Topics Discussed Below

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I.  General Questions:

1. Are there any diagnostic tests for rosacea?
   
2. What are the primary symptoms we should look for in our patients?
   
3. What are the primary triggers we should look for in our patients?
   
4. Do children and teenagers develop "true" rosacea?
   
5. What should we recommend to young patients with rosacea?
   
6. Is rosacea a progressive disorder?
   
7. Is rosacea caused by sun damage?
   
8. Is rosacea an autoimmune disorder of the facial skin?
   
9. Is rosacea a psychosomatic disorder?
   
10. Is rosacea a disorder of 'superficial' or 'deep' blood vessels?

II.  Treatment Questions:

1. Should rosacea patients fight through irritation caused by topicals?
   
2. Should rosacea be treated aggressively?
   
3. Are there any dangers to long-term use of topical medications?
   
4. What types of sunscreens should we recommend to our patients?
   
5. Do over-the-counter steroids help or hurt rosacea?
   
6. Do oral steroids have a place in rosacea treatment?

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I. General Questions

 

1. Are there any diagnostic tests for rosacea?

There are no histological, serological or other diagnostic tests for rosacea. A skin biopsy is not helpful either. A diagnosis of rosacea must come from your physician after a thorough examination of your signs, symptoms, and medical history. During your exam you should explain any problems you are having with your face, such as redness, flushing, broken blood vessels, papules, pustules, swelling, burning, itching or stinging sensations.

2. What are the primary symptoms we should look for in our patients?

At the most basic level, rosacea is a disorder of the facial blood vessels. Therefore, the primary symptoms should be blood vessel related. Facial redness, flushing and blushing are exhibited in most rosacea sufferers. Papules, pustules and swelling are also exhibited in patients. These are the primary diagnostic criteria.

 

3. What are the primary triggers we should look for in our patients?

Flushing to warm or hot environments, emotions, stress, foods/beverages, cold or windy environments, skin care products, alcohol and physical exertion. Some patients may exhibit only one or two triggers, while others may experience all of the triggers. The degree of trigger susceptibility is directly related to the severity of the vascular disorder.

4. Do children and teenagers develop "true" rosacea?

Yes. Dozens of case studies indicate that children and teenagers can develop rosacea. Frequent facial flushing that remains for an abnormal period of time is the most obvious sign. Some children also present with papules or pustules.

 

5. What should we recommend to young patients with rosacea?

With young patients, recommendations should be kept simple and user friendly. Patients should be instructed to discontinue using irritating skincare products and anti-acne products. They should also be instructed to use a sunblock with an SPF of 15 or greater. These two recommendations may be very helpful……but, just as important, they are simple and do not disrupt one's lifestyle.

 

6. Is rosacea a progressive disorder?

Rosacea is a progressive disorder. It will get worse over time if left untreated. As blood vessels become more damaged and hyper-responsive, this causes increased flushing, papules and pustules. It must be stressed that everyone is different in their susceptibility to flushing. For example, it may take one rosacea sufferer several months to progress from pre-rosacea to mild rosacea; while it may take another rosacea sufferers a decade to progress to the next stage.

 

7. Is rosacea caused by sun damage?

Rosacea is never caused by one trigger or environmental influence. However, sun damage is a strong trigger for facial flushing and causes direct damage to superficial blood vessels and dermal inflammation. So, sun damage can cause progression of rosacea in those genetically predisposed to developing the disorder.

 

8. Is rosacea an autoimmune disorder of the facial skin?

Under normal conditions, the immune system protects the human body from foreign invaders such as bacteria, viruses, and other harmful microorganisms. The immune system also plays an important role in clearing up skin inflammation. However, in certain inflammatory skin disorders such as rosacea, immune cells can do more harm than good. In rosacea, chronic facial flushing and inflammation cause the immune system to become over-reactive. The immune system sends gobs of normal immune cells into the facial skin. These normal immune cells then set up camp around facial blood vessels, releasing inflammatory substances that trigger dilation, weaken blood vessel walls, and cause inflammatory papules.

It is important for rosacea sufferers and general physicians to understand that rosacea is not an auto-immune disease. The immune system does not produce antibodies or specifically 'attack' the facial skin cells or blood vessels. The average rosacea sufferer has a perfectly healthy immune system. In rosacea sufferers, the immune system is simply over-reacting to facial inflammation and flushing. Over time, this immune system response becomes exaggerated and counterproductive.

 

9. Is rosacea a psychosomatic disorder?

When a physician examines a rosacea sufferer, he often notices symptoms such as sadness, depression, anxiety, hopelessness, and frustration. A general physician who performs brief, incomplete examinations may conclude that the patient has an underlying psychological disorder, and that the patient's mental state is causing his or her rosacea. However, rosacea experts who perform in-depth examinations and question their patients rigorously will often come to much different conclusions; they usually find that the patient's rosacea is causing the sadness, depression, anxiety, hopelessness, and frustration. After thorough examination and questioning, medical experts often find that: (1) The patient has already seen countless physicians without much help, (2) The patient cannot perform normal activities without moderate facial flushing and aggravation of the disease, (3) The patient experiences daily burning sensations that interfere with his or her lifestyle, and (4) The patient has been given incorrect medical treatment in the past, or no real hope for leading a normal life. Of course patients will be saddened, depressed, anxious, hopeless and frustrated by this disorder and its prognosis!

 

10. Is rosacea a disorder of 'superficial' or 'deep' blood vessels?

Rosacea is a disorder of both superficial and deep blood vessels. The small, thin walled superficial blood vessels exhibit physical damage and become hyper-responsive. The deeper blood vessels do not undergo physical damage, but are the main pathways through which large volumes of blood enter the superficial blood vessels of the face. These deeper blood vessels are hyper-responsive to neural and hormonal factors.

 

 

II. Treatment Questions

 

1. Should rosacea patients fight through irritation caused by topicals?

Most rosacea sufferers should not fight through irritation because this usually aggravates the underlying vascular disorder. For this reason, rosacea experts instruct their patients to never fight through facial irritation or redness. Medical experts instruct patients with sensitive skin that any form of irritation makes the skin more vulnerable to subsequent irritation. Recovery of sensitive skin and blood vessels only occurs when exposure to topical irritants is stopped, and the skin is allowed to heal.

Fighting through irritation can set into motion a disturbing series of events: physicians prescribe topical irritants to treat rosacea bumps and uneven skin texture ….. these irritants increase facial inflammation and flushing ….. physicians then prescribe topical steroids to reduce the facial inflammation ….. these steroids thin the facial skin, weaken the blood vessels, and cause vascular hyper-reactivity. This results in significant progression of the entire vascular disorder. This vicious cycle, once set into motion, is very difficult to break.

2. Should rosacea be treated aggressively?

In moderate to severe cases with frequent or intense flushing, rosacea should be treated aggressively. The goal is to stop the progression of the disorder and reverse the symptoms and vascular dysfunction. This often necessitates a multi-tiered approach with laser therapy, topical anti-inflammatory medications and oral medications.

 

3. Are there any dangers to long-term use of topical medications?

There are no dangers to using topical rosacea medications long-term. They do not thin the facial skin or have negative actions on the underlying blood vessels. Doctors often prescribe topical antibiotics for long-term treatment of rosacea, and no study to date has documented any reason for danger or concern. Topical treatments usually minimize side effects because the amount of medication absorbed into the bloodstream is either absent or minuscule.

 

4. What type of sunscreens should we recommend to our patients?

The current recommendations are to use sunscreens with inert physical blockers such as micronized zinc oxide or titanium dioxide. These ingredients are excellent sunscreens and they very rarely cause irritation to the skin. In addition, they help to decrease facial skin temperature that is usually associated with outdoor sun exposure.

 

5. Do over-the-counter steroids help or hurt rosacea?

It is not wise to use over the counter topical steroids. Although mild topical steroids are sometimes prescribed for short periods to help control redness in rosacea patients -- especially during initial treatment -- the long-term use of steroids has been found to aggravate rosacea and even induce rosacea-like symptoms in many patients.

 

6. Do oral steroids have a place in rosacea treatment?

Short term treatment with oral steroids does have a place in rosacea therapy (i.e. 5- to 7-day dose packs). In many cases, pulse-dosing with oral steroids helps relieve facial inflammation and swelling in moderate to severe rosacea sufferers. The goal of this treatment is to knock down the inflammation so that rosacea sufferers can maintain clearance on topical rosacea medications.

 

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