacea,” online version updated October, 2012.
“Rosacea in adults: Condition, Treatment and Pictures–Overview,” SkinSight.com, last modified December 22, 2008.
U.S. National Library of Medicine, “Rosacea,” MedlinePlus, last reviewed April 17, 2012.
U.S. National Library of Medicine, “Rosacea,” PubMed Health, reviewed October 22, 2011.
02/04/2013
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