Topics Discussed
Below
General Questions:
- What is rosacea?
- Who gets rosacea?
- What are the main symptoms of rosacea?
- What are the main triggers for rosacea flare-ups?
- Can rosacea be diagnosed before having a major flare-up?
- Is rosacea contagious?
- Does rosacea go away by itself or 'burn itself out'?
- Is rosacea caused by bad facial hygiene?
- Is rosacea caused by facial bacteria?
- Is rosacea caused by demodex mites?
- Is rosacea caused by abnormal sebaceous gland activity?
- If you have acne as a teenager are you more likely to get rosacea?
- Why do my rosacea papules reappear at the same place?
- Why does rosacea seem to get worse in the fall and spring?
Treatment Questions:
- My doctor prescribed oral and topical medications for rosacea
- why?
- Does topical medication wash away when you perspire?
- Why am I getting more facial veins even though my rosacea is
better?
- My doctor prescribed topical hydrocortisone - is this harmful?
- My doctor prescribed topical retinoids - is this harmful?
- My doctor prescribed topical benzoyl peroxide - is this harmful?
- My doctor prescribed dermabrasion/laser resurfacing - is this
harmful?
I. General Questions
1. What is rosacea?
At the most basic level,
rosacea is a disorder of the facial blood vessels. This disorder
results in hyper-responsive blood vessels that dilate to numerous
internal and external stimuli. This causes frequent facial flushing
and skin changes such as facial redness, inflammatory papules, pustules,
burning sensations and rhinophyma.
2. Who gets rosacea?
Approximately 13 million
people in the United States have rosacea. It most often affects
adults between the ages of 30 and 60. Rosacea occurs equally in
men and women, although men have the tendency to get the more severe
form of rosacea. Rosacea affects people of any skin color; although
it is most apparent in people with fair skin.
3. What are the main
symptoms of rosacea?
There are nine main symptoms of rosacea:
- Facial redness
- Facial telangiectasia
- Skin hyper-reactivity
- Lumpy-bumpy facial skin
- Facial papules
- Facial pustules
- Facial burning sensations
- Facial swelling
- Rhinophyma
4. What are the main
triggers for rosacea flare-ups?
- Nerve activity
- Skin irritation - topical irritants
- Sun
- Environment - heat, cold and wind
- Topical steroids
- Immune system
- Free radicals
- Stress - neural and hormonal
- Menopause
- Oral dilators - food, beverage, medications and supplements
- Exercise
- Other disease
- Collagen breakdown in facial skin
- Gastrointestinal tract disorder
- H. Pylori of the stomach
5. Can rosacea be diagnosed
before having a major flare-up?
It is sometimes possible
to identify "pre-rosacea" in teenagers and persons in
their early 20s. These individuals generally come to the dermatologist
for acne treatment and exhibit flushing and blushing episodes that
last longer than normal. The prolonged redness usually appears over
the cheeks, chin, nose or forehead. These patients usually find
topical acne medications to be irritating. If you recognize the
symptoms of pre-rosacea in a younger family member or others, they
might be advised to consult a dermatologist. Rosacea has also been
reported in children.
6. Is rosacea contagious?
No. Rosacea is not contagious.
It is not classified as an infectious disease, and there is no evidence
that it can be spread by contact through the skin. It is important
to emphasize that genetics does play a role in the development of
rosacea, so rosacea can often be seen in members of the same family
and in close relatives.
7. Does rosacea go
away by itself or 'burn itself out'?
Rosacea does not go away
by itself or burn itself out. A sufferer may notice that rosacea
symptoms wax and wane over time but, no matter what the stage or
symptom severity, the underlying disorder is still present.
8. Is rosacea caused
by bad facial hygiene?
Rosacea is not caused by bad facial hygiene because hygiene has
no effect on the underlying vascular disorder. In fact, some rosacea
sufferers who exhibit excellent hygiene and are aggressive in their
cleansing and exfoliating ritual may actually be making the underlying
rosacea worse. It is good practice to keep the face clean and moist,
but this has very little bearing on rosacea.
9. Is rosacea caused
by facial bacteria?
No, rosacea is not caused
by facial bacteria. Detailed analysis of rosacea skin and papules
have consistently demonstrated that facial bacteria are completely
normal in number and activity.
10. Is rosacea caused
by demodex mites?
No, rosacea is not caused
by facial demodex mites. Although a few studies have demonstrated
increased numbers of demodex on the skin of some rosacea sufferers,
most experts agree that they do not play a role in rosacea -- they
are just harmless passengers that are found on facial skin.
11. Is rosacea caused
by abnormal sebaceous gland growth or activity?
No, the average rosacea
sufferer has normal sebaceous glands (both in structure and activity).
Numerous clinical studies have demonstrated that true rosacea does
not involve the facial sebaceous glands. Please note that there
is one exception to this rule -- rosacea sufferers who develop rhinophyma
(the bulbous red nose). After years of flushing, rhinophyma sufferers
may experience inflammation and growth of the sebaceous glands around
the nose.
12. If you have acne
as a teenager, are you more likely to get rosacea as an adult?
No. While both conditions
may cause red papules, no relationship has been established between
teenage acne and rosacea. In fact, many rosacea patients have reported
that they enjoyed exceptionally clear complexions prior to developing
rosacea.
13. Why do my rosacea
papules reappear at the same place?
Rosacea papules are primarily
caused by underlying vascular dysfunction and damage. So, those
isolated areas of the face with vascular dysfunction are more prone
to break out with papules when a rosacea sufferer experiences a
flushing episode or flare.
14. Why does rosacea
seem to get worse in the fall and spring?
Many rosacea sufferers report that changing seasons is hard on their
condition. These rosacea sufferers are extremely susceptible to
environmental factors. For instance, in the fall they may be exposed
to colder temperatures and windy days. In the spring, their rosacea
may be aggravated by increased sun, heat and outdoor activity. While
this is frustrating, the skin will usually adapt to the environmental
changes within 4 to 6 weeks.
II. Treatment Questions
1. My doctor prescribed
oral and topical medications for my rosacea -- why?
This is a very common treatment approach. The best clearance of
rosacea symptoms are usually attained by taking an oral anti-inflammatory
(i.e. antibiotics or accutane) and a topical anti-inflammatory (i.e.
metronidazole based products). This treatment protocol is usually
followed for 4 to 6 months until the rosacea is under control and
then tapered to just a topical treatment to maintain clearance.
2. Does topical medication
get washed away when you perspire?
Once topical medication
is absorbed into the skin, the beneficial effects are not washed
away when you perspire. Dermatologists recommend applying topical
medication to clean, dry skin and waiting 15 minutes before applying
other skin-care products.
3. Why am I getting
more facial blood vessels (telangiectasia) even though my rosacea
is getting better with treatment?
Visible broken blood vessels
often develop with rosacea. These blood vessels were likely always
there, but were masked by facial redness. Once the medication has
decreased the facial redness, it is common for individual blood
vessels to become more noticeable. This is actually a positive sign
that the treatment is working.
4. My doctor prescribed
over-the-counter hydrocortisone for my rosacea. Is this recommended
for rosacea?
No. Absolutely not. Topical
hydrocortisone at any strength will worsen rosacea symptoms over
time. It causes rebound dilation, thinning of the epidermis, thinning
of the blood vessel walls, and holes in the architecture of the
dermis.
5. My doctor prescribed
topical retinoids for my rosacea papules and pustules. Is this recommended
for rosacea?
Topical retinoids are
not recommended by rosacea experts. Primary care physicians and
some general dermatologists recommend this treatment because it
will help clear the papules, pustules and pores. However, they are
taking a considerable risk with your face, because topical retinoids
cause facial flushing/irritation, stimulate the growth of new blood
vessels, and make the facial blood vessels more reactive to environmental
and skin care products.
6. My doctor prescribed
topical benzoyl peroxide for my rosacea papules and pustules. Is
this recommended for rosacea?
Benzoyl peroxide in any
form should not be used on rosacea skin. End of story.
7. My doctor recommended
dermabrasion or laser resurfacing for my facial rosacea. Is this
recommended for rosacea?
This form of treatment
is not recommended. While this may be a temporary fix for papules
and pustules often times this treatment worsens flushing episodes,
triggers a permanently red face, and induces burning sensations.
The only rosacea sufferers that should consider this treatment are
those with thickening of the nose (rhinophyma). In these cases,
dermabrasion or laser resurfacing are used to re-shape the nose.
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