1. What is Rosacea ?
Rosacea (said rose-ay-shah) is a potentially progressive neurovascular disorder that generally affects the facial skin and eyes. The most common symptoms include facial redness and inflammation across the flushing zone – usually the nose, cheeks, chin and forehead ; visibly dilated blood vessels, facial swelling and burning sensations, and inflammatory papules and pustules.
Rosacea can develop gradually as mild episodes of facial blushing or flushing which, over time, may lead to a permanently red face.
Ocular rosacea can affect both the eye surface and eyelid. Symptoms can include redness, dry eyes, foreign body sensations, sensitivity of the eye surface, burning sensations and eyelid symptoms such as chalazia, styes, redness, crusting and loss of eyelashes.
A panel of experts have agreed on a standard classification system for Rosacea. This system is a brief text that is not intended to be exhaustive, but is a place to start.
“Rosacea is a chronic cutaneous disorder, primarily of the central face. It is often characterized by remission and exacerbation and it encompasses various combinations of such cutaneous signs as flush, erythema, telangiectasias, edema, papules, pustules, ocular lesions, and rhinophyma. Primary features considered as necessary for diagnosis include flushing, erythema, papules, pustules, and telangiectasias. A variety of secondary features are listed that may be absent or present as a single finding or in any combination.”
Common Misspellings: roacea, rosae, rocase, rocacea, roace, roscea, rosacia.
1.1 Are there different types of Rosacea ?
The panel of Rosacea experts agreed on the following broad, non exclusive text (i.e. there may be other factors and types that come into play).
“The system divides rosacea into four subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. As presently worded, papulopustular rosacea is noted as often being observed following or with erythematotelangiectatic disease and phymatous rosacea as following or occurring together with either erythematotelangiectatic or papulopustular rosacea. However, Dr. Wilkin emphasized that while those descriptions are consistent with common concepts about rosacea natural history, they are provisional and subject to change.”
“In its current iteration, the classification system excludes rosacea fulminans, steroid-induced acneiform eruptions, and perioral dermatitis without rosacea signs from the diagnosis of rosacea.”
1.2 What is the difference between acne and rosacea ?
As rosacea is a neurovascular disorder it affects the flushing zone.
Is is common that Rosacea does not present with blackheads that are seen with Acne Vulgaris. Also the age of onset, and the location of redness is a clue. Rosacea is commonly an adult disease, and is generally restricted to the nose, cheeks, chin and forehead. It can coexist with acne vulgaris.
Some rosacea sufferers have a significant acne component in their symptoms so it can be easily confused with acne vulgaris. The papules and pustules of rosacea tend to be less follicular in origin.
Rosacea will probably have an underlying redness that is related to flushing and thus looks different to acne vulgaris. Acne sufferers normally do not have the accompanying redness.
Rosacea usually begins with flushing, leading to persistent redness.
As both conditions are inflammatory, the treatment for rosacea and acne vulgaris can be somewhat similar, but some of the acne vulgaris regimes are too harsh for rosacea affected skin and can severely aggravate the condition.
Rosacea sufferers are cautioned against using common acne treatments such as alpha hydroxy acids (glycolic and lactic acids), topical retinoids (such as tretinoin, Retin-A Micro, Avita, Differin), benzoyl peroxide, topical azelaic acid, triclosan, acne peels, chemical peels. Additionally the caution extends to topical exfoliants, toners, astringents and alcohol containing products.
1.3 What is the difference between Rosacea and Seborrheic Dermatitis ?
Seborrheic Dermatitis and Rosacea are closely related, they both involve inflammation of the oil glands. Rosacea also involves a vascular component causing flushing and broken blood vessels.
Seborrheic Dermatitis may involve the presence of somewhat greasy flaking involving the T zone, crusts, scales, itching and occasionally burning, and may also be found on the scalp, ears and torso. It does not usually involve red bumps as in Rosacea.
The T zone is the area shaped like a `T’ composed of your forehead, nose and around your mouth.
Just to confuse things further, the two conditions are often seen together. See also: seb derm, elidel and protopic : a warning.
1.4 What causes Rosacea ?
There are a few theories, but none are yet conclusive. Popular theories include rosacea being caused by how frequently we flush and how our blood vessels cope with this flushing ; an over active inflammatory response to some unknown pathogen.
The fact that rosacea’s cause is unknown thankfully hasn’t stopped the development of some excellent treatment regimes.
1.5 How does rosacea progress ?
“Rosacea normally progresses in the same generalised fashion, frequent dilation of facial blood vessels leads to vascular hyper-responsiveness
and structural damage.”
Rosacea experts talk about rosacea symptoms appearing in 4 stages. Over time rosacea can progress from one stage to the next.
From Dr. J Wilkin:
“Most textbooks and literature citations characterize rosacea as a disease that gradually evolves from early to later subtypes. However, there is not conclusive evidence to substantiate that course and we want to know if it really occurs. Nevertheless, the individual features within a subtype can get worse, so early treatment is advocated, even if there is not progression from one stage to the next,”
2. How can Rosacea be treated ?
The best answer is “working with the support of your registered health professional”. There are medications available that control the redness and reduce the number of papules and pustules associated with rosacea.
Current run-of-the-mill treatment might include oral antibiotics and topical metronidazole. One study showed that the use of topical metronidazole alone can help some sufferers to reduce rosacea flare-ups once the rosacea is brought under control.
For those sufferers that do not benefit from the metronidazole based treatments, there are many other options. Quite a few treatments options are often discussed on the rosacea-support email group.
Experts agree that a gentle cleansing regime is very important. Avoiding chemicals that aggravate the rosacea, but will clean and moisturise the skin is a step in the right direction. See also: mild cleanser is important.
As the sun is a strong trigger for many rosacea sufferers, a good non-irritating sunscreen used daily is very important. For those who react badly to chemical sunscreens, a physical sunscreen may be more suitable. Physical sunscreens rely on the reflective properties of the main ingredients (rather than the ability of some chemicals to absorb the sun’s energy). The most common physical sunscreens are based on zinc oxide or titatinium dioxide.
The vitamin A derivative isotretinoin (known as Accutane or Roaccutane), has been shown to be effective against severe papopustular rosacea. It works by inhibiting sebaceous gland function and physically shrinking the glands. It also has potent anti-inflammatory properties, making it ideal to treat resistant rosacea. At low doses, accutane has also been shown to reduce other symptoms such as facial burning and redness. Accutane is a strong drug, and even at the low doses found beneficial to rosacea, should be used under strict supervision of your doctor.
Low does accutane may be more suitable than the regular dose, as there are less side effects and lesser chance of aggravating redness. See also dramatic results with low dose accutane and focus on low-dose accutane.
The mixed light pulse laser – Photoderm is showing promise as a treatment for the vascular component of rosacea. It works by targeting facial microvessels that are damaged.
One treatment that has been shown to help some is Rosacea-LTD III. It is the third generation of topical mineral salt based treatment. The minerals shrink facial vessels as well as reduce papules and pustules. More information is available at http://www.rosacea-ltd.com
For those wanting to treat the flushing side of their rosacea, 2 drugs are worth investigating. Monoxidine and Clonodine are 2 anti-hypertensives that you could look at with your doctor.
From a subjective view of the rosacea-support list members it would appear that one person’s treatment does not necessarily suit another, so your mileage may vary with any recommended treatment. Experiment a little and find what helps you. Depending on the stage of your rosacea, some treatments may be aggravating, while for others the same treatment may not cause problems. Every rosacea patient is unique and needs individual treatment.
Whatever path you choose, the support of a doctor or dermatologist that is willing to work with you will be very important, so shop around until you
are happy with your health professional.
2.1 What about steroids ?
Steroids have long been prescribed for rosacea because of their perceived quick relief. Milder (1% hydrocortisone) over the counter preparations are also popular as they are thought to be safer than the prescription strength treatment.
It is worth bearing in mind the following warnings:
“After observation of long-term facial application of even low-dose corticosteroids, we have see many adults and children with a rosacea diathesis in whom severe burning and itching develop, along with bright red papules and nodules.This may occur after long-term application of even low-potency topical corticosteroids.
Application of topical corticosteroids causes immediate vasoconstriction and reduces the redness seen in rosacea and many other skin conditions. However, when patients discontinue usage of the topical corticosteroid, symptoms immediately reappear, and the symptoms are often much worse than those seen in the original condition.”
2.2 Can you be cured of Rosacea ?
Perhaps not cured in the sense of cured of a cold, but you can reduced your symptoms to a manageable level. There are plenty of treatment options out there, you may just need to experiment with a few.
3.3 Are there any Books about Rosacea I should read ?
There are very few books about Rosacea. In the last year of so there has been a couple of `self help’ books written about rosacea. You can find a
review of a couple of these at http://rosacea-support.org/book-reviews
4. Are there any non-profit organisations devoted to Rosacea ?
The National Rosacea Society is a non profit organisation set up to provide information about Rosacea. You can find them at http://www.rosacea.org/ They publish newsletters online as well as conduct surveys about rosacea sufferers. Also they make published information available to sufferers via regular mail. The National Rosacea Society are an introductory organisation that are a good first point of contact for information. In the past the NRS has awarded grants for 37 studies into rosacea.
4.1 Are there any support groups related to Rosacea ?
There is an email support group that you can subscribe to. This email group is free and unmoderated. Currently there are about 7000 users. To find out more information about the list, visit http://rosacea-support.org or go straight to the email hosting page at http://health.groups.yahoo.com/group/rosacea-support/
Rosacea Reading Glossary
As you read more about Rosacea, you might come across lots of terms that are new to you. Below is a short list of some of the terms you might come across.
accutane: a powerful vitman A derivate that was originally prescribed for severe acne vulgaris. Has been used effectively for rosacea as well. Also known as roaccutane. for more info http://www.rocheusa.com/products/accutane/. See also: focus on low-dose accutane
aczone: (dapsone) a topical treament for acne vulgaris.
ascomycin: a new macrolactam immunomodulator showing some promise for inflammatory skin disorders.
azelaic acid: the active ingredient in finacea and other rosacea treatments.
blepharitis: inflamation and crusting of the eyelid.
boswellia: also known as boswellin or “Indian frankincense,” comes from the Boswellia serrata tree that grows in the dry hills of India. Known the anti-inflammatory properties of the tree bark’s gummy resin, called salai guggal.
cutaneous: pertaining to the skin.
demodex mites: (demodex folliculorum and demodex brevis): microscopic mites that lives in the skin. Many theories relate the involvement of demodex mites to rosacea, but so far after many years of research a causative link has not been found. See also demodex mites
DMSO: (dimethyl sulfoxide) a solvent approved by the FDA for organ transplant preservation and interstitial cystitis (a bladder disease).
chalazion: a lump on the eyelid that is caused by a clogged duct of one or more of the meibomian glands on the eyelid.
clonidine: an anti-hypertensive, which works by controlling nerve impulses along certain nerve pathways. As a result, it relaxes blood vessels so that blood passes through them more easily.
clarithromycin: a macrolide antibiotic used to treat tonsillitis and other bacterial infections. Clarithromycin is available under several brandnames for example Biaxin, Biaxin XL and Klacid.
conjunctivitis: inflammation of the conjunctiva (the thin transparent lining in the front of the eyeballs and eyelids).
cutanix: makers of the Dramatic Relief Multi-Action Skin Therapy targetted for eczema and rosacea sufferers
dapsone: sulphone antibiotic medication available for many years to treat leprosy. also used in a topical (aczone) to treat acne.
diflucan: (fluconazole) is used to treat fungal infections, including yeast infections of the vagina, mouth, throat, esophagus, abdomen, lungs, blood, and other organs.
diroseal: (Avene Eau Thermale Diroseal Treatment Cream) is a anti-redness cream containing Retinaldehyde and Dextran Sulfate. See also diroseal now available in australia.
DRL: dramatic relief lotion, now known as Dramatic Relief Multi-Action Skin Therapy, topical product for rosacea and eczema from Cutanix.
dry eye: a condition brought about by abnormal production in the quantity or quality of tears.
edema: presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body, especially wrt subcutaneous tissues.
elidel: (pimecrolimus) a topical treatment for atopic dermatitis and erythrotelangiectatic, papulopustular, and edematous rosacea. See also: seb derm, elidel and protopic : a warning.
epifacial: another term referring to a full face treatment using photoderm.
epilight: a treatment very similar to photoderm, originally intended for hair removal. differs by using different filters to photoderm. For more information see http://www.skinandhealth.com
epitan: a drug development company, owners of Melanotan and EPT1647, a synthetic peptide which stimulates the body to make eumelanin, the dark pigment of the skin.
erythema: inflammatory redness of the skin.
erythematotelangiectatic: having symptoms of both erythema and telangiectasias
Ester-C: a form of vitamin C that contains both ascorbic acid and metabolites.
ESB: Endoscopic Sympathetic Block, clamps used to block the transmission of the neural impulses in the sympathetic chain. Is considered a reversible procedure. See http://privatix.magenta.net
ETS: Endoscopic Transthoracic Sympathectomy (or endoscopic transthoracic sympathicotomy) a procedure where a surgeon excises the major sympathetic nerves that supply the hands, neck and face. Main indications for ETS are blushing and hyperhidrosis. One place for more information: http://www.sweaty-palms.com/ets.htm
finacea: azelaic acid 15%, a topical treatment for rosacea, proven to reduce the number of inflammatory papules and pustules associated with rosacea. See Also focus on finacea (azelaic acid 15%).
fotofacial: a treatment regime using photoderm pioneered by Dr. Patrick Bitter Jnr., for more information, see http://www.fotofacial.com
grape seed extract: a source of an ntioxidants bioflavanoid known as proanthocyanidins (PCO bioflavanoids)
Helicobacter pylori: bacteria that live in the cell lining of the stomach. Part of the folklore of rosacea is that it is caused by H. pylori. This theory is confused by the fact that treating h. pylori also has some benefit for rosacea symptoms. So far no causative link between h.pylori and rosacea has not been found.
hyperhidrosis: a disorder characterized by excessive sweating caused by an overactivity of the sympathetic nervous system of the sweat glands.
hypertrophy: the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells.
hyperemia: abnormally increased blood flow
Intendis: the manufacturers of finacea.
IPL: Intense Pulse Light, a description of the technology used in the family of machines made by ESC. For more information, see http://www.skinandhealth.com
isotretinoin: the a vitamin-A derivative that is the active ingredient in accutane (also known as roaccutane). See also focus on low-dose accutane
iontophoresis: therapy that uses a local electric current to introduce the ions of a ionic therapeutic agents through the skin.
keratitis: infection or inflammation of the cornea of the eye.
ketoconozole: the active antifungal ingredient in nizoral, helpful for seborrheic dermatitis and dandruff.
klaron: a topical treatment containing sodium sulfacetamide.
lumenis: a laser manufacturer, responsible for the IPL range of machines such as Vasculight, Quantum and Lumenis One.
lupus: an auto-immune disease that causes inflammation in various parts of the body such as the skin, joints and kidneys. Skin flushing is an important symptom of lupus.
melanotan: a brand name for a drug developed by epitan which stimulates the body to make eumelanin, the dark pigment of the skin.
metrolotion: (metronidazole 0.75%), a topical treatment for rosacea, closely related to metrogel and metrocream.
metrocream: (metronidazole 0.75%), a topical treatment for rosacea, closely related to metrogel and metrolotion.
metronidazole: a topical treatment for rosacea. Has been found by some to effective against rosacea. Has a yet to be understood anti-inflammatory action. Is the active ingredient in metrogel, metrocream, metrolotion, rozex and noritate. See also focus on metronidazole.
meibomitis: inflammation of the oil producing meibomian glands of the eye.
MSM: (methylsulfonylmethane) a derivative of DMSO.
Multilight: a member of the Intense Pulsed Light family, along with the photoderm machine. For more information see http://www.skinandhealth.com Can also be used for hair removal.
naturopathic: a treatment philosophy that avoids use of pharmaceutical medication and surgery in favor of natural alternatives
noritate: a 1% metronidazole treatment. for more info http://www.dermik.com/prod/noritate/Noritate.jsp
novacet: a topical treatment containing sodium sulfacetamide.
ocular: of the eye.
oracea: a new variant of periostat, targetted for inflammatory skin conditions like acne and rosacea.
papulopustular: having symptoms of both papules and pustules.
papule: a small, solid, elevated skin lesion, less than 0.5cm in diameter.
perioral dermatitis: perioral refers to the area around the mouth, and dermatitis indicates redness of the skin. In addition to redness, there are usually small red bumps or even pus bumps and mild peeling.
periostat: (doxycycline hyclate) originally developed to combat periodontal disease, also used for its anti-inflammatory properties for acne and rosacea.
photoderm: an intense light source, fired at the facial skin to reduce flushing associated with rosacea. a new treatment for rosacea that is producing some exciting results. For more information see http://www.skinandhealth.com
photofacial: a treatment regime using photoderm, pioneered by Dr. Patrick Bitter Snr.
photorejuvenation: a broad term used describe Intense Pulsed Light treatments. photorejuvenation treatments are aimed at stimulating collagen formulation.
phymatous: having symptoms of abnormal growth, as found in rhinophyma.
pimecrolimus: the active ingredient in elidel, a topical treatment for atopic dermatitis and erythrotelangiectatic, papulopustular, and edematous rosacea. Pimecrolimus, is derived from ascomycin, a natural substance produced by the fungus Streptomyces hygroscopicus var. ascomyceticus. Pimecrolimus selectively blocks the production and release of cytokines from T-cells. These cytokines in the skin cause the inflammation, redness and itching associated with eczema.
plexion: a cleanser from Medicis containing sodium sulfacetamide and sulfur. It is indicated in the topical control of acne vulgaris, acne rosacea and seborrheic dermatitis, for those patients without sensitivities to sulfonamides or sulfur. The exact mode of action of sulfur in the treatment of acne is unknown, but it has been reported that it inhibits the growth of Propionibacterium acnes and the formation of free fatty acids.
protopic: a topical treatment for rosacea containing tacrolimus.
pustule: a vesicle filled with cloudy fluid, such as pus, often associated with a hair follicle but can exist independently.
pycnogenol: an antioxidant extracted from the bark of the French maritime pine (Pinus maritima) and the Canadian Spruce (Tsuga canadensis)
Quadrinone: the patented active ingredient in Cutanix Dramatic Relief
Quantam SR: a member of the Intense Pulsed Light family, along with the photoderm machine. For more information see http://www.skinandhealth.com
rhinophyma: abnormal growth of the soft tissue of nose, caused by sebaceous gland hypertrophy and hyperplasia (increased growth and number of sebaceous glands).
roaccutane: a powerful vitman A derivate that was originally prescribed for severe acne vulgaris. Has been used effectively for rosacea as well. Also known as accutane. for more info http://www.roaccutane.com.au. See also focus on low-dose accutane
rosacea fulminans: a rare form of rosacea that appears very quickly.
rosac cream: a topical preparation from Stiefel Laboratories that contains sodium sulfacetamide 10% and sulfur 5% cream with sunscreens.
rosaliac: a treatment containing vitamin CG (ascorbyl glucoside, a slow-release form of vitamin C); xanthine, a caffeine derivative that works as a vasoconstrictor; and vitamin B3, which acts as an anti-inflammatory agent. Manufactured by La Roche-Posay.
rosanil: a cleanser from Galderma containing sodium sulfacetamide and sulfur. It is indicated in the topical control of acne vulgaris, acne rosacea and seborrheic dermatitis, for those patients without sensitivities to sulfonamides or sulfur.
rosula: a sodium sulfacetamide and sulfur based topical treatment used in the treatment of acne, rosacea, and seborrheic dermatitis
rozex: 0.75% metronidazole based treatment also known as metrogel. for more info http://www.medsafe.govt.nz/consumers/cmi/r/rozexgel.htm
rosacea-ltd: a non-prescription topical treatment for rosacea, see http://www.rosacea-ltd.com
rosacure: an anti-redness and moisturizing face cream. Originates from Italy, where it is called Synchrorose. Contains Silymarin (Lady’s Thistle Extract) which is a bioflavonoid, and hyaluronic acid which provides hydration to the skin, are all contained in an oleosome delivery system.
sansrosa: a company producing treatments for inflammatory skin diseases. One such product is SR101 or SR110 a rosacea anti-redness cream.
seborrheic dermatitis: an inflamatory skin condition, associated with itchy flaking skin. See also:seb derm, elidel and protopic : a warning.
sebaceous gland: a gland often associated with a hair follicle, that produces sebum.
sodium sulfacetamide: a topical treatment used for acne, dandruff and seborrheic dermatitis.
stromectol: (ivermectin) a highly active broad-spectrum anti-parasitic agents used to treat infections caused by roundworms, threadworms, and other parasites.
stye: inflammation of an eyelash follicle on the edge of the eyelid.
subcutaneous: under the skin.
tacrolimus: the active ingredient in protopic, a topical treatment for atopic dermatitus and steroid induced rosacea.
telangiectasias: damaged micro blood vessels, often visible on the surface of the skin.
tetracycline: an antibiotic often prescribed for rosacea.
V-beam: the fifth generation (hence roman 5=V) of the pulse dye laser. for more information, see http://www.vbeamlaser.com
vascular: of the blood vessels.
vasculight: a IPL+laser machine that can be used to give mixed wavelength and fixed wavelength treatments. Can target large and deep blood vessels. For more information see http://www.skinandhealth.com
VEGF: vascular endothelial growth factor, one of the number of genes associated with angiogenesis.
versapulse: a type of laser, for more information, see http://www.coherentinc.com
wobenzyme N: (wobenzym) a multi-enzyme supplement.
YAG laser: (yttrium aluminum garnet, uses a Neodymium (Nd) ion) thought to be good for treating deep and large blood vessels esp. in leg veins.
zileuton: (zyflo) a treatment originally developed for asthma that was targetted to also be useful to treat acne and subsequently rosacea.
ZincO: (ZincO Cream) a micro-fine zinc oxide dimethicone sunscreen formulated by Linda Sy to be used by rosacea sufferers.
zithromax: (azithromycin) is in a class of drugs called macrolide antibiotics, used to treat many types of bacterial infections.