Although the underlying cause or causes of rosacea have yet to be discovered, this unsightly and embarrassing condition can now be successfully controlled with medical therapy and lifestyle modifications to avoid those factors that may aggravate or trigger its signs and symptoms.
Rosacea is a chronic and often progressive disorder that typically first appears as a redness on the cheeks, nose, chin or forehead that comes and goes. As the condition progresses, the redness becomes more severe and persistent, and visible blood vessels called telangiectasia may appear. Along with the redness, bumps (papules) and pimples (pustules) often develop, and in many people the eyes are also affected, feeling gritty and appearing watery or bloodshot.
Rosacea may also be associated with facial discomfort – including burning, stinging or itching - as well as a dry appearance, raised red patches, facial swelling and skin thickening. In severe cases, the nose may become enlarged from excess tissue, a condition known as rhinophyma.
Dermatologists often prescribe initial treatment with oral and topical therapy to bring rosacea under immediate control, followed by long-term treatment to maintain remission. In a multicenter clinical study, nearly 80 percent of rosacea patients using medical therapy remained in remission after six months, while 42 percent of those using a placebo had relapsed.
After medical treatment controls the redness, bumps, pimples and other inflammation, dilated blood vessels previously hidden by the redness may become more visible. In most cases, advanced surgical devices such as a pulse dye laser or intense pulsed light source may be used in the dermatologist's office to erase these tiny blood vessels virtually without pain or discomfort. Unsightly overgrowth of tissue on the nose, called rhinophyma, can also be surgically corrected with a pulse dye or CO2 laser.
When rosacea affects the eyes, a condition known as ocular rosacea, a physician usually prescribes a combination of treatments tailored to the individual. This may include local and systemic therapy, as well as cleansing and tearing agents, all of which may be adjusted over time.
In addition to medical therapy, rosacea sufferers can reinforce their chances of maintaining remission by identifying and avoiding environmental and lifestyle factors that trigger rosacea flare-ups in their individual cases. In a recent survey of 1,221 rosacea sufferers by the National Rosacea Society, 96 percent of those who believed they had identified personal trigger factors said that avoiding these factors had reduced their flare-ups.
While a vast array of potential rosacea triggers affects various individuals, nearly all seem to be related to flushing. However, what triggers a flare-up in one sufferer may not affect another. According to a survey by the National Rosacea Society, the most common rosacea triggers in descending order include: sun exposure, emotional stress, hot weather, wind, heavy exercise, alcohol, hot baths, cold weather, spicy foods, humidity, indoor heat, certain skin-care products and heated beverages.
The National Rosacea Society offers a rosacea diary booklet to assist patients in identifying which factors are their particular culprits to avoid, as well as booklets that provide comprehensive information on the disorder.
Beyond medical therapy and lifestyle modifications, proper skin care and knowledgeable use of cosmetics can help soothe and conceal any remaining signs of the disorder.
A rosacea facial care routine recommended by many dermatologists starts with a gentle and refreshing cleansing of the face each morning. Patients should use a mild soap or cleanser that is not grainy or abrasive, and spread it with their fingertips. A soft pad or washcloth can also be used, but avoid rough washcloths, loofahs, brushes or sponges.
Next, rinse the face with lukewarm water several times and blot it dry with a thick cotton towel. Never pull, tug, scratch or treat the face harshly.
Patients should let their face air dry for several minutes before applying topical medication. Let it dry again for an additional five or 10 minutes before using any makeup, moisturizers or other skin-care products.
Many patients have found that cosmetics and certain skin-care products can effectively mask the redness, visible blood vessels and other signs of rosacea. Green-tinted moisturizers are available to soothe the skin and counter visible redness, and green or yellow cosmetics may also be used for this purpose. In addition, the skillful use of cover-correcting makeup can successfully conceal visible blood vessels, bumps and pimples.
When selecting cosmetic and skin-care products, rosacea sufferers should be sure to avoid products that burn, sting or irritate their skin. A National Rosacea Society survey of more than 1,000 rosacea patients identified the following ingredients as causing a flare-up in their individual cases: alcohol (66 percent), witch hazel (30 percent), fragrance (30 percent), menthol (21 percent), peppermint (14 percent) and eucalyptus oil (13 percent).
As with most conditions, treatment of rosacea must be tailored by a dermatologist or other qualified physician to the needs of each individual patient. The keys to minimizing the effects of this conspicuous and embarrassing disorder are early diagnosis and faithful compliance with medical therapy and any lifestyle modifications that may be necessary.
For comprehensive information on rosacea, visit the National Rosacea Society Web site at rosacea.org, or call its toll-free number at 1-888-NO-BLUSH. Information and educational materials are also available by writing the National Rosacea Society, 196 James Street, Barrington, Illinois 60010 or via e-mail at firstname.lastname@example.org.
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