Rosacea is a chronic but treatable skin condition that primarily affects the central face, and is often characterized by flare-ups and remissions.

Although rosacea may develop in many ways and at any age, surveys indicate that it typically begins any time after age 30 as flushing or redness on the cheeks, nose, chin or forehead that may come and go. Studies have shown that over time the redness tends to become ruddier and more persistent, and visible blood vessels may appear.

Left untreated, inflammatory bumps and pimples often develop, and in severe cases — particularly in men — the nose may grow swollen and bumpy from excess tissue. In as many as 50 percent of patients the eyes are also affected, feeling irritated and appearing watery or bloodshot.

Rosacea makes the skin extremely sensitive. Because the skin is so sensitive, many things can cause rosacea to flare. Rosacea flares are more than a minor inconvenience. Each time your skin flushes, it can stay red a little longer. Rosacea may start to appear on more of your skin. In some people, repeated flushing leads to skin that stays permanently red.

WHO IS PRONE TO ROSACEA?

Although rosacea can affect all segments of the population and all skin types, individuals with fair skin who tend to flush or blush easily are believed to be at greatest risk. The disorder is more frequently diagnosed in women, but tends to be more severe in men. There is also evidence that rosacea may tend to run in families, and may be especially prevalent in people of northern or eastern European descent.

In surveys by the National Rosacea Society (NRS), nearly 90 percent of rosacea patients said this condition had lowered their self-confidence and self-esteem, and 41 percent reported it had caused them to avoid public contact or cancel social engagements.

WHAT CAUSES ROSACEA?

Although the exact cause of rosacea is unknown, various theories about the disorder’s origin have evolved over the years. These have often related to its primary outward signs and symptoms: flushing and redness, bumps and pimples, and the small visible blood vessels. The range of possible causes has included defects in the immune system, nervous system and facial blood vessels, and the presence of microbes and Demodex mites.

Microscopic Demodex mites are a natural part of the human microbiome — the ecological community of microorganisms that live within and on the body. Two species of Demodex are found in humans. Demodex folliculorum live in hair follicles, primarily on the face, as well as in the meibomian glands of the eyelids; Demodex brevis live in the sebaceous glands of the skin.

While Demodex folliculorum are found on the skin of all humans, they frequently occur in greater numbers in those with rosacea. There has been much debate as to whether their increased numbers are a cause or result of rosacea. However, evidence appears to be mounting that an overabundance of Demodex may possibly trigger an immune response in people with rosacea, or that the inflammation may be caused by certain bacteria associated with the mites.

These mites are most plentiful in the same regions of the face that are most commonly affected by rosacea — the cheeks, nose, chin and forehead — large quantities of mites have been found in biopsies of rosacea papules and pustules.

While the cause of rosacea is unknown and there is no cure, knowledge of its signs and symptoms has advanced to where they can be effectively controlled with various therapies and lifestyle changes.

SYMPTOMS

Persistent Redness

Persistent facial redness is the most common individual sign of rosacea, and may resemble a blush or sunburn that does not go away. Many people with rosacea have a history of frequent blushing or flushing. This facial redness may be accompanied by a sense of heat, warmth or burning comes and goes, and is often an early feature of the disorder.

 

Bumps and Pimples

Small red solid bumps or pus-filled pimples often develop. While these may resemble acne, blackheads are absent and burning or stinging may occur.

Visible Blood Vessels

In many people with rosacea, prominent and visible small blood vessels called telangiectasia developon the cheeks, nasal bridge, and other areas of the central face.

Eye Irritation

In many rosacea people, the eyes may be irritated and appear watery or bloodshot, a condition commonly known as ocular rosacea. The eyelids also may become red and swollen, and styes are common. Crusts and scale may accumulate around the eyelids or eyelashes, and patients may notice visible blood vessels around the lid margins. Severe cases can result in corneal damage and loss of visual acuity without medical help.

Skin Thickening

The skin may thicken and enlarge from excess tissue, most commonly on the nose (known as rhinophyma). This condition is less common, but can lead to facial disfigurement and inadequate nasal airflow if severe.

DIFFERENT TYPES OF ROSACEA

There are four types of rosacea, though many people experience symptoms of more than one type.

Erythematotelangiectatic rosacea is characterized by persistent redness on the face.

Papulopustular Rosacea often begins as pus-filled or red bumps that form close together on your skin

Phymatous Rosacea causes skin to thicken and scar, making it bumpy, swollen, and sometimes discoloured.

Ocular Rosacea – symptoms affect the eyes, causing them to look watery or bloodshot. There may be an associated feeling of burning or irritation in your eyes. Ocular rosacea can cause persistently dry, sensitive eyes, and cysts may form on the eyelids.

How Are Acne and Papules and Pustules Different?

Although it is now known that there is no connection between acne and rosacea, the term “acne rosacea” was once frequently used to describe the bumps (papules) and pimples (pustules) of papulopustular rosacea, and the misleading term is still sometimes used today. This has often led to confusion and rosacea sufferers with bumps and pimples may mistakenly diagnose themselves as having acne. The two disorders require different treatment, however, and acne medications may cause rosacea symptoms to get worse.

Though both conditions may involve bumps and pimples, the causes and biochemical processes are different for each. Acne is a product of many factors, involving the hair follicles, hormonal stimulation of oil glands, inflammation and bacteria. Unlike in people with rosacea, blackheads are often present in acne, and bumps and pimples on the trunk are common. Acne is most commonly seen in teens, and is usually a transient condition.

In contrast, rosacea is a chronic disorder that typically begins in adulthood and occurs primarily in the central portion of the face. Rosacea’s most common feature is redness (erythema), which may come and go and may become more permanent over time. A study published in the Pakistani Journal of Medical Science found that rosacea patients with papules and pustules were more than three times more likely than acne sufferers to have background redness, burning and itching. Unlike acne patients, rosacea patients may also developvisible blood vessels on their face, and the eyes can become involved.

WHAT ARE THE TRIGGERS?

The biggest key to controlling rosacea is to avoid triggers — factors that cause the skin to flush. Identifying these factors is an individual process, however, because what causes a flare-upfor one person may have no effect on another. A good place to start is by looking at this list of common rosacea trigger factors that may affect various individuals.

Foods

• Liver
• Yogurt
• Sour cream
• Cheese (except cottage cheese)
• Chocolate
• Vanilla
• Soy sauce
• Yeast extract (bread is OK)
• Vinegar
• Eggplant
• Avocados
• Spinach
• Broad-leaf beans and pods
• Citrus fruits, tomatoes, bananas, red plums, raisins or figs
• Spicy and thermally hot foods
• Foods high in histamine

Beverages

• Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne
• Hot drinks

Temperature-related

• Excessively warm environments
• Saunas
• Hot baths
• Overheating

Medical conditions

• Frequent flushing
• Menopause
• Chronic cough
• Caffeine withdrawal syndrome

Emotional influences

• Stress
• Anxiety

Physical exertion

• Exercise
• “Lift and load” jobs

Skin care products

• Some cosmetics and hair sprays, especially those containing alcohol, witch hazel or fragrances
• Hydro-alcoholic or acetone substances
• Any substance that causes redness or stinging

Weather

• Sun
• Strong winds
• Cold
• Humidity

 

Burning And Stinging Are Neglected But Important Symptoms In Managing Rosacea

According to a study recently published in the European journal Acta Dermato-Venereologica on burning and/or stinging in individuals with rosacea, most guidelines for managing rosacea identify the primary objective as clearing the visible signs of rosacea, while unseen symptoms such as burning and stinging are not always addressed even though they add to patients’ burden of disease and lower quality of life.

Burning and stinging were common throughout all types of rosacea, in which at least 85% of individuals with bumps and pimples, 38% to 53% of those with ocular rosacea, and almost 14% of individuals with persistent facial redness and visible blood vessels reported burning or stinging as bothersome symptoms.

Neurovascular dysregulation and an altered immune response are both thought to be key elements involved in the development of the burning and stinging response. People with rosacea may have an increased density of transient receptor potential channels, a type of ion channel on cells that are involved in sensory reception, and activation can lead to experiences of flushing and burning pain.

The presence of Demodex mites on the face, known to be higher in those with rosacea than in people with healthy skin, may also play a role via a stimulated immune response and/or skin barrier damage leading to hypersensitivity. In addition, an impaired skin barrier may reduce resistance to irritants and allergens, and may contribute to the signs and symptoms of rosacea.

TREATMENTS

The primary goal of treatment is to control the redness, inflammation, and skin eruptions.

There are many different products on the market but it is beyond the scope of this blog to make particular recommendations. However, it is generally advisable to you use very mild skin cleansers which do not cause irritation and high-quality, oil-free cosmetics and moisturizers to help prevent irritation. Also, use a sunscreen with broad spectrum coverage (SPF 30 or higher for UVB protection and zinc oxide or titanium dioxide for UVA protection) to help prevent symptoms triggered by sunlight.

Standard medical treatment involves long-term treatment with oral antibiotics has been shown to control skin eruptions and curb the progression of rosacea. In most cases it can take months to see any improvement.

In more advanced cases, laser surgery may be used to eliminate visible blood vessels or excess skin tissue caused by rhinophyma.

HOW BIOMED CAN HELP

BioMed can helpthose with rosacea in various ways. For example, supporting the immune system with Bioregulatory medicines. Checking for any vitamin or nutrient deficiencies via computerised health screening. Intense Pulsed Light therapy (IPL), a popular, non-invasive treatment, can offer long-term improvements in the condition.