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Facial Flushing and its Relationship to Rosacea
II. Facial flushing
is the first and universal symptom of rosacea
III. Facial flushing
is underestimated because it is not always visible
IV. Why is flushing
localized to the face?
V. Rosacea sufferers
Facial flushing is the
classic symptom of rosacea. In all simplicity, flushing is the result
of increased blood flow through dilated facial blood vessels. During
a flush, a rosacea sufferer's face can turn various shades of red
depending on the amount of blood flowing through the skin. A sufferer
may experience a fire-red face during intense flushes, a mildly-red
face during moderate flushes, or a barely noticeable pinkish-hue
during mild flushes. Depending on the stage of rosacea, a facial
flush can be transient (lasting only for seconds), or long-standing
(lasting for days, weeks or months).
II. Facial Flushing
is the First and Universal Symptom of Rosacea
Medical experts indicate
that frequent facial flushing is the first symptom of rosacea:
- Dr. Wollina states, "Recurrent flushing is the earliest
component of rosacea to be apparent." (1)
- Dr. Marks indicates that frequent or persistent flushing is
the first tell-tale sign of rosacea. (2)
- Numerous other rosacea studies and reviews suggest that facial
flushing is the first symptom of rosacea. (3-10)
- Rosacea experts urge general physicians to be on the lookout
for pre-rosacea flushing because it is an early warning sign of
rosacea. Dozens of experts point out that pre-rosacea flushing
can often be detected in children, teenagers, and young adults.
(11 - 19)
III. Facial Flushing is underestimated because it is not
General physicians and
rosacea sufferers often underestimate the frequency of facial flushing
because it is not always visible to the naked eye. A facial flush
does not always have to result in a fire-red appearance; in many
cases it may only result in a pinkish-hue, or a 'healthy glow'.
In fact, medical experts point out that facial skin can be completely
normal-toned (pale-colored) during some flushing episodes. These
physicians have found that blood vessel dilation can occur deep
within the facial skin, making it hard to detect. (20) More
recently, a non-invasive clinical study has verified this phenomenon;
utilizing laser doppler flowmetry and reflectance spectroscopy,
Drs. Anderson and Maibach demonstrated that blood vessel dilation
can occur long before the naked eye can visibly detect it. (21)
IV. Why is Flushing
Localized to the Face?
Vascular experts indicate
that normal facial blood vessels have several important characteristics
that make them much more likely to dilate (and be noticed), than
most other blood vessels in the human body:
- More blood vessels: Clinical studies demonstrate that
normal facial skin is supplied by an incredibly high number of
blood vessels - much greater than most other areas of the body.
(6, 39, 49, 50)
- Greater blood flow: Clinical studies indicate that resting
blood flow in normal facial skin is much greater than that found
in other areas of the body. (6, 51-53) In fact, under normal
conditions, facial blood flow is 10 to 20 times greater than that
required to supply the skin with oxygen and nutrients! (54)
- Greater width of blood vessels and more superficial blood
vessels: In some areas of the face, blood vessels are very
wide and close to the surface of the skin. (55, 56) Both
of these attributes make facial blood vessels more visible to
the naked eye.
- Specialized thermoregulatory blood vessels: The facial
skin contains specialized 'thermoregulatory shunt vessels' that
are unique to the face. The only purpose of these vessels is to
aid the body in releasing heat. These vessels bring large volumes
of blood to the superficial layers of the facial skin. (54, 57-64)
- Facial blood vessels respond to more stimuli: Normal
facial skin is generally much thinner and more penetrable than
other areas of the human body, and thus facial blood vessels continually
'see' and respond to more stimuli (i.e., environmental and skincare
insults). (65, 66)
In addition to the above
reasons why normal facial blood vessels may be more prone to visible
flushing, rosacea sufferers may have other alterations
that make them even more susceptible to flushing (1, 7, 13,
23, 67, 68):
Normal Vascular Smooth Muscle Cells
Damaged Vascular Smooth Muscle
Normal Endothelial Cells
Damaged Endothelial Cells
Normal Healthy Blood Vessel Walls
Vessel Walls Atrophied/Defective
Innervated by Normal Nerves
Innervated by Dilator Nerves
V. Rosacea Sufferers
Whatever the reason for
flushing, clinical studies have shown that rosacea sufferers have
a much greater rate of resting blood flow than normal subjects:
- In a controlled clinical study of 25 rosacea patients, research
physicians found that facial blood flow, as measured by laser-doppler
flowmetry, was significantly higher than normal subjects. Blood
flow was a whopping 4 times higher! (69)
- Consistent with the above findings, two additional studies
found that resting facial blood flow (as indicated by increased
facial heat), was greater in all rosacea subjects when compared
to normal control subjects. (12), (18)
- Wollina, U. Rhinophyma--unusual expression of simple-type keratins
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