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What’s Rosacea?

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When Red is More Than A Blush

Rosacea is a common skin disorder that affects 13 million people in the United States. It is non-contagious and usually begins as a redness, like a blush, appearing on the face - most often on the cheeks, nose, chin, and forehead. Pimples, reddening and sensitivity of the eyes and thickening or enlargement of the nose generally accompany rosacea. Rosacea can be as mild as a slightly reddish appearing nose or ?rosy cheeks.? It may also become severe, manifesting as a breakout of large red pimples, frequently infected or inflamed eyes, a greatly enlarged nose or persistent devastating bouts of flushing. Rosacea is often just redness and sensitivity to products.

People with rosacea truly suffer. Rosacea is not just about having a red face. People often mistake those with rosacea for being drinkers. The truth is rosacea sufferers frequently have burning and itching sensations which can be very uncomfortable.

In surveys completed by the National Rosacea Society, more than 76 percent of rosacea patients said their condition reduced their self-confidence and self-esteem. Forty-one percent reported that it had caused them to avoid public contact or to even cancel social engagements. Among rosacea patients with severe symptoms, almost 70 percent said the disorder had adversely affected their professional interactions, and just about 30 percent said they had even missed work because of their condition.

Did you know - More women are impacted by rosacea than men, and there are many triggers including:

- Alcoholic beverages
- Hot beverages or soup
- Spicy foods
- Wind
- Cold
- Heat
- Sun
- Exercise and emotional stress

People with rosacea often have very sensitive skin, and are easily irritated by skin care products, especially those containing fragrance. Luckily, there are many treatments to help and Dr. Amy Taub, Chicago dermatologist, recommends several products and treatments available to rosacea sufferers.

Treatment for 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.

Topical Rosacea Products

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 skin condition. 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 of oral and topical antibiotics, the oral antibiotics are usually discontinued after two to four 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 of the condition.

Rosacea that is resistant to antibiotics usually benefits from treatments of 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.

Rosacea Laser Treatment

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 do not go back to their more closed resting state when the stimulus or trigger (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 do not 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 (one to two times per year) will probably be necessary.

All prescription meds are approved for the acne component of rosacea and the redness treatment is secondary and often not effective. The most effective treatment for the redness of rosacea is also lasers. In addition, new topical agents over the past five years have emerged and are extremely good at reducing the redness and sensitivity of rosacea. These include Calmplex and pyratine. Products containing green tea work well as well to combat redness when they are in a very high concentration.

Dr. Taub often suggests the use of zinc oxide based sunscreens - kept in a cool place - to calm rosacea symptoms down. She recommends the use of ice packs during a flare-up. Dr. Taub also tells patients to get fragrance-free shampoo and conditioner as well as to use all fragrance-free products.

For consumers interested in other over-the-counter solutions, Dr. Taub recommends the near 50 customized rosacea products available at Skinfo - www.skinfo.com/pages/rosacea_treatment_products/79.php

Avoiding alcoholic beverages or other flare factors can help keep rosacea in place. However, Dr. Taub cautions against avoiding everything, just the things you notice that worsen rosacea ? for example, some people can drink white wine but not red, some can drink beer but not wine.

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 with 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.

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 products, especially those containing fragrance.

Rosacea cannot be cured, but it can be controlled. Studies are under way to further advance today's treatment options.

About Dr. Taub

Dr. Amy Forman Taub is a board-certified dermatologist who founded Advanced Dermatology, Skinfo® Specialty Skincare Boutique and SKINQRI in Lincolnshire, Illinois, a suburb of Chicago. Advanced Dermatology is a state-of-the-art medical and cosmetic dermatology practice nationally recognized for excellence in dermatologic care. Skinfo and skinfo.com, a professional skincare website, offer physician-dispensed and cosmeceutical-grade skincare products and product information to the public.
Dr. Taub is currently an Assistant Clinical Professor at Northwestern University Medical School. Prior to opening Advanced Dermatology, Dr. Taub was the Medical Director for the Division of Dermatology of Northwestern Memorial Physicians Group. She is also a consultant to leading laser and drug companies.

Dr. Taub is recognized globally for educating and training physicians from all over the country with industry leading techniques on cosmetic and laser procedures. She's been featured in ELLE Magazine, New Beauty, Red Eye, Daily Herald, Chicago Health & Beauty and more.

Dr. Taub is a member (Fellow) of the American Academy of Dermatology (AAD), the American Society for Dermatologic Surgery (ASDS), the American Society for Laser Surgery and Medicine (ASLMS), the Chicago Dermatologic Society, and the Illinois State Dermatologic Society. Dr. Taub is also a Charter Board of Director for the American Society of Photodynamic Therapy (ASPDT), a member of the Leaders Society to the Dermatology Foundation, on the Advisory Council of the Skin Cancer Foundation, and on the Research Committee for the ASDS.

For more information, please visit http://www.advdermatology.com