What is Rosacea?

Rosacea is a skin condition typically appearing in people during their 30s and 40s. It affects the middle third of the face, causing persistent redness (erythema) over the areas of the face and nose that normally blush -- mainly the forehead, the chin and the lower half of the nose. It is marked by the presence of hard pimples (papules) or pus-filled pimples (pustules), and small visible spider-like veins. The tiny blood vessels in these areas enlarge (dilate) and become more visible through the skin, appearing like tiny red lines (called telangiectasias). In later stages of the disease, the face may swell and the nose may take on a bulb-like appearance called rhinophyma.

The pimples that occur in rosacea resemble teenage acne. In fact, rosacea is frequently mistaken for acne and is also referred to as acne rosacea.

What are the signs and symptoms of rosacea?
Rosacea typically causes inflammation of the skin of the face, particularly the forehead, cheeks, nose, and chin. When rosacea first develops, it may appear, then disappear, and then reappear. However, in time the skin fails to return to its normal color and the enlarged blood vessels and pimples arrive. Rosacea rarely reverses itself. It lasts for years and, if untreated, it will worsen. Rosacea does not cause the blackheads and whiteheads that are in common acne.

Is rosacea like acne?
Rosacea is basically different than acne. Unlike common acne, rosacea is not primarily a plague of teenagers, but occurs most often in adults (ages 30 to 50), especially those with fair skin.

Like acne, the skin can have pimples and papules. Unlike acne, however, people with rosacea do not have blackheads.

In early stages of rosacea, people typically experience repeated episodes of flushing. Later, areas of the face are persistently red, telangiectasia appear on the nose and cheeks, as well as inflamed papules and pustules. Over time, the skin may take on a roughened, orange peel texture. Very late in the disorder, a small group of patients with rosacea will develop rhinophyma, which 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, as it is called, frequently precedes the other manifestations on the skin. Most of these eye symptoms do not threaten sight, however. Telangiectasia may appear around the borders of the eyelid, the eyelids may be chronically inflamed, and small lumps called chalazions may develop. The cornea of the eye, the transparent covering over the lens, can also be affected, and in some cases vision will be affected.

Rosacea strikes both sexes. It tends to be more frequent in women but more severe in men.

What causes rosacea?
The cause of rosacea is unknown. A history of redness and flushing precedes Rosacea in most people. Furthermore, rosacea tends to affect the "blush" areas of the face. Emotional factors (stress, fear, anxiety, embarrassment, etc.) may trigger blushing and aggravate rosacea. A flare-up can be caused by changes in the weather like strong winds or a change in the humidity. Sun exposure generally aggravates rosacea.

The consensus among many experts is that multiple factors may lead to an overreaction of the facial blood vessels, which triggers flushing. Over time, persistent episodes of redness and flushing leave the face continually inflamed. Pimples and blood-vessel changes follow.

Certain genetic factors may also come into play, although these have not been fully described. The condition is more common in women and light-skinned, fair-haired people. It may be more common in people of Celtic background, although this is an area of disagreement among experts.

Certain antibiotics are useful in the treatment of rosacea, leading some researchers to suspect a bacterium or other infectious agent may be the cause. One of the newest suspects is a bacterium called Helicobacter pylori, which has been implicated in causing many cases of stomach ulcers but the evidence here is mixed.

Demodex folliculorum - Parasites

Other investigators have observed that a particular parasite, the mite Demodex folliculorum, found in hair follicles may play a role in the development of rosacea. The mite can also be detected, however, in the skin of people who do not have the disease. It is likely that the mite does not cause rosacea, but merely aggravates it.

Demodex live around these follicles and have four short legs, choosing to move mostly at night. The level of infestation increases with age. This infestation is a world-wide phenomenon called "demodicosis" and is usually symptom-free. Reactions and accompanying inflammation can occur in humans. It also occurs in animals, including family pets, leading to skin irritation, hair loss and red rash.

Fresh skin scrapings viewed under a microscope can reveal the mites which feed on dead cells and skin fats.

The prevalence of this mite in people with rosacea has been recorded as significantly higher than people without rosacea:

an infestation of 51% in rosacea;

an infestation of 28% in eczema;

an infestation of 31% in lupus discoides.

The highest density of mites present on the cheeks in people with rosacea and antibiotic usage at the end of one month showed no statistically significant difference in mite density.

It is possible that the increased number of demodex mites in rosacea cases plays a part in rosacea by provoking inflammatory or allergic reactions by blocking follicles or by assisting the survival of micro-organisms,

Bacteria

The bacteria Heliobacter pylori (that is associated with stomach ulcers) and medications like vasodilators (that cause blood vessels to widen) have also been thought possibly to bring out rosacea.

Treatment

Many people are able to avoid outbreaks by reducing things that trigger flushing. Alcoholic beverages, hot beverages, and spicy foods are among the more common factors in the diet that can provoke flushing. Reducing or eliminating these items in the diet can help limit rosacea outbreaks in many people. Exposure to heat, cold, and sunlight are also known triggers of flushing. The specific things that provoke flushing vary considerably from person to person, however. It usually takes some trial and error to figure these out.

Treatment of dermatological imperfections such as acne and rosacea has received relatively little investigative attention. And while such imperfections may not be considered as aesthetically unpleasant or inconvenient, they are nonetheless undesired imperfections.

The aesthetic treatment of abnormal dermatological conditions such as acne and rosacea has hitherto involved using topical treatments, physical methods of pore extraction, and oral antibiotics as well as oral retinoids. Investigation of treatments has been concentrated primarily on the use of antibiotics, steroid therapies, and low intensity blue light for photochemical therapy.

Dermatology Treatment

Dermatologists, while unable to cure rosacea, have a variety of treatments that diminish the disease’s signs and symptoms. According to a study of 1,077 rosacea patients, 87 percent said their rosacea was under control with treatment. Today’s treatments range from topical products and oral medications to treat the papules and pustules, to laser therapy for treating visible blood vessels on the face and laser surgery for rhinophyma.

Dermatologists often use a combination of treatments, depending on individual patients’ needs. Sometimes doctors prescribe both an oral antibiotic and a topical product.

Medications
Doctors prescribe topical antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria A common topical antibiotic prescribed is metronidazole (Metrocream, Metrogel, Noritate). Another prescription medication is azelaic acid (Azelex, Finacea), which reduces redness and inflammation.

Oral antibiotics also are prescribed because they tend to work faster than topical ones. In many cases, dermatologists first prescribe both oral and topical antibiotics to lessen signs and symptoms, followed by long-term use of a topical antibiotic alone to maintain remission. Some of the most common prescription oral antibiotics include tetracycline, minocycline, doxycycline and erythromycin.

Isotretinoin (Accutane) is a powerful medication sometimes used for more severe cases of inflammatory rosacea. Doctors don't prescribe it for the treatment of mild cases or for telangiectasia or for redness of the face. Usually prescribed for cystic acne, it works to inhibit the production of oil by sebaceous glands. People who take it need close monitoring by a dermatologist because of the possibility of serious side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in an Food and Drug Administration-approved monitoring program to receive a prescription for the drug. In addition, isotretinoin may increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels. For most people, however, these levels return to normal when the medication is stopped.
Your doctor may treat ocular rosacea with oral antibiotics.

The duration of your treatment depends on the type and severity of your symptoms, but typically you'll notice an improvement within one to two months. Because symptoms may recur if you stop taking medications, long-term regular treatment is often necessary.

Surgical
Enlarged blood vessels, some redness and changes due to rhinophyma often become permanent. In these cases, surgical methods, such as laser surgery and electrosurgery, may reduce the visibility of blood vessels, remove tissue buildup around your nose and generally improve your appearance.

Alternative treatment

Some reports advocate gentle circular massage for several minutes daily to the nose, cheeks, and forehead. Controlled studies are lacking, however.

A deficiency in hydrochloric acid (HCl) in the stomach may be a cause of rosacea, and supplementation with HCl capsules may bring relief in some cases.

Sun and Rosacea

Avoid the sun (between 10 am - 3pm).

Use sunscreen (UVA/UVB - SPF 15 or higher).

Wear a hat with a 3 inch brim (protects neck, ears, eyes and scalp).

Wear sunglasses (protects eyes).

Cover up (sun protective clothing, long sleeved shirts, pants). Avoid artificial tanning (tanning beds, sun lamps).

Check skin regularly (dry, scaly, reddish, and slightly raised lesions).

If you are taking medications, your doctor or pharmacist should be consulted to see if the medications will sensitize the skin to the sun and aggravate sunburn or rashes.

Common drugs which may do this are certain antibiotics, birth control pills, diuretics, antihistamines and antidepressants.

Topical Rosacea & Acne Treatment

The dermis is composed of cellular and extracellular constituents that interact with one another to form a highly ordered, yet quite dynamic structure. Other than water, the major components of the extracellular matrix are collagen, elastic fibers, fibronectin, glycosaminoglycans, and proteoglycans.

BIOBALM stimulates growth and remodeling of the dermal extracellular matrix, "bulks-up" the tissues and alters the milleau surrounding the hair follicle and sebaceous glands. Enhancing the body's own healing response promotes growth of dermal collagen and other extracellular matrix in the area surrounding the hair follicles. This reorganization of dermal collagen affects the structure and function of sebaceous glands, altering their activity and reducing the incidence, severity and appearance of erythematous papules such as, but not limited to, rosacea, and both inflammatory and comedonal, papular and pustular acne.

Acne-prone skin is erythematous not only in areas of active acne, but also in areas where acne has previously occurred, or where it is about to occur. In addition, acne lesions often have excess melanin pigment in the area where inflammation has caused deposition of excess epidermal melanin in the superficial dermis and in the area of the hair follicles.

BIOBALM can also treat other conditions that result in erythematous papules, such as rosacea. As such, the term erythematous papules is meant to include, but not be limited to, acne and rosacea.