Rosacea is a progressive inflammatory vascular disorder that is characterized by four stages. It primarily affects the central part of the face & is recognized by facial redness, & can be accompanied by spots. It rarely affects the scalp, neck, chest or other areas. In severe cases, particularly in men, the soft tissue of the nose may swell, producing a bulbous enlargement know as rhinophyma.

Cause
Cause is unknown, though it is a genetic vascular disorder. Its mainly seen in Caucasians with light skin & hair.
Symptoms usually begin between the ages of 30 & 50.
Women are 3 times more likely than men to develop Rosacea, however men tend to get more severe symptoms.

Development of Rosacea

Pre-Rosacea

This is where a person flushes to a stimulus, but returns immediately to normal when the stimulus is removed.

Blood vessels dilate to stimuli, open wider & stay open for longer periods of time compared to a normal person.
No visible damage can normally be seen. Begins with sudden reddening of the face.
Generally inherited, & made worse by incorrect product usage.

Stage 1 (Early Stage)
Frequent flushing occurs ½ hour or more after a trigger (i.e. alcohol intake or very hot/cold environment, irritating ingredient). The nose & cheeks become very red & may take days to disperse.

Tends to appear on more sun exposed i.e. cheeks & nose spreading out to the sides.
Clients complain of sensitivity, itching, burning, & lowered tolerance to skin care products

Stage 2 (Middle Stage)
Vascular damage occurs due to frequent intense facial flushing resulting in long lasting redness, swelling & inflammatory spots.

Broken veins become evident
Inflammation is present, with pimples & spots resembling acne type breakouts, which can cause confusion between recognizing the condition as either Acne or Rosacea. ( Rosacea was once called “Acne Rosacea” because of this & acne medication was sometimes prescribed in error for the condition. It is now known that acne is a completely different skin condition to Rosacea & must never be confused)
Genetically the capillaries lose elasticity. When elasticity is broken, the vessel walls become weak & leaky. The stagnation of blood prevents removal of toxins, waste & CO2 from the area. Therefore skin has to eliminate the toxins & waste through the skin in the form of spots & pustules consisting of lymph fluid only, & must not be squeezed.

Stage 3 (Advanced)
Swelling of the tissues now occurs as the blood vessels become leaky and the lymph cannot be removed fast enough.

As the facial tissues become more swollen, sebaceous (oil) glands enlarge on cheeks & nose.
Inflammation, swelling & broken veins
Disfigurement of facial contours can begin, the skin becomes coarse thickened & irregular

Untreated Stage 3
In severe cases of rhinophyma, sufferers develop large inflammatory nodules, furuncles, tissue hyperplasia, & hypertrophies of the chin, cheeks, forehead, ears & nose.

Ocular or Opthalmic Rosacea

• Persistent burning & grittiness in eyes
• Inflamed or swollen eyelids, & bloodshot eyes
• Eyelashes sometimes fall out
• Rosacea keratitis has an unfavourable prognosis, & in extreme cases can lead to blindness.
• Most frequent symptoms are chronically inflamed margins of eyelids with scales & crusts similar to seborrheic dermatitis
• Pain & photophobia may be present
• Ophthalmic complications are independent of the severity of facial Rosacea.

Rosacea is commonly confused with Acne, due to the spotty breakouts that can sometimes accompany Rosacea. Rosacea was once known as Acne Rosacea, but that is now obsolete. Here are the differences:

Some doctors confuse rosacea with acne due to the appearance of pustules which can resemble acne. They subsequently wrongly prescribe acne medication. Some acne medications such as roaccutane will worsen a Rosacea condition. Roaccutane medication is only for Acne sufferers & not for Rosacea sufferers, because roaccutane shrinks the oil gland to reduce oil production. Rosacea sufferers do not have oily skin, so do not need this. Roaccutane will sensitise the skin & make it very dry so will exacerbate a Rosacea condition.

Roaccuane users cannot have facial waxing, electrolysis, or use facial exfoliating products as the skin will be too thin to use them. Regular liver checks are necessary due to its toxicity. Skin may remain permanently dry when a client ceases using roaccutane. High suicide rates are common in roaccutane patients, & it may be withdrawn from the Irish market soon because of this.

Roaccutane can work very well for severe acne patients, but is always a last resort when nothing else works.

Careful monitoring of what causes flare-ups on an individual basis should be recorded. Modifying lifestyle can increase clearance of Rosacea i.e. eating habits, stress levels, gentle products & limiting factors that contribute to flare ups.

What Causes Flare Ups?
Stress & Fatigue: Stress stimulates the nervous system, which causes dilation of blood vessels flushing the skin.

Menopause: Lowered oestrogen levels trigger hot flushes worsening Rosacea.
Sun Exposure/ Extreme Weather: A major factor, which increases blood flow to the skin. The sun can also cause lymphatic damage, causing degeneration of elastin & collagen fibres.

Diet: Alcohol, cola (aspartame & NutraSweet), caffeine, spicy food, hot soups, chocolate, tomatoes, citrus fruits & histamine producing foods will trigger flare ups. Heavy meals will cause flushing as the body tries to digest the meal. Eating regular small meals is advised.

Smoking: Lack of vitamin C, depleted by smoking causes weaker capillaries & robs skin of oxygen. Sometimes this is the cause of broken veins.

Exercise: Cardiovascular exercise is not recommended for Rosacea sufferers. Clients should be advised to exercise gently, to avoid flushing skin.

Incorrect Skincare & Cosmetic Usage:Certain cosmetic ingredients should be avoided especially those found in acne treatments as it can exacerbate the condition. Gentle products must be used.A daily Sunscreen is imperative , Skincare products should have anti-inflammatory and natural antibiotic benefits. Mineral make up is also advised, as it is chemical free & oil free

Avoid
Oil based skincare & Make up, because oil retains heat in the skin & aggravates rosacea. Use water based or oil free foundation instead i.e Minerals foundation, which is also chemical free, so is gentle for sensitive skins

Rosacea Treatments at Mi Skn Clinic: A course of Laser Genesis treatments are recommended, with intervals of about a month apart is a fantastic treatment to dramatically reduce redness & clear inflammation. Usually about 3 treatments are necessary, depending on severity.

Medical Treatments For Rosacea

• Antibiotics i.e. Tetracycline.Topical cream. i.e. Protopic (Non steroidal cream)
• Anti Inflammatory Diet (Foods that are alkaline reacting in the body, rather than acid reacting)

Alkaline diet reduces inflammation in the body:
Tomatoes, potatoes, peppers, white bread, white rice, red meat, shellfish, caffeine, alcohol, fried food, sugar, sweets, biscuits cakes. (Arthritis sufferers – avoid citrus & dairy also)

80% of diet should be: fresh veg, salad, fruit, drink more water.

20% of diet should be: grains, i.e. brown wholemeal bread, brown pasta, brown rice, sweet potatoes, Turkey, chicken, lamb

Breakfast: Porridge, muesli, weetabix ideally.(Special K, Corn flakes allowed sparingly)

Low fat dairy: skim milk, low fat cheese, low fat yogurts.(natural yogurt, vanilla yogurt preferred, as less sugar).Butter should be salt free, but full fat – use sparingly. No hydrogenated spreads!

Salad dressings: olive oil, lemon juice, apple cider vinegar.

Supplements: Lecithin granules – 3 tbsp daily (over cereal, yogurts, salad), Slippery elm bark powder daily (repairs intestinal wall- to impede leaky gut). Omega 3 fish oils daily. Olive oil (3 tbsp daily)

Snacks: almonds. Low fat yogurt – especially natural & vanilla flavour, as less sugar, fresh fruit, dried apricots, raisons, popcorn, tortilla chips. (In moderation!)

Water: 6 – 8 glasses daily

Fruit to eat alone: always eat apples, melon, bananas alone, never with other foods. (or else they become acid reacting in the body)