Rosacea: A Complex But Treatable Condition

rosacea_cartoonRosacea is a very common chronic skin condition that affects more than 16 million Americans.  Rosacea is actually a syndrome that consists of combinations of various signs and symptoms.

On the face, these symptoms include flushing, redness, broken visible blood vessels, acne-like pimples, and eye irritation.  At extremes, some people with rosacea also contract rhinophyma, which is growth of excess skin (that is also frequently red and irritated) on the nose.

In addition to these common symptoms, people with rosacea often feel burning and stinging on the face, especially when flushing occurs along with dryness and foreign body sensation in the eyes.  Unlike acne, rosacea generally first appears on a person between 30-60 years of age.  It tends to start on or around the nose, and then spreads laterally over time to involve the cheeks, chin, and the forehead.

As if the physical signs and discomfort were not enough, recent studies through the National Rosacea Society have reported a significant negative impact among those with rosacea on their quality of life socially, emotionally and professionally.  In a survey of 1675 rosacea patients:

  • 72% with moderate to severe redness felt that rosacea inhibited their social lives.
  • More than 60% revealed that they avoided face-to-face contact.
  • 39% actually refused or cancelled social engagements due to their redness.
  • 28% had even missed work due to flareups.

Unfortunately, there is no diagnostic blood test for rosacea.  The diagnosis of rosacea is called a clinical diagnosis in that doctors assess various symptoms and characteristic visual signs to make the diagnosis.

Symptoms can be intermittent, and can sometimes be worsened by lifestyle and environmental factors called triggers.  The most common triggers in order of importance include:

  1. Sun Exposure
  2. Emotional Stress
  3. Hot Weather
  4. Wind
  5. Heavy Exercise
  6. Spicy Foods
  7. Alcohol Consumption

rosaceaThe tricky thing about rosacea triggers is that some triggers that may be severe for one patient may not affect another.  They can vary by individual, and it is very useful for patients to keep a diary to identify what affects them the most.

Other than avoiding triggers, consistent and gentle skin care is another important key in the management of rosacea.  I generally advise rosacea patients to follow a gentle cleansing regimen involving washing with a mild cleanser and avoiding abrasive rubbing.

The face should be rinsed with lukewarm water and blotted dry before applying any skin products.  If you use over-the-counter skin care products, avoid those that burn or sting when you apply them to your face.  Most common ingredients to avoid include alcohol, witch hazel, menthol and eucalyptus oil.

There are a number of medical therapies for rosacea that are primarily focused on the acne-like pimples that some with rosacea develop.  Unfortunately, they do not permanently address the most common and debilitating aspect of rosacea, which is facial redness.

rosacea_laserLaser light therapy is the only treatment that can reliably diminish facial redness.  How does laser accomplish this improvement?

Without going too much into the physics of laser, essentially the laser beam is aimed at the individual blood vessels. The laser beam causes the blood to heat up, resulting in the blood vessel collapsing upon itself.

Immediately after the treatment, the treated area is red from the heat of the laser, but quickly dissipates.  Larger blood vessels of the facial surface appear more narrow in diameter and may darken in color, while the smaller blood vessels become invisible to the naked eye.

rosacea_triggersThe rosacea blood vessels collapsing is just the first step.  Your body will get the signal that there has been an injury and will send what are essentially scavenger cells to pick apart and recycle the components of the blood and blood vessels.

This same mechanism occurs when you have a bruise or a black-and-blue mark.  The gradual fading that occurs over days to weeks is your body scavenging and recycling as described above.

Within a month after the first treatment, the process will be complete and then another round of blood vessels can be treated.  If rosacea is being treated with laser for the first time, generally several treatments are needed to work through the layers of blood vessels that develop over time.

Because rosacea is a chronic condition for which there is no known cure, I always advise patients, even after successful laser therapy, that new blood vessels will develop over time and gradually.  In contrast to initial therapy, one treatment is frequently sufficient if this new redness is treated within 6-12 months.

In summary, if you have rosacea, there is hope to avoid and treat the redness that causes the most common distress of this condition.  If you have facial redness but are not sure if you have rosacea or not, please call us at (207) 873-2158 for a free and confidential consultation.

If you are absolutely sure you have rosacea and wanted to get the red out, please also call the number listed above.  We can improve your social, professional and emotional quality of life.

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