ROSACEA

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Rosacea (pronounced rose-ay-shah) is a disease affecting the skin of the face -- mostly where people blush. Rosacea usually starts with redness on the cheeks and can slowly worsen to include one or more additional symptoms and parts of the face, including the eyes.

Because changes are gradual, it may be hard to recognize rosacea in its early stages. Unfortunately, many people mistake rosacea for a sunburn, a complexion change, or acne and do not see a doctor.

Rosacea can't be cured, but it can be controlled.

WHAT SHOULD I LOOK FOR?

Many rosacea patients have only one or two symptoms; here is a complete list of the most common ones:

Redness: This looks like a blush or sunburn and it's caused by flushing (when a larger amount of blood flows through vessels quickly and the vessels expand under the skin to handle the flow). The redness gradually becomes more noticeable and wonÍt go away. Facial skin may get very dry.

Pimples: Later, pimples may appear on the face. These pimples may be inflamed -- small, red, and solid (papules) or pus-filled (pustules) like teenage acne. Because they look alike, rosacea has been called "adult acne" or "acne rosacea." But, people with rosacea donÍt normally have the blackhead or whitehead type of pimples (called comedones) that are usually seen in teenage acne.

Red lines: When people with rosacea flush, the small blood vessels of the face get larger -- eventually showing through the skin. These enlarged blood vessels look like thin red lines on the face, usually on the cheeks. These lines may be hidden at first by flushing, blushing, or redness but they usually re-appear when the redness is cleared up. Doctors call these lines telangiectasia (tell-an-jek-taze-yah).

Nasal bumps: When rosacea isn't treated, some people -- especially men -- may eventually get small knobby bumps on the nose. As more bumps appear, the nose looks swollen. This condition is called rhinophyma (rye-no-feye-muh).

WHO GETS ROSACEA?

Rosacea is usually seen in adults. It seems to affect fair-skinned people more often, though it can affect any skin type. Most people who get rosacea have a history of flushing or blushing more easily and more often than the average person (they are sometimes described as having "peaches and cream" complexions).

Women get rosacea a little more often than men, but men are more likely to develop rhinophyma.

The image of one famous sufferer, W.C. Fields, helped to mistakenly link rosacea with alcoholism. Although drinking alcohol can make rosacea worse, even people who never drink alcohol can develop rosacea.

HOW DOES ROSACEA PROGRESS?

In most people, the first sign of rosacea is rosy cheeks; the face gets red in patches and stays red -- eventually redness doesnÍt go away at all.

Rosacea is a chronic condition. In most people symptoms come and go in cycles. These flare-ups are common. Although the condition may improve (go into remission) for a while without treatment, it is often followed by a worsening of symptoms (redness, pimples, red lines, or nasal bumps) that progresses over time.

WHAT CAUSES ROSACEA?

There are many theories but none have been proven. Researchers now believe that there is some link between rosacea and how often (and how strongly) people flush or blush.

WHAT SHOULD I DO ABOUT ROSACEA?

See your dermatologist. ItÍs easy to mistake skin disorders and doctors know best how to identify and treat rosacea. Non-prescription acne medications may irritate dry, sensitive skin. These products may have ingredients that arenÍt appropriate for treating rosacea.

CAN ROSACEA BE TREATED?

Definitely yes. Treatment can lessen or get rid of symptoms. Most dermatologists think that early treatment can keep rosacea from getting worse -- even prevent blood vessels from enlarging or rhinophyma from developing.

WHAT TREATMENT IS USED FOR ROSACEA?

Several medications are available by doctor's prescription. they control redness and reduce the number of papules and pustules. Some are applied to the skin (topically) and others are taken by mouth (orally) -- different types can be used in combination.

The most widely used topical antibacterial medication for rosacea is metronidazole. Tetracycline is a commonly used oral antibacterial treatment. In most cases, it may take several weeks to see results -- donÍt worry. Once symptoms have cleared, patients may need to continue taking medication to keep rosacea under control.

Controlling the causes of flushing and blushing can help prevent rosacea from getting worse and blood vessels from getting larger. But once red lines appear, they can only be covered up by makeup or removed by a surgical method. Surgery can also be used to correct a nose enlarged by rhinophyma.

WHY DO I HAVE TO KEEP TAKING MEDICATION AFTER MY ROSACEA HAS CLEARED?

Without regular treatment, redness and pimples can return. Studies of patients who stopped treatment after their symptoms were successfully cleared show that rosacea came back in many of the patients within a week to 6 months.

CAN ROSACEA BE CURED?

Not yet. But, simple treatments can control rosacea, improve the skinÍs look, and maybe even stop or reverse progress of the disease. Getting medical help early and following the treatment program carefully are the keys.

CAN ANYTHING MAKE ROSACEA WORSE?

Facial flushing can make symptoms worse. It can even cause flare-ups in patients whose rosacea was under control with medication. Flushing can be triggered by many things ... hard exercise -- even menopause or some medicines. The most common triggers are: hot drinks, alcohol, spicy foods, stress, sunlight, extreme heat or cold.

Experts say you should avoid anything that causes flushing. But what bothers one person may not cause a problem in another. YouÍll need to find out what things affect you and decide if you want to change your habits to avoid them. Just remember -- flushing may affect your success in controlling rosacea. Talk to your doctor about how you can learn to identify -- and deal with -- your own flushing triggers.

HOW DO I USE MY MEDICATION?

Follow instructions carefully -- the success of your treatment depends on it. Make sure you understand the "hows" of your medication:

how much to use

how often to use it

how long to continue treatment

how to use it correctly

If you have any questions about any medication, talk to your doctor.

Often doctors will prescribe two or more medications to be used at the same time. Following are general guidelines for using the different types of rosacea medications.

Topical antibacterials: Gels such as topical metronidazole are usually applied twice a day (morning and evening) to the areas affected. Use on a clean, dry face to lessen the chance of irritation. Avoid products that contain alcohol or other irritants.

Topical steroids: Prescription and non-prescription topical steroids are sometimes used on a short-term basis to help control redness. Long-term use is not recommended.

Oral antibacterials: Capsules or tablets are taken by mouth usually once or twice a day. Some of these, such as tetracycline, should be taken on an empty stomach (milk and certain foods may keep the medication from being absorbed into the bloodstream).

WHAT ABOUT WASHING OR MOISTURIZING MY FACE?

How and what you use to cleanse your face -- and keep it moist -- are important when you have rosacea. Following a regular cleansing and medication routine will make treatment easier and more successful. You should be careful about what products you use with rosacea medications.

Soaps/Cleansers: Only very mild products should be used on the face. Avoid products that contain alcohol or irritants.

Moisturizers: Apply a quality moisturizer as needed. When using with a topical medication, you can usually apply the moisturizer after the medication has dried.

Sunscreens: Use an SPF 15 or higher whenever you think youÍll be in the sun.

In general, it helps to choose facial products that wonÍt clog pores; theyÍll have the word "noncomedogenic" (non-coh-mee-dough-jen-ic) on the package. Avoid products that contain alcohol (check hair spray and astringent labels), acetone, or oil.

WHAT SHOULD I EXPECT FROM MY MEDICATION?

About 70% to 80% of rosacea patients see significant improvement with oral or topical medications or a combination of both.

Whether you see improvement -- and how much you see -- depends on how far the disease has progressed when treatment started and how carefully youÍve followed the directions for your treatment.

Following instructions carefully and having patience will improve the odds of success. Certainly, avoiding the triggers of flushing will also help to improve your condition.

ROSACEA TRIPWIRES (Factors that may trigger rosacea flare-ups)

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 & pods citrus fruits, including tomatoes, including lima, navy or bananas, red plums, raisins or pea figs, spicy & thermally hot foods, foods high in histamine.

BEVERAGES: Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne hot drinks, including hot cider, hot chocolate, coffee and tea.

EMOTIONAL INFLUENCES: Stress, anxiety.

PHYSICAL EXERTION: Exercise, lift and load jobs.

TEMPERATURE-RELATED: Saunas, hot baths, simple overheating, excessively warm environments.

WEATHER: Sun, strong winds, cold, humidity.

DRUGS: Vasodilators, topical steroids.

MEDICAL CONDITIONS: Frequent flushing, menopause, chronic cough, caffeine withdrawal symptoms.

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.