Rosacea: Symptoms, Causes, Triggers and Treatments

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Rosacea is a severe or chronic inflammation of the capillaries of the facial skin which causes the facial skin to redden. The redness (known as erythema) of the face, and the flushing of the skin are common symptoms but in more severe cases which are not uncommon, sufferers can also experience hard pimples (papules) or pus-filled pimples (pustules).  Small visible spider-like veins called telangiectasias develop, the skin can become blotchy and can look like alcohol-related redness and acne where the spots occur.  Rarely, and in later stages of the disease, and usually only in men, the face swells, the skin can thicken and the nose may take on a bulb-like appearance which is called rhinophyma.

Rosacea  typically affects areas of the face, particularly the cheeks, nose, forehead, and chin, but it can also affect the neck, back, scalp, arms, and legs. Sufferers can also suffer dry eyes and sore eyelids. 

The problem typically first occurs when people are in their 30s and 40s. Rosacea affects 1 in 10 people usually in middle age.

Symptoms

Although there are similarities in the symptoms rosacea and acne are not connected. Rosacea skin can have pimples and papules which are similar to acne but unlike with acne blackheads are never a symptom.

The early symptoms of rosacea are repeated red flushes which can be accompanied by a sensation of heat. Triggers for flushes can include hot drinks or sunlight or exercise.  Rosacea can develop over time so areas of the face becomes persistently red and small spidery veins called telangiectasia appear on the nose and cheeks, and can be accompanied by inflamed papules and pustules.

In severe cases the skin may take on a roughened, orange peel texture. Very late in the disorder, and only for a small group of patients, particularly men,  a condition called rhinophyma can develop were the skin thickens and can give the nose a bulb-like look.

Up to one half of patients with rosacea may experience symptoms related to their eyes. Ocular rosacea often precedes the other manifestations on the skin. The symptoms do not threaten sight, but spidery veins appear around the borders of the eyelids can become chronically inflamed and small lumps called chalazions may develop. In a small number of cases the transparent cover over the eye’s lens, the cornea, can also be affected and in rare cases vision will be affected.

Causes

The specific causes of rosacea are unknown although there are a number of consistent factors: most patients will have a history of redness and flushing.

Multiple factors may be a causal influence of symptoms and combine over time to create an overreaction of the facial blood vessels which make the flushing a permanent condition.

Certain genetic factors may also come into play: The disease is more common in women and light-skinned, fair-haired people as well as people from a Celtic background, although this is an area of disagreement among experts.

Some success has been achieved with antibiotic treatments of rosacea which suggests a bacterium or other infectious agent may be a factor. Helicobacter pylori, believed to be a causal factor many cases of stomach ulcers has been suggested by some but challenged by others. One theory is the bacteria may stimulate the production of a protein called bradykinin, which is known to cause blood vessels to expand.

Other studies have observed that a particular parasite, the mite Demodex folliculorum, can be found in areas of the skin affected by rosacea  but the mite can also be detected in the skin of people who do not have the disease. The mites usually live harmlessly on human skin, but people with rosacea have particularly large numbers, which may play a role in the condition but no one is sure if the mite is a cause or an effect. Some researchers have suggested the symptoms may be caused by the skin reacting to bacteria in the mites’ faeces.

In short neither doctors nor scientists know the causes of rosacea and treatment relies on eliminating likely causal factors and relieving the symptoms to ease the worst effects.

Triggers

Recent research has shown external triggers can lead to the activation of certain molecules within the skin called peptides. Increased levels of these peptides may in turn affect the immune system or nerves and blood vessels (neurovascular system) of the skin. Activation of these systems can cause dilation of blood vessels, redness and inflammation.

The problem is different people can have different triggers, but there are some consistencies:

  • exposure to sunlight
  • humidity
  • wind stress
  • extremes of heat and cold
  • stress, anxiety, anger, embarrassment
  • strong winds
  • strenuous exercise
  • hot baths and saunas
  • alcohol
  • hot foods and drinks
  • spicy foods
  • dairy products
  • caffeine – found in tea, coffee and cola
  • allergies from chemical ingredients in makeup
  • the menopause
  • other medical conditions
  • certain medicines – such as amiodarone, corticosteroids and high doses of vitamins B6 and B12

Tests and diagnosis of rosacea

There is no clinical test for rosacea and diagnosis is reached after examining the patient’s skin, and asking about symptoms and triggers. The presence of enlarged blood vessels will help the physician distinguish it from other skin disorders.  The presence of a rash on the scalp or ears usually indicates a different or co-existing diagnosis. Rosacea signs and symptoms are mainly on the face.

Treatments

Never ever exfoliate — it can damage and exaggerate the problem.

Never use a thermal mask or cleanser — it can open up the capillaries, making the skin more red.

Protect yourself from the sun — by wearing a hat and using a Chemical Free moisturiser with  Zinc based SPF

Soothe the skin — with Aloe Vera, Chamomile and Calendula. These are Vasoconstrictors in plant form, and have the constrictive properties of aminophyllines and theophyllines.

Use a facial cleanser without chemicals — chemicals can cause the skin to be ultra sensitive  as well as  strip the skin of it of its natural oils.

If you use make up, use mineral make up — ordinary Make up can have harsh chemical ingredients.

Eliminate trigger events — don’t take a sauna or a hot shower or bath in warmer than lukewarm water and always use lukewarm water on your face.

Eliminate trigger foods that make your face flush — try to eliminate them from your diet or at least be aware of them. Cut back on foods that contain histamines or 5-HT, which is the precursor to histamine and is present in eggplant, avocado and bananas. And then other things that make you flush, like red wine or hot water.

Take measures to avoid or counter stress — easier to say than do. Consider yoga or meditation…

 

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