What Can Be Done for Rosecea?.?

Treatment Pales Rosacea’s Red Face
by Margie Patlak

When she was a teenager and her friends were bemoaning the
whiteheads and blackheads erupting on their faces, Marcia Meyer of
Kensington, Md., had a clear, ruddy complexion. She was surprised,
then, when her face broke out in pimples for the first time when she
was in her 20s. Feeling she was “too old for this,” Meyer says, and
upset over her appearance, she went to see her dermatologist, who
told her she had a skin disorder known as rosacea.
Although few people are familiar with the disease, rosacea is a
common skin disorder that afflicts about 1 in 20 people in this
country, estimates dermatologist and rosacea expert Jonathan Wilkin,
M.D., of Ohio State University in Columbus. Despite its prevalence,
many people with the condition go undiagnosed, he says.
Wilkin has seen patients who seek care for other skin disorders
and don’t realize they have rosacea until he points it out to them.
“Most people with rosacea are surprised to hear it’s something the
medical field can help them with,” he says, “because they think it’s
just a complexion problem that runs in their family.”
The disorder can be effectively curbed with various drugs, laser
treatments, and surgery, including products regulated by the Food and
Drug Administration, as well as by preventive measures. Without
proper care, in contrast, rosacea may progress to a more disfiguring
condition.
Although it can occur among adults of any age and of any skin
color, rosacea is more prevalent among fair-skinned people between
the ages of 30 and 50. The disease is more common in women, but more
severe when it strikes men. People who flush easily are more prone to
rosacea, as are people with peaches-and-cream complexions, including
many with Irish, English, or Eastern European ancestry, a survey by
the National Rosacea Society suggests. The tendency towards rosacea
appears to be inherited; often several people in a family have the
condition.

Red Mask
Rosacea usually begins with frequent flushing of the face,
particularly of the nose and cheeks, although sometimes the redness
spreads to the chin and forehead as well. The flushing is caused by
swelling of the blood vessels under the skin of the face and can last
as little as a few minutes to as long as a few hours. In most cases,
however, eventually the blood vessels stay dilated and a sunburn-like
redness becomes a permanent feature on the central areas of the face.
This red mask can serve as a red flag for attention. Meyer notes
that people tend to tease her about being out in the sun too much.
“I’m probably the only person who uses makeup to tone down her face,
rather than the reverse,” she says.
Once the redness becomes permanent, it often is accompanied by
pus-filled or solid red pimples. There are no blackheads or
whiteheads with rosacea, and the pimples are usually limited to the
central portion of the face. Thin red lines that resemble a road map
also tend to surface. These lines are actually small blood vessels in
the upper layers of the skin that have become enlarged. If rosacea is
not treated, a condition called rhinophyma can develop in some
people. Rhinophyma occurs much more frequently in males than in
females. The hallmark of rhinophyma is a big bulbous red nose like
the one sported by the late comedian W.C. Fields, who had rosacea
with rhinophyma. The nose can also become thicker at the base.
This disfiguring condition “has never killed anyone,” notes
Wilkin, “but it has ruined a lot of lives.”
Rosacea can also cause a persistent burning and grittiness of
the eyes or inflamed and swollen eyelids. In severe cases, vision may
become impaired.

Waxing and Waning
Rosacea is a chronic ailment that waxes and wanes. Between
flare-ups, some people have no signs of the disorder. But other
people still have facial redness or red lines, accompanied by pimples
during flare-ups.
Dermatologists usually diagnose rosacea by its symptoms; no
tests are available, but on rare occasions skin biopsies can pinpoint
the condition. Few people with rosacea have all the symptoms of the
disorder, which can make it tricky to diagnose at times, Wilkin
admits. He strongly suspects rosacea in people with just a few
symptoms of the disorder if other people in their family have the
condition.
There is also a condition known as steroid-induced rosacea,
which occurs in some people after applying corticosteroid ointments
to their face for a long period to treat eczema or other rashes. The
onset of this condition is sudden. The same telltale redness,
pimples, and thin, wavy red lines appear on the face as in standard
rosacea, but people with steroid-induced rosacea usually have these
symptoms wherever the steroid ointment was applied–up to the
hairline–and not just centrally located on the face, for example.
People with steroid-induced rosacea also often have a distinctive
shine to their facial skin.
Steroid-induced rosacea is treated first by stopping the steroid
and then by taking the same medications as with standard rosacea.
Although it can take several months of treatment before symptoms
subside, steroid-induced rosacea is not likely to recur unless
corticosteroids are applied again on the face. Less commonly, oral or
inhaled corticosteroids can also induce rosacea.

Searching for a Cause
Although dermatologists have been speculating about causes for
standard rosacea for more than a century, none have been definitively
proven. Most experts think the condition can be provoked by several
different factors, some of which may work together to cause rosacea.
One might be an underlying vascular disorder that causes blood
vessels in the face to expand and fluid to build up in the skin. This
fluid can trigger an inflammatory response that manifests as facial
pimples or excess tissue growth on the nose.
Wilkin says several findings support this theory. One is that
researchers detected structural abnormalities in the small blood
vessels in the facial skin of patients with rosacea. Another is that
rosacea worsened when people with the condition take drugs such as
theophylline and nitroglycerin, which dilate blood vessels. Also,
people with rosacea are more likely to suffer from migraines, which
are also thought to be caused by a vascular disorder. A vascular
cause for rosacea might also explain why the condition is more common
in older women, who are more likely to have swelling of the facial
blood vessels as part of the menopausal “hot flashes.”
In addition to vascular disorders, another factor that might
play a role in fostering rosacea is a microscopic mite by the name of
Demodex folliculorum. This mite, a normal resident in human skin,
lives in hair follicles, where it dines on cast-off skin cells. They
have been retrieved from almost every area of human skin, but they
have a taste for the face.
Two recent studies revealed that the mites were significantly
more numerous in facial skin samples of people with rosacea than of
people without the condition. In addition, the mite population peaked
on the skin samples of these patients in the spring, when rosacea
tends to flare up. The studies were done by Frank Powell, M.D., and
colleagues at the Mater Misericordiae Hospital in Dublin, Ireland,
and by F. Forton, M.D., and B. Seys, M.D., of the Saint Pierre
University Hospital in Brussels, Belgium.
According to Powell, other studies show that patients with
steroid-induced rosacea also had a boosted mite population on their
faces. This population dropped when the rosacea subsided after
treatment with an ointment that kills mites.
Although these findings do not prove that the skin mite causes
rosacea, they do suggest that Demodex might play a role in fostering
the disorder. The mites may provoke rosacea by clogging skin
follicles, which in turn might trigger an inflammatory response.
Rosacea may also be triggered by an allergic-like reaction to these
skin mites or to the bacteria the mites harbor. Forton proposes that
an underlying vascular disorder of the face that fosters flushing
could create an environment particularly hospitable to Demodex mites.
These mites could then multiply excessively or penetrate more deeply
into the skin, triggering an inflammatory response in the form of
pimples.

Other Flare-Up Triggers
Several other factors have been found to aggravate (but not
necessarily cause) rosacea, mainly by triggering flushing. These
factors include drinking hot beverages, smoking, certain emotions
(such as worry and anxiety), spicy foods, large meals, exposure to
temperature extremes, wind, excessive sunlight, and overindulgence in
alcohol. (Although alcohol can worsen rosacea, a nondrinker can
develop a case of rosacea just as severe as someone fond of alcohol.)
Make-up, moisturizers, sunscreens, or other skin products used on the
face that contain alcohol or other irritating ingredients can also
foster a rosacea flare-up.
What worsens one person’s rosacea may not have any effect on
another person’s symptoms–it’s very individual. “Many patients can
actually reduce or eliminate the need for medications to control
their rosacea,” said Wilkin, “by avoiding the factors that trigger
it.”

Treatment Effective
If preventive measures aren’t effective, however, the pimples
can often be effectively treated with certain drugs. FDA has approved
Metrogel (metronidazole), a topical antiprotozoal and antibacterial,
to treat rosacea. Doctors may also use several other approved drugs
to treat rosacea-induced acne. Such drugs include oral and topical
antibiotics, particularly those in the tetracycline family, and these
are also often used to treat eye manifestations of rosacea. (Pregnant
women should not take tetracycline because it can discolor the unborn
child’s teeth.)
Such therapy for acne is effective in about three-quarters of
rosacea patients, usually within a few months, according to
dermatologist Seymour Rand, M.D., of FDA.

Removing Unsightly Vessels
Wilkin says that some rosacea patients find antibiotic therapy
not only relieves their acne, but also decreases facial redness,
which had been hiding the spidery red lines of enlarged blood
vessels. Dermatologists can usually rid the face of these enlarged
blood vessels by destroying them with an electrical needle or a
laser. Patients who have this treatment experience little or no
discomfort. Their faces may look somewhat bruised for about a week
after the procedure, and may scab, peel or crust.
To treat the more extensive facial redness, dermatologists can
use lasers to destroy the expanded blood vessels in the skin that
cause it. One recent study by San Diego dermatologist Nicholas Lowe,
M.D., and associates found laser therapy effective in more than
three-quarters of treated patients. In more than half of those, the
therapy not only rid the face of the redness or red lines, but also
stemmed the acne. This finding further supports a vascular cause for
rosacea, according to Wilkin.
Lasers or electrical devices are also used to remove the excess
tissue that accumulates on the nose in patients with rhinophyma. The
tissue can also be removed with a scalpel or a rapidly rotating wire
brush, which is often used by dermatologists to scrape away tissue in
a procedure known as dermabrasion. Local anesthesia numbs patients’
noses before treatment. The nose looks red for a year or so following
tissue removal and then assumes a normal skin color, according to
Wilkin. “I’ve seen people whose noses were the size of baseballs look
great after treatment,” he says.
One of the most difficult barriers to countering rosacea is
convincing people with the disorder to seek care. Even after Meyer
knew she had rosacea, for example, she delayed seeking medical
treatment for a flare-up because she thought the emotional stress she
was experiencing at the time was behind her “acne.”
“Even though my personal problems hadn’t gone away,” she said,
“within a week of treatment, my ‘acne’ did. My appearance improved so
quickly, I wished I hadn’t waited so long to see my dermatologist. I
hope others won’t be so slow to go to the doctor.”
Many people don’t see a doctor because they don’t realize they
have a condition that can be treated. But as Wilkin notes: “People
with rosacea can be very hopeful, whatever stage they’ve got, because
there’s something that can be done for everyone.”
Margie Patlak is a writer in Elkins Park, Pa.
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You should call back your dermatologist and have him adjust your Metro cream. My doctor prescribed one with sulphur in it which is a common ingredient but it was irritating my skin. My skin was burning and peeling within two days of use. When the sulphur was removed the cream worked wonders. The only other solution would be laser treatment to shrink the blood vessels. You can always ask your doctor to refer you to someone who does this. I will look into it. The cream is good but as you know it does not cure it, it only reduces or relieves the symptoms of Rosecea. I have been using it for about three and a half years now.