Expert Advice | Rosacea

Rosacea is a chronic skin problem that is not well understood and characteristically affects people with pale skin, blue eyes and generally starts in middle age. People with darker skins also get rosacea, but the signs are less florid. It is always associated with redness of the skin, often with small papules (or lumps) which may become pustules. It may resemble acne but if you look closely at the skin, you will not see any blackheads. The skin feels uncomfortable and usually the central areas of the face are involved. While this is a chronic disease, in some cases there are periods of remission and at other times, it is worse.

The cheeks are generally cherry red, especially close to the nose – due to telangictasia (dilated broken blood vessels). Very often, dilated blood vessels are prominent markers, but in general, the pinkness of the skin is due to actinic damage to the underlying microscopic blood vessels. The nose is almost always involved and after many years, may become thickened and misshapen. A potato nose (called rhinophyma) is always due to this condition.

Causes

No one knows the exact cause of rosacea at this stage. We know it is aggravated by the following:

• Sun
• Heat
• Warm drinks
• Alcohol
• Infestation of tiny mites (demodex folliculorum)
• Photo damage (sun damage)- would have accumulated into quite a severe state in pale- skinned
  individuals by middle age, even in colder areas where UV-A damage still occurs.
• Emotional stress
• Spicy foods
• Heavy exercise
• Telangictasia destruction of collagen support around the blood vessels and this of course would be the
  result of a chronic photo- degradation of both Vitamin A and C.

Visual Signs

• Flushing – many people who have rosacea have a history of frequent blushing or flushing. The facial redness, which may come and so, often is the earliest sign of the disorder. 
• Resistant redness – persistent facial redness may resemble a blush or sunburn that does not go away.
• Bumps and pimples- small red solid bumps and pus- filled pimples often develop in rosacea. Sometimes the bumps may resemble acne, but blackheads are absent. Burning or stinging may also be present.
• Visible blood vessels- small blood vessels become visible on the skin of many people who have rosacea.

Treatment
Topical or even oral antibiotics - Tetracyclines are often given but one should be aware that tetracycline aggravates photo-damage.

Retinoic acid and this initially aggravates the condition by making the cane eruption worse and increasing the redness of the skin. However, after prolonged use the skin does improve. Generally patients stop using the retinoic acid before they can get the improvement.

Long term use of skin care range containing vitamin A and C with antioxidants, leads to improvement in the rosacea. Address the chronic deficiency of vitamin A in the skin that has been a major contributor to the problem. I explain that it is easier to treat the skin with a retinyl palmitate product (vitamin A), but the chance exists that the redness may be aggravated and the skin may feel a bit more sensitive for several weeks before it starts to improve. Start on a lowest dose of retinyl palmitate and suggest that they should continue to use it for more than one tube if their skin feels sensitive. Generally increase the levels of Vitamin A. Rosacea is an ideal problem to treat with an Alpha Hydroxy cream at the same
time as Vitamin A. This will generally be sufficient treatment for mild cases of rosacea, but it may take several months before the skin is comfortable.

For more severe cases use a peel – the peel is TCA as a cream either of 2.5 or 5 %. By the third peel even fairly severe cases of rosacea have made a dramatic improvement with less signs of inflammation, less acne eruption and more comfortable skin. If an infestation of the skin is part of the problem. Generally the third peel even fairly severe cases of rosacea have mad a dramatic improvement with less signs of inflammation, less acne eruption and more comfortable skin. Later on, when the skin has improved, one can address the telangiectasia. Topical vitamin C will help restore the collagen support around the dilated blood vessels. I have seen many people who have responded within months to the regime I have described above.