Rosacea is a chronic disorder of the facial skin that produces skin swelling and inflammation, along with small blisters and telangiectasia, clusters of tiny blood vessels just under the skin surface. It usually appears after age 30 and affects women, especially those with light skin and fair hair, three times more often than men. The disease is more severe in males, however. Often beginning as a prominent flushed appearance in the center of the face that gradually covers the cheeks and chin, rosacea develops over time. At first, it may be mistaken for a tendency to blush easily or an extreme sensitivity to cosmetics. As the disease progresses, the skin is persistently ruddy. Symptoms may come and go, but rarely disappear permanently. Also, the nose may become red and bulbous, a complication that is often mistakenly attributed to alcoholism. The use of alcohol may aggravate rosacea, but it does not cause the nasal deformity. About half of all people with rosacea also have chronic conjunctivitis, an inflammation of the membrane covering the eye. In a few serious cases, the eyelids and mucous membranes of the eyes are also affected, and rosy patches may develop on trunk, arms, and legs. The cause is unknown, but some researchers theorize that an infectious agent may playa role. Anything that increases the flow of blood to the surface may worsen the condition; for example, stress, menopausal hot flashes, spicy foods, alcohol, exposure to sun and warm temperatures, and vasodilating drugs, agents that cause small arteries to dilate, or open wider.
Diagnostic Studies And Procedures
Dermatologists can often diagnose rosacea on the basis of a skin examination and the patient’s description of its onset. However, a physical examination, blood tests, and perhaps a skin biopsy may be needed.
Although rosacea is not known to be a bacterial disease, antibiotics are a mainstay in its treatment. Tetracycline is the preferred drug, because its long term use normally does not produce serious side effects. Initially, the drug is taken three times a day, but after the symptoms improve, the dosage usually can be lowered. Antibacterial skin cleansers or gels may also be prescribed, and in some cases, a topical antibiotic such as metronidazole gel . Topical agents can take up to two months to produce noticeable improvement. In severe cases, oral isotretinoin (Accutane), a derivative of vitamin A that is used to treat cystic acne, may be recommended. Because this drug can cause severe birth defects, it should not be taken by any woman who might be pregnant. Doctors are instructed to do a pregnancy test before prescribing the drug for a woman of reproductive age, and to stop the drug at least three months before conception is attempted. A deformed nose may require surgery to remove the excess tissue. Small growths can be taken off with a laser beam or electric needle; larger ones are excised with a scalpel. Dermabrasion, a skin peeling technique using rapidly revolving abrasive brushes, may then be used to smooth the skin’s surface.
Naturopathy and Nutrition Therapy
Hot or spicy foods that can cause facial flushing should be avoided, along with alcohol, caffeine, and other substances that have a vasodilating effect. Some practitioners recommend vitamin B supplements, but caution against high doses of niacin because it is a vasodilator that can cause facial flushing and thus tends to worsen the condition. Rosacea patients have been found to produce less gastric acid and lipase, a digestive enzyme. Therfore, some nutritionists prescribe hydrochloric acid capsules and enzyme supplements such as pancreatin. However, their effectiveness has not been proved. Patients on antibiotic therapy are advised to eat yogurt with live cultures or to take acidophilus tablets to prevent an overgrowth of yeast.
Anyone with rosacea must be extremely careful to avoid irritating the facial skin. Stay away from all skin products that contain alcohol, including toners, moisturizers, cosmetics, sunscreens, and aftershave lotions. Even herbal and hypoallergenic products may create problems, especially if they contain yeast, mint, camphor, or other ingredients that bring blood to the surface. Medicated cosmetics formulated for acne or some other skin problem are not effective for treating rosacea and might even worsen the problem. Similarly, DO NOT apply fluorinated cortisone or other corticosteroid creams or ointments to the skin. Accutane greatly increases the skin’s sensitivity to sun; if you are taking this drug, be sure to wear a sunblock such as titanium dioxide outdoors. As much as possible, avoid activities that increase surface blood flow, especially to the face. For example, try not to stand over a hot stove or steamy food. Exercise is important to maintain health, but pick activities such as walking or swimming that are unlikely to result in overheating and perspiring. Do not use saunas or hot tubs, and don’t apply hot towels or ice cold compresses to the face. You can use a cool compress, however, to reduce redness and alleviate irritation temporarily. Try a combination of I tablespoon of oatmeal and ½ cup of cool water, soaking a smooth, soft cloth such as a man’s handkerchief in the mixture, and patting it gently onto the skin.
Other Causes of Skin Inflammation
Similar symptoms may be caused by an allergic reaction to medications, or by discoid lupus, which affects only the skin. Perioral dermatitis produces redness and papules around the mouth and on the chin. Granulomas, benign skin tumors, have a similar look.