How serious is the skin condition Rosacea

So how serious is the skin condition Rosacea? Many people don’t even know that they are suffering from rosacea. Some think it’s their teenage acne nightmares coming back to haunt them, while others think that something else is wrong with them and put it down to other possibilities such as hormonal imbalances or allergies. But once you’ve been diagnosed and you are sure that you have Rosacea, the next question inevitably is, “Is this a serious health issue for me?”

The article below is taken from an article published by American Health and Drug Benefits and attempts in a professional way, to answer this question.

So How Serious Is the Skin Condition Rosacea? Read This Article

The skin condition known as rosacea is a common and serious disorder that is under recognized and under treated. According to the American Academy of Dermatology, rosacea affects at least 14 million US adults, or 1 in every 10 individuals.1 According to the National Rosacea Society (NRS), that number is now estimated to be 16 million.2 Despite this relatively high incidence, the diagnosis of rosacea is often delayed or is never made.2 The consequence is needless suffering for many patients.

how serious is rosacea“Rosacea’s impact on appearance can be a disabling blow to the emotional and social lives of those who suffer from this poorly understood condition,” said Mark V. Dahl, MD, Chairman of the NRS Medical Advisory Board.3 “In addition, the stress of facing friends, family, and coworkers can act as a trigger for flare-ups, leading to a tailspin that can become increasingly hard to bear.”3

If brought to the attention of a dermatologist, however, rosacea can be effectively managed. Proper treatment results in a marked improvement in skin, and therefore in the social and emotional impairments reported by patients with rosacea.

How serious is the skin condition Rosacea? Rosacea is a medical condition with biological underpinnings; it is not a cosmetic problem. Its underlying features are inflammation and vascular reactivity, which lead to erythema and papulopustules. Although proper skincare management, along with topical and oral treatments, can improve many of the symptoms of rosacea, there are still unmet medical needs. Current treatments help with the papulopustules of rosacea, but they are not very effective in treating the redness that concerns so many patients. New agents currently in development have mechanisms of action that address this common characteristic.

The exact incidence of rosacea is unknown, because a uniform diagnosis is lacking and many patients with rosacea remain undiagnosed. The accepted incidence is 10 percent among fair-skinned individuals, the population that is most likely to be affected by rosacea, based on a large Swedish study.4 Although rosacea predominantly affects very light-skinned people, it can occur in individuals of any race or skin tone,5 and is believed to affect approximately 4 percent of those with darker skin.6,7 Up to 35 percent of Americans have affected family members; therefore, a genetic link has been proposed.8

Common Triggers 

Many patients with rosacea report that environmental and other factors serve as triggers for flares. Although the list of potential rosacea triggers in each individual may be unique and lengthy, a survey of 1066 patients with rosacea documented common factors, including

  • sun exposure 81 percent,
  • emotional stress 79 percent,
  • hot weather 75 percent,
  • wind 57 percent,
  • heavy exercise 56 percent,
  • alcohol consumption 52 percent,
  • hot baths 51 percent,
  • cold weather 46percent,
  • spicy foods 45 percent,
  • humidity 44 percent,
  • indoor heat 41 percent,
  • certain skin care products 41 percent,
  • heated beverages 36percent,
  • and certain cosmetics 27 percent.9

Avoidance of obvious irritants, therefore, is helpful in the management of rosacea, but it is rarely sufficient.

A potential role for microbial organisms in the pathogenesis of rosacea has been a long-standing assumption. According to Del Rosso and colleagues, current evidence suggests that a microbial source is not mandatory for the development of rosacea; however, proliferation of Demodex folliculoru may incite a flare by triggering an immune response that is dysregulated and augmented in patients with rosacea.10 The most recent studies suggest that the important factor is not the mere presence of Demodex, because the organism is also found in skin that is not affected by rosacea, but the magnitude of the infestation.11-13

The Pathophysiology of Rosacea

The pathophysiology of rosacea has become an active area of research in the past decade, especially with the increasing understanding of the role of inflammation in many diseases. Rosacea is now understood to be an inflammatory disorder, based on the finding of an abnormal innate immune response system in persons with “rosacea-prone” skin.10

Del Rosso and colleagues recently elaborated on what they call the 2 inherent characteristics of rosacea-prone skin: neurovascular dysregulation and inflammation that produce physiochemical and structural changes in the skin.10 In their review of rosacea as an inflammatory disorder, Del Rosso and colleagues wrote, “Current evidence supports neurovascular dysregulation and altered immune response as integral components of vasodilatory reactivity and ‘neurogenic’ symptoms such as stinging and burning.”10 They noted that neurovascular dysregulation causes vasodilation and neurosensory symptoms, whereas an increased immunologic response to triggers activates an acute and chronic inflammatory response.10

With this hyperreactive immune system as background, environmental triggers can incite an exaggerated immune response. This triggering of the innate immune response system induces a signaling cascade of inflammatory factors that lead to chronic inflammation and an altered vascular state. Part of this inflammatory response most likely involves the toll-like receptor 2 (TLR2), which is a pattern recognition receptor that is expressed in the skin of patients with rosacea, but not in other people; abnormal TLR2 function may explain enhanced inflammatory responses to environmental stimuli.14

In explaining the facial erythema (or redness) of rosacea, Del Rosso and colleagues pulled all these factors together to construct a picture of inflammation and vascular reactivity that includes an augmented innate immune response (ie, an increase in TLR2, cathelicidin precursors and peptides, and kallikrein-5); changes in the vasculature (ie, increased vascular endothelial growth factor, increased mast cells, and downstream effects of LL-37); neurovascular dysregulation (ie, vascular response, vasodilation, and neurosensory symptoms); dermal matrix degradation (ie, an increase in reactive oxygen species and matrix metalloproteinases, and a decrease in antioxidant reserve); vasodilation (ie, neurovascular dysfunction and increased nitric oxide leading to dilation and increased blood flow); and rosacea dermatitis (ie, stratum corneum barrier dysfunction and an increase in cytokines).10

Diagnosis

There is no available test for rosacea. The diagnosis requires an elevated index of suspicion based on the clinical manifestations.

To establish the diagnosis of rosacea, at least 1 of the following primary features must be present: facial erythema for at least 3 months (ie, nontransient), transient erythema (ie, flushing and blushing), papules and pustules (ie, pimples), or telangiectasia (ie, small dilated blood vessels near the skin’s surface).15 Secondary features that may occur, but are not necessary for diagnosis, include burning or stinging, plaques, dry appearance, edema, ocular manifestations, peripheral location, and phymatous changes.15

The 4 Subtypes of Rosacea

Rosacea is classified into the following 4 subtypes—erythematotelangiectatic, papulopustular, phymatous, and ocular, and each may require different treatments.15,16

1. Erythematotelangiectatic rosacea is considered the most common subtype. The common characteristics are flushing and persistent central facial erythema, with or without telangiectasia. Patients with this subtype experience prolonged (≥10 minutes) flushing, which can result from environmental triggers. Skin sensitivity is often described as burning and stinging after the application of topical agents. Patients with erythematotelangiectatic rosacea may also have telangiectasias that contribute to overall redness, a sign of this subtype and the least treatable with available medications. Erythematotelangiectatic rosacea often resembles chronic sun damage, from which it should be differentiated (although the 2 can occur concomitantly). Other disorders to rule out are photosensitivity reactions and the butterfly rash of lupus.15,16

2. Papulopustular rosacea is characterized by persistent central facial erythema with transient, central facial papules or pustules, or both. This type is marked by bumps and pimples (and in severe cases, nodules) that are a result of chronic inflammation. Persistent erythema of the central face, subtle telangiectasias, facial edema, and ocular inflammation may also be present. Papulopustular rosacea must be differentiated from acne, which typically occurs in younger persons and may emerge on areas other than the face.15,16

3. Phymatous rosacea is a disfiguring form of rosacea that is uncommon in women and develops over years. It is marked by thickened skin, irregular surface nodularities and enlargement often involving the nose (the “W.C. Fields appearance”), but sometimes also the chin, cheeks, forehead, ears, and eyelids. Patients fear this manifestation of the disease, but few actually develop it, especially with proper treatment.15,16

4. Ocular rosacea is characterized by foreign-body sensation in the eye, burning, stinging, itchy eyes; ocular photosensitivity (light sensitivity); blurred vision, telangiectasia of the sclera or other parts of the eye, or periorbital edema. Ocular rosacea may be misdiagnosed unless it is accompanied by other features of rosacea, but in 20 percent of patients with rosacea, ocular signs are the first indication of the disorder. An ophthalmic consultation is warranted to avoid further complications of this manifestation of rosacea.15,16

A 2013 NRS survey of patients with rosacea focused on the signs and symptoms of this condition.17 Of the 1072 patients surveyed, 31 percent said that flushing was their first symptom and 24 percent said that persistent redness was their first sign of rosacea. In addition, although the progression of rosacea signs and symptoms varied considerably among patients, 94 percent said that flushing was the first or second sign and 57 percent said it was persistent redness.17

“Rosacea goes undiagnosed in so many people because the most common initial symptoms—and persistent redness—are often overlooked or mistaken for something else, such as sunburn,” commented John E. Wolf, Jr., MD, Chairman, Dermatology Department, Baylor College, Houston, TX.

The Psycho-social Toll of Rosacea

How serious is the skin condition Rosacea psychologically? According to a 2012 NRS survey of 801 patients with rosacea, those with any rosacea subtype can experience the negative social impact of this condition.18 In the survey, 61 percent of patients with erythematotelangiectatic rosacea (characterized by redness) said that their rosacea had inhibited their social lives; that percentage rose to 72 percent in patients with moderate or severe redness; 77 percent in patients with papulopustular rosacea; and 85 percent among patients whose symptoms included phymatous rosacea. Among the respondents who had the eye irritation of ocular rosacea, 71 percent said that their social lives were inhibited.18

Conclusion
Rosacea is a serious medical condition that is often under diagnosed and under treated but can cause considerable distress, impact daily function, and disrupt social relationships—in other words, rosacea can clearly diminish a patient’s quality of life. Current treatments are effective, but only to a point. This medical disorder will benefit from new therapies that can impact the underlying biology of rosacea and provide improved control of the mechanism of rosacea and improved quality of life for patients.

References

  1. American Academy of Dermatology. Rosacea: who gets and causes. www.aad.org/skin-conditions/dermatology-a-to-z/rosacea/who-gets-causes. Accessed April 15, 2013.
  2. National Rosacea Society. Red alert: rosacea harbors social minefield for more than 16 million Americans. www.rosacea.org/press/20130401.php. April 1, 2013. Accessed July 15, 2013.
  3. National Rosacea Society. Rosacea awareness spotlights social impact, warning signs. Rosacea Rev. Spring 2013. www.rosacea.org/rr/2013/spring/article_1.php. Accessed May 23, 2013.
  4. Berg M, Lidén S. An epidemiological study of rosacea. Acta Derm Venereol. 1989;69:419-423.
  5. Abram K, Silm H, Oona M. Prevalence of rosacea in an Estonian working population using a standard classification. Acta Derm Venereol. 2010;90:269-273.
  6. .McAleer MA, Fitzpatrick P, Powell FC. Papulopustular rosacea: prevalence and relationship to photodamage. J Am Acad Dermatol. 2010;63:33-39.
  7. Woolery-Lloyd H, Good E. Acne and rosacea in skin of color. Cosmet Dermatol. 2011;24:159-162.
  8. National Rosacea Society. Widespread facial disorder may be linked to genetics. Press release. June 2, 2008. www.rosacea.org/press/archive/20080602.php. Accessed April 15, 2013.
  9. National Rosacea Society. Rosacea triggers survey. www.rosacea.org/patients/materials/triggersgraph.php. Accessed April 15, 2013.
  10. Del Rosso JQ, Gallo RL, Kircik L, et al. Why is rosacea considered to be an inflammatory disorder? The primary role, clinical relevance, and therapeutic correlations of abnormal innate immune response in rosacea-prone skin. J Drugs Dermatol. 2012;11:694-700.
  11. Sattler EC, Maier T, Hoffmann VS, et al. Noninvasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy. Br J Dermatol. 2012;167:1042-1047.
  12. Zhao YE, Wu LP, Peng Y, Chang H. Retrospective analysis of the association between Demodex infestation and rosacea. Arch Dermatol. 2010;146:896-902.
  13. Forton FM.Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link.J Eur Acad Dermatol Venereol. 2012;26:19-28.
  14. Yamasaki K, Kanada K, Macleod DT, et al. TLR2 expression is increased in rosacea and stimulates enhanced serine protease production by keratinocytes. J Invest Dermatol. 2011;131:688-697.
  15. Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. 2002;46:584-587.
  16. Baldwin HE. Diagnosis and treatment of rosacea: state of the art. J Drugs Dermatol. 2012;11:725-730.
  17. National Rosacea Society. New patient survey defines progression of rosacea. July 8, 2013. www.rosacea.org/weblog/new-patient-survey-defines-progression-rosacea. Accessed July 18, 2013.
  18. National Rosacea Society. Rosacea patients feel effects of their condition in social settings. Rosacea Rev. Fall 2012. www.rosacea.org/rr/2012/fall/article_3.php. Accessed April 12, 2013.

Filed Under: ROSACEA QUESTIONS

Do I Have Rosacea? Diagnosing Rosacea Correctly

Have you been asking yourself “Do I have Rosacea or is this some other type of skin condition?” Perhaps someone suggested to you, that you have it. If so, then you are not alone. Rosacea is a very common skin condition that many people often battle with. It causes redness on the cheeks, nose, chin and even on the forehead. It may also cause soreness & burning in the eyes and some people may also get pimples & pustules on the inflamed areas of their face.

Who Should More Likely Be Asking Do I Have Rosacea?

People who are more prone to this type of skin condition include;

  • Those between age 30 and 60
  • People with fair skin- often with blond hair & blue eyes
  • Those of Scandinavian or Celtic ancestry
  • If there is someone in the family tree that has had the same condition
  • Those who have had lots of acne
  • Women also tend to be affected more than men

Although many people can be affected by this disorder, if you fall into any (or all) of the above group(s) of people, the question “Do I have rosacea?” is one that you more likely should be asking yourself. More especially so, if you are experiencing some of the following symptoms.

Do I Have Rosacea or Something Else?

This skin condition may be mistaken for any other skin disease and this is why it is important that you understand its signs and symptoms in order to accurately resolve the question “do I have rosacea or not”. The signs and symptoms of rosacea have been classified by medical researchers into 4 primary groups. Note that each group requires its own treatment.

1) Erythematotelangiectatic Rosacea – this subtype often affects people with highly sensitive skin and the signs/symptoms include;

  • Swollen skin
  • Flushing & redness at the center of the face
  • Highly sensitive skin that may sting and/or burn
  • Visible broken blood vessels(i.e. spider veins)
  • Dryness, roughness and even scaling of the skin

2) Papulopustular Rosacea – this is very common with middle aged women and includes:

  • Highly sensitive skin that may burn or sting
  • Spider veins (visible broken blood vessels)
  • Oily skin
  • Acne like breakouts that tend to come & go
  • Plaques (i.e. raised patches of skin)

3) Phymatous Rosacea – this is however very rare and at first, the person may have signs & symptoms of another subtype.

  • A skin with a bumpy texture
  • Thickened skin especially on the nose (i.e. rhinophyma), forehead, chin, ears and on the cheeks.
  • Visible blood vessels that are broken may be seen
  • Oily skin
  • Skin pores that appear too large

4) Ocular Rosacea – this affects the eyes. Look for these signs:

  • Very dry eyes that burn, sting, are itchy and very sensitive to light.
  • Blurred vision and declining eyesight
  • Cysts and visible spider veins on the eyelids
  • Bloodshot or watery eyes
  • That gritty feeling as if sand is in the eyes

Common Rosacea Triggers

It is important to note that unlike other skin conditions such as psoriasis, rosacea is not an autoimmune problem (where the immune system begins to fight illegitimate ‘enemies’ causing inflammation). It is more of a “design flaw” in the dermis layer of the skin. Rosacea symptoms usually flare when something causes the facial blood vessels to expand and this is what produces the redness and other symptoms.

Some of the common triggers (things that cause flare-ups) include;

  • Exercise
  • Exposure to sun or/and wind
  • Stress
  • Hot weather
  • Spicy foods
  • Hot baths
  • Alcohol
  • Temperature swings (e.g. from cold to hot or vice versa).

Treating Rosacea

It is often easy for doctors to diagnose this disorder by looking at the pattern of redness in a person’s face. Although there is no cure, physicians will often prescribe some medications and other treatments that always help people control its symptoms and therefore prevent it from worsening.

The most common treatments, according to the symptoms, include the following options;

  • Breakouts and redness: can be treated with: skin creams contain medicines like azelaic acid, metronidazole or brimonidine. Pills like low-dose antibiotics (e.g. doxycycline) can also be used.
  • Dry, sensitive skin: moisturizers, sunscreen and any other product that protects sensitive skin
  • Redness (resulting from the tiny blood vessels): Laser and a certain light treatment referred to as IPL (intense pulse light).
  • Red, dry & irritated eyes: Artificial tears or eye drops containing cyclosporine.
  • Bumpy or thickened skin: Cosmetic surgery

Preventing Rosacea

If you have asked yourself the question “Do I have rosacea?” and believe that the answer is “yes”, then some of the tips that may be helpful include;

1) Visit a dermatologist: This will help you to

  • Receive the necessary treatment (e.g. the necessary medication) that will help to control the disease. Note that, control means that you do not see the rosacea and will not feel symptoms such as burning & itching.
  • Prevent its conditions from worsening (which will otherwise make it difficult to treat).

2) Know your triggers

It is very important that you learn what triggers the flare-ups so as to avoid them. As mentioned above, some of them include; stress, sunlight, certain foods among others. It is also important to note that, what may trigger a flare-up on one person may not be the same on another person and that is why it is very important to learn what triggers yours.

3) Follow a skin care plan

It is also important that you protect your face/skin especially from the harmful sunrays (e.g. by not exposing yourself to the sun between 10 am & 4pm). When outdoors, always remember to wear a visor or a wide brimmed hat and also to use a sunscreen. You should also avoid skin care products that may scratch or irritate your skin

Rosacea can also affect the quality of life and reports have shown that living with this condition may cause feelings of embarrassment & frustrations worry low self esteem, work related problems, anxiety and even depression.

Please Note:- If you’re not comfortable with some of the pharmaceutical or other ‘medical profession’ type remedies outlined above and prefer natural solutions, we have a whole section dedictated to Natural Remedies for Rosacea.

Filed Under: ROSACEA QUESTIONS, ROSACEA SYMPTOMS

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