About Rosacea

Definition of rosacea by famous dermatologist

Rosacea is a hereditary, chronic (long term) skin disorder that most often affects the nose, forehead, cheekbones, and chin (Dr. Berasques). Groups of tiny microvessels (arterioles, capillaries, and venules) close to the surface of the skin become dilated, resulting in blotchy red areas with small papules (a small, red solid elevated inflammatory skin lesion without pus, that is minor when the size is of a small measles lesion, moderate when about the size of a pencil eraser, and severe when the papule is the size of a small currency coin or the tip of the little finger) and pustules (pus-filled inflammatory bumps). The redness can come and go, but eventually it may become permanent. Furthermore, the skin tissue can swell and thicken and may be tender and sensitive to the touch. Note: Pustules are NOT pimples. Pimples have a bacterial component to their pathogenesis and are also mainly localized in and around the hair follicles.

The inflammation of rosacea can look a lot like acne, but blackheads and whiteheads are almost never present. Rosacea is a fairly common disorder -- about one in every twenty Americans is afflicted with it. Rosacea usually begins with frequent flushing of the face, particularly the nose and cheek areas. This facial flushing is caused by the swelling of the blood vessels under the skin. This redness can serve as a flag for attention. Telangiectasis is easy to recognize, characterized by the visible presence of capillaries, bright red in color. Diffuse redness frequently precedes the appearance of telangiectasis and is a constant flushed appearance. True diffuse redness is quite different from a localized erythema as seen in cases of sunburn, inflammation or over stimulation. With both telangiectasis and diffuse redness, the redness is not transitory and there generally is not an increase in skin temperature, but particularly there are no alterations in the tissue structure or biochemistry as seen in rosacea. The circulatory network of the skin is extensive and the capillaries are the smallest, most delicate vessels. During normal blood circulation the capillaries undergo constant changes. In between beats the pressure is relieved and the vessels constrict back to their normal size. This return to normal size is accomplished by the natural elasticity in the structure of the capillary. If telangiectasis is present, the capillaries' elasticity is deteriorated so they remain slightly dilated. The constant influx of blood perpetuates this slight dilation. The skin gradually becomes congested and eventually the capillaries become visible through the skin's surface. When it comes to telangiectasis, sometimes a person's lifestyle and habits can be the skin's worst enemy. In a fair, delicate skin predisposed to telangiectasis, a steady diet of hot, spicy food, chronic alcohol consumption and eating meals too quickly will promote telangiectasis. And many retinoids (chemical structure of vitamin A) used for acne as well as many harsh soaps continue to aggravate the skin. Then there's cigarette smoking, which depletes the skin of vitamin C, essential for the formation of collagen, accelerates the cross linkage of collagen and the hardening of elastin and furthermore creates a trillion free radicals, which destroy the capillary structure. Smoking, which additionally robs the skin of oxygen, is a potent initiator of telangiectasis. Also, the smoker may have a variety of medical problems such as high blood pressure, and mineral deficiencies, which can cause the appearance of telangiectasis.

Rosacea-Ltd III can be used by those with rosacea, acne or seborrheic dermatitis skin conditions ranging from mild to severe. To view rosacea pictures of what we would consider more severe cases, consider these images ( pictures of a man's face ,and a woman's face with rosacea),

Rosacea is most common in Caucasian women between the ages of 30 and 60. However, when the disorder does occur in men, it tends to be more severe than in women, and is sometimes accompanied by rhinophyma (a nose that becomes chronically red and enlarged). Fair-skinned individuals seem to be more susceptible to this condition than darker-skinned individuals. People who flush easily, too, seem to be more prone than others to develop rosacea. Rosacea is not a life-threatening illness, but it is chronic and can be distressing for cosmetic reasons, and can cause physical discomfort.

Article Of The Week:

THE CONTROVERSY OVER STEROIDS AND ROSACEA

In the treatment of severe facial eczema, one may be prescribed a limited time dose of a topical steroid.

Initially the anti-inflammatory and vasoconstrictive effects of the topical steroids result in what appears to be clearance of the primary dermatitis. Cortisones work by decreasing inflammation, swelling, burning and itching at the site of application. When applied in an ointment they can help the skin maintain moisture. In general steroid ointments are stronger than steroid creams because the medicine penetrates better when in an ointment form.

Topical steroids are generally used to treat the symptoms of eczema, a skin condition characterized by itchy, red, scaly skin. They are also used for other inflammatory skin conditions such as psoriasis and dermatitis. They don't cure the conditions but can ease the symptoms. They work by reducing inflammation of the skin and thus easing the symptoms of itching, redness and swelling that occur with many skin conditions.

When a rosacea patient is treated for a prolonged time with topical steroids the disorder may at first respond, but inevitably the signs of steroid atrophy emerge with thinning of the skin and marked increase in telangiectases. The complexion becomes dark red with a copper-like hue.

Soon the surface becomes studded with round, follicular, deep papulopustules, firm nodules, and even secondary comedones. The a ppearance is shocking with a flaming red, scaling, and papule-covered face.

Topical steroids frequently cause thinning of the skin if used for long periods of time. They can also cause acne-like pustules, dermatitis, broken blood vessels under the skin, stretch marks, loss of skin color (which may clear-up on stopping treatment) and, when used on the face, a rosacea-like disorder (reddening of the skin), also known as steroid rosacea. Other side effects can include itching, easy bruising, and in some cases skin infection.

The persistent use of topical steroids leads to epidermal atrophy, degeneration of dermal structure, and collagen deterioration after several months. Ultimately the skin develops the appearance of rosacea, and it is rendered extremely vulnerable to bacterial, viral, and fungal infection. Patients persist in using steroid creams or ointments because they have typically learned the hard way about the severe rebound inflammation that occurs if they stop. In short, they find themselves caught between rosacea like steroid dermatitis and the erythematous pustular eruptions of steroid rebound.

Steroid rosacea is an avoidable rosacea condition, which in addition to disfigurement is accompanied by severe discomfort and pain.

Withdrawal of the steroid treatment is inevitably accompanied by exacerbation of the rosacea like symptoms.

On initial assessment, it can be very difficult to distinguish between true rosacea and its steroid-induced mimic. The neck and scalp are often the giveaway, said Dr.Roger Allen of the University Hospital, Nottingham, England. Steroid-induced rosacea is often diffuse, extending from the face down along the neck. In balding men, the scalp is often affected. True rosacea tends to be less diffuse. Unfortunately there is no easy way to resolve steroid-induced rosacea, short of ceasing steroid use. This is, admittedly, a hard sell to patients who have already experienced the severe erythema, edema, and pustular eruptions associated with steroid rebound. Topical or systemic antibiotics may be needed if the patient has a bacterial infection. Cold chamomile tea compresses are a soothing adjunct for patients in the throes of steroid backlash. It is important to understand the rebound phenomenon in steroid induced rosacea. The rosacea sufferer is often baffled by their observation that the same medicine that was so effective in clearing their primary dermatoses or acne is now causing this distressing rosacea like condition, and that their skin gets markedly worse if they stop treatment. Prudence in steroid use is essential. Patients with seborrheic dermatitis, acne vulgaris, or other dermatoses simply should not be treated with topical corticosteroids.

Want to learn more about the effects of steroid induced rosacea? Visit these pages devoted to the rosacea connection and topical steroid use.

http://www.rosacea-ltd.com/malta.php3

http://www.rosacea-ltd.com/flushing.php3

www.rosacea-ltd.com/rossteroids.php3

To learn more about rosacea, click on the links below.

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This page last updated: March 17, 2010