There's nothing like a red face to get people to notice you – for all the wrong reasons. On first encounter, they may wonder whether it's shyness, alcohol or poor hygiene that is responsible for a nose or cheeks as red as Vermont in autumn, or pimples that look like they should have disappeared after your high school prom.
For an estimated 16 million American adults, the culprit behind this embarrassing and misleading facial appearance is rosacea, a chronic and often mystifying disorder that becomes increasingly common as individuals pass through the most susceptible ages – from 30 to 60. Despite its prevalence, however, medical data indicate that only a small fraction of rosacea sufferers are being treated.
"Although rosacea is not life-threatening, it is often psychologically and socially devastating, and can even lead to facial disfigurement," said Dr. Richard Odom, professor of dermatology at the University of California-San Francisco. "While most cases of rosacea can be easily treated, millions of people suffer needlessly in spite of the turmoil it can create in their personal lives."
Sometimes referred to as "adult acne," rosacea is actually a different and potentially far more serious disorder than teenage acne - and requires different therapy. Also unlike teenage acne, rosacea seldom goes away by itself, and tends to become increasingly severe and life-disruptive without medical help.
For most people, rosacea starts innocently enough, and may at first be mistaken for a sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to your cheeks, nose, chin or forehead. Then just when you start to feel concern, the redness disappears. Unfortunately, it happens again and again, becoming redder and lasting longer and longer each time. Eventually, visible blood vessels may appear, and burning and stinging are also common.
Without medical treatment, bumps and pimples often develop along with the redness, growing more pervasive over time. In about half of rosacea sufferers, the eyes are also affected, feeling irritated and appearing watery or bloodshot, and in severe cases the nose may become enlarged and bulbous from excess tissue.
Perhaps even more ravaging than its physical effects, rosacea often inflicts significant damage to the emotional, social and professional lives of its victims. In National Rosacea Society surveys of more than 1,200 rosacea patients, 76 percent said rosacea's effect on their facial appearance had lowered their self-confidence and self-esteem. Sixty-nine percent said they had experienced embarrassment as a result of the disorder, and nearly 63 percent reported difficulty in establishing new relationships. Forty-one percent said they had avoided or canceled face-to-face contact because of their condition, and 58 percent said the effect of untreated rosacea on their appearance had made them the subject of stares, misconceptions, rude comments and jokes.
Eighty-eight percent of those with severe symptoms said this disorder had affected their professional interactions, and nearly 51 percent reported they had missed work because of their condition. Thirty-nine percent said it might even have prevented them from being chosen for a new job.
"It would be hard to invent a more embarrassing disease than rosacea," said Dr. Ted Grossbart, a psychologist at Harvard Medical School. "It affects the one part of the body that cannot be hidden - the face - and tends to strike people at a time in life when they may be increasingly self-conscious about changes in their appearance. Moreover, especially because this condition is not widely known, it can leave its victims feeling isolated and even alienated from society."
Unfortunately, popular notions surrounding rosacea's appearance lead many to assume that this potentially disfiguring disorder is self-inflicted. Many people might consider someone with common rosacea symptoms, including a flushed face and red nose, to be an alcoholic. However, while alcohol can aggravate the condition, the symptoms can be just as severe in a nondrinker. Some rosacea sufferers also draw suspicions that their symptoms may be due to poor hygiene, even though the condition is completely unrelated to personal cleanliness.
While the exact cause of rosacea remains a mystery, researchers are continuing to increase the medical understanding of the disorder. Facial blood vessels may dilate too easily, leading to the flushing or redness that may be triggered by various lifestyle and environmental factors. Potential inflammatory pathways for the development of bumps and pimples have also been identified, including an allergy-like immune response involving a type of antimicrobial protein known as a cathelicidin. A recent study also found that certain bacteria present on otherwise harmless Demodex mites could prompt an inflammatory response in rosacea patients.
In a survey of rosacea patients by the National Rosacea Society, nearly 52 percent of the respondents indicated they had a family member who also suffered from rosacea or similar symptoms. Sometimes referred to as the "Curse of the Celts," rosacea was found to be 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 German, English, Scottish, Scandinavian and eastern European ancestry.
Rosacea has been considered more common in women, but 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 the disorder has appeared, an astonishing array of lifestyle and environmental factors has been found to trigger flare-ups of symptoms in various individuals. Some of the most common rosacea triggers include sun exposure, emotional stress, hot weather, wind, strenuous exercise, alcohol, hot baths, cold weather, spicy foods, indoor heat, heated beverages and certain skin-care products.
"The single most important action anyone who suspects they 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 control its progression and minimize or reverse its effects."
Dermatologists usually prescribe oral and topical medical therapy to bring the symptoms under immediate control, and then continue with long-term therapy to maintain remission.
Another important step is to identify and avoid those individual factors – such as weather, stress or certain foods - that seem to trigger rosacea flare-ups in each individual case. 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 other booklets with detailed information on the disorder.
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, 111 Lions Dr., Ste. 216, Barrington, Illinois 60010, or via e-mail at firstname.lastname@example.org.
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