“Emotional stress is not only a common rosacea trigger but is often the result of its symptoms, creating a tailspin for many patients,” said Dr. John Wolf, chairman of dermatology at Baylor University. “Add to this the social impact and potential physical discomforts of the disorder, and there are many aspects of rosacea that go well beyond its effects on personal appearance.”

In recent NRS surveys, 69 percent of rosacea patients said they experienced a flare-up related to emotional stress at least once a month, and more than 90 percent of the respondents said they had suffered some form of physical discomfort from their condition. In earlier surveys, more than 76 percent said rosacea had lowered their self-esteem, and 88 percent of those with severe symptoms reported that it had adversely affected their professional interactions.

“It’s important for people to know that rosacea can be effectively controlled with medical therapy and lifestyle modifications,” Dr. Wolf said. “This can substantially improve the quality of their lives.”

During Rosacea Awareness Month and throughout the year, the NRS will conduct public education activities to reach the millions of rosacea sufferers who may not realize they have a medical condition that can be treated, emphasizing the warning signs and urging those who suspect they may have rosacea to see a dermatologist. Educational materials are also available to health professionals for their patients through the NRS Web site at www.rosacea.org.

Although rosacea varies from one patient to another, the primary signs may include flushing or transient erythema (redness), persistent or nontransient erythema, papules (bumps) and pustules (pimples), or telangiectasia (visible blood vessels), according to the NRS standard classification of rosacea, developed by a consensus committee and review panel of 17 experts worldwide. Secondary features may include burning or stinging, plaques (raised patches on the skin), a dry appearance, edema (swelling), ocular manifestations and phymatous changes, in which the skin thickens.

The standard subtypes of rosacea reflect the most common patterns of signs and symptoms, and characteristics of more than one subtype may occur at the same time. Subtype 1 (erythematotelangiectatic) rosacea is characterized by flushing and persistent redness on the central portion of the face, while subtype 2 (papulopustular) rosacea also features papules and pustules.

Subtype 3 (phymatous) rosacea includes thickening of the skin, irregular nodularities and enlargement, especially of the nose. Subtype 4 is ocular rosacea, where the eyes may have a watery or bloodshot appearance, the sensation of a foreign body, burning or stinging, dryness, itching, light sensitivity or a host of other signs and symptoms.

For more information, visit All About Rosacea.

To watch the entire interview, click here.

A malfunction in part of the body’s nervous system may be linked to the redness as well as the bumps and pimples of rosacea, according to a recently completed study by Dr. Akihiko Ikoma and colleagues at the University of California-San Francisco.

The investigators took blood and biopsy samples from members of 10 families in which some individuals had rosacea. Through innovative biochemical and genetic testing, they found those with rosacea suffered from irregularities in a variety of transient receptor potential (TRP) ion channels, which serve as prominent components of the nervous system. Because a variety of TRP channels can be activated by factors that trigger rosacea symptoms, the researchers noted, impaired functioning of these channels may play a critical role in the development of the disorder.

For example, TRPV1 is activated by capsaicin, a substance present in spicy food, as well as by heat or under inflammatory conditions. TRPV2 may play a role in innate immunity, inflammation and the sensing of heat. TRPV4 is also activated by moderate heat and may promote flushing, stinging and burning.

The researchers also found the immune system of those with subtype 1 (erythematotelangiectatic) rosacea, characterized by flushing and redness, showed significantly increased reactivity for TRPV2 and 3, as well as gene expression of TRPV1. Subtype 2 (papulopustular) rosacea, characterized by bumps and pimples, showed enhanced reactivity of the immune system for TRPV2 and 4, and had gene expression of TRPV2. These TRP nerve channels may therefore be promising targets in the development of future rosacea therapy, the researchers said.

In a separate study of 27 patients with subtype 1 rosacea, 18 with subtype 2 rosacea, 19 with photodamaged skin and prominent telangiectasia and 11 control subjects without rosacea or sun damage, Dr. Yolanda Helfrich, assistant professor at the University of Michigan, found that patients with subtype 1 rosacea had a greater number of mast cells that were discharging their contents than the control subjects.

Mast cells are found in skin tissue surrounding blood vessels and nerves, and release many mediators involved in rosacea, including histamine, associated with flushing. Since virtually all the mast cells in the rosacea patients were positive for interleukin 17, Dr. Helfrich noted that this cytokine – which plays a key role in development of rheumatoid arthritis and psoriasis – may also contribute to rosacea.

In addition, though some individuals with skin aging due to sun exposure also had prominent facial telangiectasia, she found significant biological differences between this group and those with rosacea, suggesting that the presence of visible blood vessels alone should not necessarily lead to a diagnosis of rosacea.

• Take care of yourself. A hectic schedule can lead to stress-induced flare-ups. Get plenty of rest, eat right, maintain a daily exercise routine and don't over-commit yourself.


• Follow your prescribed medical therapy. Now more than ever is the time to use your rosacea medication. Surveys have suggested that patients who use medication have greater success in maintaining remission of their signs and symptoms.


• Keep the kitchen cool. Holiday cooking can quickly heat up the kitchen and lead to a rosacea flare-up. Open the window. Keep a damp towel nearby to pat your face and take a break to a cooler part of the house when you can.


• Be vigilant about food and beverage triggers. Holiday parties often feature an array of tempting dishes, but avoid items that affect your condition. Patient surveys cite alcohol (especially red wine), heated beverages and spicy foods as particularly common rosacea triggers.


• Protect your skin. Holiday activities can mean a lot of running in and out of doors. Take care to protect your face with a scarf in cold or windy weather.

In the survey of 748 rosacea patients, 69 percent of the respondents said they experience a flare-up related to emotional stress at least once a month. Thirty-one percent said this happens every few days, while 14 percent said it happens once a week, 16 percent said it occurs every few weeks and 9 percent said once a month. Twenty-two percent reported a rosacea outbreak due to stress only every few months, and 5 percent noted a frequency of once a year. Only 5 percent said they had never experienced a stress-related flare-up.

"Emotional stress appears to be linked to a growing range of reactions in the body that have been increasingly shown to affect the skin, including flushing and inflammation,” said Dr. Richard Granstein, chairman of dermatology at Cornell University. “As a result, a great many rosacea patients should be able to benefit from either minimizing stressful situations or learning to modify their reactions to them.”

Family problems were the top causes of stress triggering a flare-up, cited by 49 percent of the survey respondents who had experienced a stress-related outbreak, followed closely by problems at work, named by 48 percent. Other common causes of stress included relationship problems, mentioned by 40 percent; financial concerns, cited by 38 percent; health problems, named by 33 percent; social events, 31 percent; criticism, 31 percent; uncertainty, 30 percent; public speaking, 27 percent; deadlines, 22 percent; and loss of a loved one, 18 percent.

Anxiety was the leading form of emotional stress, cited by 76 percent of the survey respondents, followed by worry, named by 63 percent. Other types of emotions mentioned included frustration, affecting 52 percent; anger, reported by 49 percent; embarrassment, 40 percent; fear, 27 percent; excitement, 23 percent; grief, 20 percent; indecision, 14 percent; and guilt, 13 percent.

The good news is that more than 67 percent of the survey respondents said they have been able to minimize the causes of stress and their reactions to stress to reduce their rosacea flare-ups. The NRS offers a “Rosacea Diary” that can help patients pinpoint which situations or reactions may be causing stress-related flare-ups. Once those are identified, patients can employ strategies to alter their activities as well as adopt techniques to reduce emotional stress, such as moderate exercise, cognitive therapy, relaxation or meditation routines.

“Stress can exacerbate a variety of health concerns, including rosacea, but medical therapy is also available to help rosacea patients keep their condition under control,” Dr. Granstein said. “Faithful compliance with prescribed therapy, coupled with stress-reduction techniques, can go a long way toward breaking the cycle of stress-related flare-ups.”

Other features include tips for dining out without flare-ups, Q&As on the possibility of relationships between rosacea and the inner ear, and rosacea and small intestinal bacteria overgrowth (SIBO), success story tips from readers and a new patient survey on the physical discomforts of rosacea.

“In managing rosacea, it’s important for patients to know they do not have to avoid every potential trigger, because what may cause a flare-up in one person may not affect another,” said Dr. Lisa Maier, assistant professor of dermatology at the University of Michigan, during the annual meeting of the American Academy of Dermatology. “The key is to identify and avoid those specific factors that affect their individual cases.”

Although the array of potential rosacea triggers may be endless, some of the factors most commonly identified by rosacea patients include sun exposure (affecting 81 percent), emotional stress (affecting 79 percent), hot weather (75 percent), wind (57 percent), heavy exercise (56 percent), alcohol (52 percent) and spicy foods (45 percent). Other common triggers include cold weather, indoor heat, heated beverages, humidity, and certain skin-care and cosmetics products.

To help patients identify factors that affect their individual cases, the NRS offers a “Rosacea Diary.” The diary guides patients on a daily basis to observe and record weather conditions, foods and beverages consumed, lifestyle factors such as strenuous exercise, products used on the face, compliance with medical therapy and the occurrence of any flare-ups. By keeping track for a period of time, patients may identify which lifestyle and environmental factors to avoid in their particular case.

A new smartphone app is now available free online at app stores to help rosacea patients better manage their condition. The rosacea app acts as a personal journal with a “trigger tracker” section to identify triggers, and includes a “substitution finder” that suggests alternate foods and drinks that may be used in place of those causing flare-ups.

Patients can look for various ways to minimize their individual triggers, such as heat and cold weather. Use a scarf to protect against the wind and cold, and wear layered clothing to adjust from outdoors to inside. Avoid excessive indoor heat and do not sit next to a fireplace or hot stove. Some patients may also want to limit or avoid alcohol, especially red wine, during holiday festivities.

“Rosacea doesn’t have to take all of the enjoyment out of life,” Dr. Maier said. “Rosacea can be successfully managed by adhering to medical therapy and making the right lifestyle adjustments on an individual basis.”

In their study of 14 rosacea patients, the researchers found that a high percentage had neurologic (43 percent) or neuropsychiatric (50 percent) conditions such as headache, depression, essential tremor and obsessive-compulsive disorder.

Rosacea is likely to have many causes, they explained, such as contributions from dysfunction of blood vessels as well as the innate immune system – the body’s own self-defense. Based on their clinical findings, they proposed that improper functioning in the nervous system may be comparably important in developing the symptoms of rosacea, and that the role of the nervous system may be a significant consideration for the optimal treatment of this disorder. Nerve dysregulation may contribute to rosacea via various mechanisms, they said, including the release of inflammatory chemical substances, vascular instability and nerve injury leading to symptoms of burning and stinging.

While these early findings are intriguing, this is a small sample size and points to the need for further study. They suggested that further research is needed to better define the underlying pathophysiologic characteristics and to identify additional effective treatment methods.

Reference:

1. Scharschmidt TC, Yost JM, Truong SV, et al. Neurogenic rosacea: a distinct clinical subtype requiring a modified approach to treatment. Arch Dermatol 2011;147:123-126.

“From both medical and appearance standpoints, it makes sense to apply medication before makeup,” said Dr. Zoe Draelos of Dermatology Consulting Services, who conducted a recent study to assess the use of facial cosmetics and topical rosacea therapy.¹ The new study found that most patients had a good cosmetic appearance after applying facial foundations following topical therapy, and their use did not cause rosacea symptoms to worsen.

In the study of 28 women with moderate rosacea by Dr. Draelos and colleagues, investigators gave a mean score of 9.4 out of 10 points for the subjects’ overall appearance after application of therapy followed by foundation for two weeks. The women were rated as equally at ease applying foundation after medication as they were when the study began. Moreover, after just the second week, only 18 of the participants continued to be classified as having moderate rosacea while the others were reclassified as mild.

“The high degree of patient acceptance of this therapeutic regimen could be expected to have a favorable effect on patient compliance and treatment outcomes,” the investigators noted.

“When considering or reading about the latest looks, the key for rosacea patients is to choose products that are appropriate for sensitive skin,” Dr. Draelos said. “In other words, be sure to avoid anything that stings, burns or causes irritation.”

She noted that using fragrance-free and allergy-tested products may reduce risk of skin irritation, and a patch test on a peripheral area like the neck may be useful before using a product on your face to determine whether a product affects your individual skin.

Although irritants can vary among individuals, reading the fine print on the product label may reveal ingredients that are common irritants. Liquid or semi-liquid products may contain such potential rosacea triggers as alcohol, witch hazel, menthol, peppermint and eucalyptus oil. For dry products, Dr. Draelos said, consider using mineral powder or eye shadow, which typically do not contain irritating ingredients.

“Cover-corrective makeup may be especially useful for individuals with more severe rosacea symptoms,” Dr. Draelos said. A sheer, green-tinted primer or foundation may be ideal as a base, followed by a yellow-toned powder to help further tone down the look of redness, she noted. Use a light touch when applying foundation, and you may want to use an antibacterial brush, she said, which can be washed easily, rather than a sponge or your fingertips.

“Always replace your cosmetics on a regular basis, about every three to six months,” she said. This will minimize the chance of contamination.

Reference

1. Draelos ZD, Colón LE, Preston N, et al. The appearance of facial foundation cosmetics applied after metronidazole gel 1%. Cutis 2011;87:251-259.

“We are pleased to award new grants for these additional avenues of rosacea research that may lead to important advances in its treatment and potential prevention or cure,” said Dr. Jonathan Wilkin, chairman of the NRS Medical Advisory Board, which selects grant applications for funding. “Studies to date have made significant progress toward the more effective control of this disorder, and we are grateful for the support of the many thousands of patients whose donations make these studies possible.”

Dr. Ferda Cevikbas, postdoctoral fellow at the University of California-San Francisco, and colleagues were awarded $25,000 to assess the role of PACAP, a neuropeptide that may affect rosacea. They plan to define the distribution of PACAP in skin samples from rosacea patients, determine whether PACAP induces inflammation and test whether cathelicidin – a known factor in rosacea’s pathophysiology – modulates the release of PACAP. The researchers also plan to test whether countering the effects of PACAP is beneficial and may thus be used as a rosacea therapy.

Dr. Edward Wladis, assistant professor of ophthalmology at Albany Medical College, was awarded $12,100 to identify specific cytokines – molecules that regulate the immune system – that are involved in ocular rosacea by studying eyelid tissue from individuals with and without the disorder. Dr. Wladis noted that while inflammation is normally a healthy part of the immune response, aberrations in the cytokines’ concentrations and functioning in rosacea may result in unhealthy prolonged inflammation.

This knowledge may have significant therapeutic implications for ocular rosacea, as medications have been designed to suppress specific cytokines. Dr. Wladis will also investigate the role of toll-like receptors (TLRs) – proteins that identify invading agents and alert the innate immune system to begin protective reactions.

Dr. Richard Granstein, chairman of dermatology at Cornell University, and colleagues were awarded $25,000 to study the potential role of Th17 cells, a newly discovered class of cells that appear to be involved in a number of inflammatory and autoimmune disorders. Earlier study results strongly indicated that release of ATP – a neurotransmitter and carrier of chemical energy throughout the body – from nerves under stressful situations may initiate a sequence of events leading to or exacerbating inflammation in the skin. This study will investigate whether this inflammation results because Th17 cells are produced during this process in rosacea.

The NRS is also continuing to fund studies by Dr. Richard Gallo and colleagues at the University of California-San Diego on the potential role of cathelicidins in rosacea; Dr. Joseph Rothnagel and colleagues at the University of Queensland, Australia, on kallikreins and rosacea; Dr. Thad Wilson and colleagues at Ohio University on nerve activity in rosacea; Dr. Aki Ikoma and colleagues at the University of California-San Francisco on the neurovascular system and rosacea; and Dr. Noreen Lacey and colleagues at the University College in Ireland on the effect of antibiotics on sebocyte cells in rosacea.

Sponsored post
The following announcement was issued by Intendis, Inc.:

INTENDIS INTRODUCES "THE ROSACEA APP"
Information at the Tip of Your Fingers

Morristown, NJ –Imagine coping with a skin condition that may not behave in quite the same way on any given day. If you have rosacea, every day brings the possibility of a flare up and sometimes the trigger is unexpected. For those of you struggling with this condition, help has arrived. Intendis, Inc., part of the Bayer Group, which makes Finacea® (azelaic acid) Gel, 15%, has developed the first Smartphone application (app) for rosacea sufferers. This app has been thoughtfully designed to provide consumers with information, support and tools they can use to learn about and help manage their mild to moderate rosacea. It is called The Rosacea App and is available free to anyone who has an iPhone, Blackberry or Android Smartphone.

Features That Make Rosacea Easier to Cope With
The Rosacea App has been designed to deliver information about specific issues faced by people with rosacea. It works as a resource for information, as well as a personal daily journal. It offers daily Weather Alerts, since the disease can be affected by factors such as heat, cold and wind. It also describes symptoms and treatments. For any rosacea patient who has ever paused to try to remember "what happens if I eat this?" or who wonders how the weather of the day will affect their disease, The Rosacea App functions as a reminder and an interactive memory making the hurdles of this condition easier to overcome. The Rosacea App may easily become part of the user's daily life.

But The Rosacea App goes further. In a clear and easy-to-understand format it talks about lifestyle issues such as foods and beverages that may cause flares, and also offers a Substitution Finder that helps identify foods and drinks that may be substituted in place of those causing flare ups. For anyone who has questions about the condition, The Rosacea App offers an Assessment Tool. It helps one gain a better understanding of their own, unique relationship with the condition with a Trigger Tracker and Frequently Asked Questions section. It provides information about Finacea® (azelaic acid) Gel, 15% and how this treatment option may help their mild to moderate rosacea.

Going the Distance
The Rosacea App leads the user from one section to the next to help make daily decisions about how to manage their condition. But the help doesn't stop there. The Rosacea App provides a coupon offer for Finacea® that can be used at the pharmacy directly from their Smartphone. It also gives the user the ability to register for special offers and to sign up for a monthly newsletter. There are those who want to talk to their doctor but don't know where to begin. The Rosacea App is equipped with a questionnaire to fill in that will help facilitate a discussion with their healthcare provider.

The Rosacea App has benefitted from hours of research and planning – the result being this comprehensive resource full of information to help guide those coping with this skin disease which affects upwards of 16 million Americans. The Rosacea App was well-received by dermatologists at its introduction during the recent annual American Academy of Dermatology meeting in early February 2011. It is encouraging to see that the specialists treating this condition see great value and utility in this app, but the real benefit will only be realized by getting The Rosacea App into the hands of those who need it most – those suffering from mild to moderate rosacea.

"Finacea is the only FDA-approved gel for the treatment of the bumps, pimples and associated redness of mild to moderate rosacea" said William Griffing, President & CEO of Intendis-US. "As the makers of a leading rosacea treatment, we felt strongly motivated to support patients who have to cope with the issues of rosacea every day. By making this app available at no cost, The Rosacea App user will always have the latest information, tools and support. We believe it will open up a new window for anyone who has to make decisions about their disease on a daily basis."

# # #

About Rosacea
To learn more about rosacea, please visit www.rosacea.org

INDICATION & USAGE
FINACEA is indicated for topical treatment of inflammatory papules and pustules of mild to moderate rosacea. Although some reduction of erythema which was present in patients with papules and pustules of rosacea occurred in clinical studies, efficacy for treatment of erythema in rosacea in the absence of papules and pustules has not been evaluated.

IMPORTANT SAFETY INFORMATION
FINACEA is for dermatologic use only, and not for ophthalmic, oral, or intravaginal use. FINACEA is contraindicated in individuals with a history of hypersensitivity to propylene glycol or any other component of the formulation. In clinical trials, sensations of burning/stinging/tingling occurred in 29% of patients, and itching in 11%, regardless of the relationship to therapy. Post-marketing safety - Skin: facial burning and irritation; Eyes: iridocyclitis on accidental exposure to the eye. There have been isolated reports of hypopigmentation after use of azelaic acid. Since azelaic acid has not been well studied in patients with a dark complexion, these patients should be monitored for early signs of hypopigmentation.

Other than FINACEA, Intendis, Inc. (part of the Bayer group) does not promote or endorse any products or recommendations made by third parties. All products and brand names listed are the property and responsibility of their respective trademark and copyright holders.

Please see full Prescribing Information for FINACEA at www.finacea-us.com.

FINACEA is a registered trademark of Intendis, Inc.

Intendis is part of the Bayer Group

About Intendis
Intendis Inc. is an U.S. based affiliate of Intendis GmbH, a fully integrated pharmaceutical company based in Berlin, Germany. As part of the Bayer Group, Intendis is dedicated to Dermatology and focuses on the development and marketing of high quality, innovative topical therapies, targeted to treat skin disorders. Intendis' objective is to become a leading partner in the field of dermatology. Find out more at www.intendis-us.com.

Media Contact:
Suzanne Lane
The Lane Communications Group
slane@thelcgroup.com
1+ 212.757.6880.

Forward-Looking Statements This release may contain forward-looking statements based on current assumptions and forecasts made by Bayer Group or subgroup management. Various known and unknown risks, uncertainties and other factors could lead to material differences between the actual future results, financial situation, development or performance of the company and the estimates given here. These factors include those discussed in Bayer's public reports which are available on the Bayer website at www.bayer.com. The company assumes no liability whatsoever to update these forward-looking statements or to conform them to future events or developments.

Other features include tips for healthy skin, Q&As on itching and facial beauty procedures, a new success story and a new patient survey on rosacea and sun protection.

“To many people, the flushing or redness of rosacea may resemble a sunburn, and the bumps and pimples may be mistaken for a typical case of acne,” said Dr. Richard Odom, professor of dermatology at the University of California-San Francisco. “Adding to the confusion, even fewer are likely to associate the eye problems of ocular rosacea with a skin disorder.”

He noted that this lack of understanding causes many rosacea sufferers to delay seeing a dermatologist because they assume they have a temporary condition that will ultimately disappear on its own. Without medical help, however, the effects of rosacea usually persist and may grow increasingly severe.

Unfortunately, this widespread ignorance about the disease has made it the subject of numerous myths. One common misconception is that rosacea sufferers, who often have a red face and nose, are alcoholic. In fact, while alcohol consumption may aggravate the disorder, the symptoms can be just as severe in a teetotaler.

Another false assumption is that a person's skin problem is due to poor hygiene, and many sufferers do not realize they have a medical condition that can be successfully controlled with proper diagnosis and treatment.

"Because rosacea affects the way we look, its consequences often go far deeper than its physical impact alone," said Dr. Ted Grossbart, a psychologist at Harvard Medical School and author on the emotional impact of skin diseases. "Nobody likes feeling unattractive, and the effect of rosacea on appearance makes a person emotionally vulnerable. Especially because this condition is not well understood, rosacea can leave its victims feeling isolated and even alienated from society."

In National Rosacea Society surveys of more than 1,200 rosacea patients, 76 percent said rosacea had lowered their self-confidence and self-esteem, and 69 percent said they had experienced embarrassment as a result of the disorder. Nearly 63 percent reported difficulty in establishing new relationships, and 41 percent said they had avoided or canceled face-to-face contact because of their condition.

For most people, rosacea starts innocently enough. Suddenly, without warning, a flush comes to their cheeks, nose, chin or forehead. Then just when they start to feel concern, the redness disappears. Unfortunately, it happens again and again, becoming ruddier and lasting longer and longer each time.

Eventually, visible blood vessels may appear, and bumps and pimples often develop, growing more extensive over time. In many rosacea sufferers, the eyes are also affected, appearing watery or bloodshot and feeling gritty or irritated. Without treatment and proper care, severe cases of this condition, known as ocular rosacea, can potentially lead to corneal damage and reduced vision.

In severe cases, especially in men, the nose may also become enlarged from excess tissue. This is the condition that gave comedian W.C. Fields his trademark red bulbous nose.

In addition to these basic signs and symptoms, many rosacea sufferers may experience facial burning, stinging or itching, as well as a dry appearance. Other potential signs of rosacea include raised red patches, facial swelling and skin thickening. In some people, rosacea may also develop on the neck, chest, scalp, ears or elsewhere beyond the face.

While the cause of rosacea remains a mystery, there are various factors that may put people at greater risk for acquiring the disorder or that trigger its eruptions. These factors fall into such diverse categories as genetic heritage, skin type, weather, emotional influences, physical exertion, certain foods and beverages, adverse reactions to drugs and cosmetics, and underlying medical conditions. But a thread that generally runs through them all is that each may relate to flushing.

In surveys of rosacea sufferers by the National Rosacea Society, 40 percent of the respondents indicated they had a family member who also suffered from rosacea or similar symptoms. More than 72 percent of the respondents said they had fair skin, while 27 percent said their complexion was medium and less than 1 percent reported dark complexions.

Sometimes referred to as the "Curse of the Celts," rosacea was found especially common among individuals of Irish descent. While the disorder can occur in all ethnic groups, rosacea was also found unusually prevalent among people of English, Scottish, Scandinavian and northern or eastern European ancestry.

Rosacea is more frequently diagnosed in women, but is often more severe in men. However, this perception may arise in part because women are more likely to see a physician, while men are more likely to seek medical attention only after the condition reaches advanced stages.

Once rosacea appears, an astonishing array of lifestyle and environmental factors has been found to aggravate the condition or trigger flare-ups of symptoms in various individuals. Some of the more common rosacea triggers include sun exposure, emotional stress, hot weather, alcohol, spicy foods, strenuous exercise, wind, hot baths, cold weather, heated beverages and certain skin-care products.

"The single most important action a person who suspects he or she may have rosacea can take is to see a dermatologist for diagnosis and treatment," Dr. Odom said. "Although rosacea cannot be cured, effective medical therapy is available that can halt its progression and minimize or reverse its effects."

Dermatologists usually prescribe oral and topical therapy to bring symptoms under immediate control, and then continue long-term therapy to maintain remission. When appropriate, lasers or other devices may be used to remove visible blood vessels, reduce extensive redness or recontour an enlarged nose. A gentle skin-care regimen is recommended, and cosmetics may also be used to minimize the appearance of redness.

Another important step is to identify and avoid those factors that seem to trigger rosacea flare-ups in individual cases. Just as with allergies, minimizing the things that aggravate the condition can go a long way toward reducing its effects.

To help rosacea sufferers identify and avoid their individual triggers, the National Rosacea Society offers a rosacea diary booklet, as well as a range of other materials with detailed information on the disorder.

In the survey of 1,134 rosacea patients, 60 percent of all respondents and 88 percent of those reporting severe symptoms said the disorder had negatively affected their interactions with others in the workplace. Among those with severe symptoms, 51 percent said they had even missed work because of their condition.

“Because the signs and symptoms appear on the most visible part of the body, rosacea is much more difficult to ignore than many other conditions,” said Dr. Boni Elewski, professor of dermatology at the University of Alabama-Birmingham. “Beyond any physical discomfort, such as facial burning and stinging or eye irritation, the effect of rosacea on personal appearance can be emotionally and socially debilitating.”

In the new survey, 69 percent of all respondents and 87 percent of those with severe symptoms said they had noticed others staring at their face when they were experiencing a rosacea flare-up. Forty-five percent of all respondents, including 66 percent of those with severe symptoms, reported that they had heard rude or inappropriate comments in the workplace about their facial appearance.

Nineteen percent of all respondents and 39 percent of those with severe symptoms felt they did not receive a job offer because of their appearance. In addition, 19 percent of all respondents and 41 percent of those with severe symptoms believed they were denied a promotion or new responsibilities because of the way they looked.

“While there is no cure for rosacea, the good news is that medical therapy is available to bring it under control and maintain remission of its signs and symptoms,” Dr. Elewski said. “Patients may also be able reduce the frequency and severity of their flare-ups with gentle skin care and by identifying and avoiding environmental and lifestyle factors that trigger flare-ups in their individual cases.”

More than 64 percent of all of the survey respondents reported that effective treatment of their rosacea had improved their interactions with others in the workplace.

Noting that the prevalence of eye involvement in rosacea is probably higher than often presumed, Dr. E. Lazaridou and colleagues of the Aristotle University Medical School, Thessalonika, Greece, examined 100 rosacea patients for ocular signs and symptoms using two tests to determine the presence of eye dryness.

The researchers found ocular symptoms in 33 of the patients, including a burning sensation and tearing, bloodshot eyes and blepharitis (swollen eyelids). In addition to ocular rosacea, 11 of these patients had subtype 1 (erythematotelangiectatic) rosacea, 17 had subtype 2 (papulopustular) rosacea and four exhibited subtype 3 (phymatous) rosacea.

In 24 of the rosacea patients and 24 patients without rosacea, the Schirmer test was used to determine whether the eye produces enough tears to keep it moist. Additionally, the tear break-up time (TBUT), the time required for dry spots to appear on the eye’s surface while the patient avoids blinking, was performed in each eye. The rosacea patients’ Schirmer test results were significantly lower compared with healthy control subjects, and the average TBUT was also shorter.

The researchers concluded that the Schirmer and TBUT tests could be useful in screening and early diagnosis of rosacea to prevent the potential development of sight-threatening conditions.

Reference

1. Lazaridou E, Fotiadou C, Ziakas N, et al. Clinical and laboratory study of ocular rosacea in northern Greece. J Eur Acad Dermatol Venereol 2011;Mar 2. doi:10.1111/j.1468-3083.2011.03995.x.