Rosecea

 

Rosacea is a red facial rash and is one of the most common skin conditions in Ireland. It may be transient, recurrent or persistent.

 What causes Rosacea?

The cause is unknown and whilst not a food allergy it may be aggravated by foods which cause heat/flushing e.g. spicy foods or alcohol. Many people deteriorate in spring and it is frequently made worse by the sun. It is associated with demodex infection in some individuals (see below).

 It has many manifestations including red/yellow spots, lumps, bumps, scaling, broken blood vessels, flushing and in rare instances overgrowth of the tissues of the nose (rhinophyma). 

It is more common in women and when severe can be associated with the ‘intolerant skin syndrome’ whereby they develop extremely sensitive skin and all topical cosmetics/therapies burn and sting.

 Ocular rosacea is where the eyes are affected and become red, sore and gritty.

•    Demodex folliculorum:

Demodex folliculorum mites are much more frequent in rosacea patients then in control groups. Early vascular and connective tissue changes probably create a favourable setting for a secondary proliferation. Demodex folliculorum may represent an important cofactor especially in papulopustular rosacea, in which a delayed hypersensitivity reaction is suspected, but it is not the cause of rosacea.

 ·       Psychogenic factors:

 Psychological stress may influence rosacea but it is not its primary cause.

 

·       Flushing and vascular pathogenesis:

 Rosacea patients are predisposed to flushing and blushing. Several triggers are known like heat, cold, ultraviolet radiation, emotions, alcohol, spices or hot drinks. Flushing after drinking hot water, coffee or tea is due to pharyngeal warming of the blood per fusing the hypothalamus by counter current heat exchange involving the jugular vein and carotid arteries. Hyperthermia in rosacea patients causes a decrease of blood shunting from the face to the brain. The dysfunction seems to be a microcirculatory disturbance of the facial angular veins (Vena facialis sive angularis) which are involved in the vascular cooling system of the brain. This may lead to a venous congestion and failure of thermoregulation. The facial angular veins drain the parts of the face which are mostly affected by rosacea including the conjunctiva. This could explain the frequent involvement of the eyes. A vascular dysfunction could also be the reason for the increase of migraine headaches in rosacea patients. Rosacea skin reacts normal to various vasoactive chemicals like caffeine or to chemomediators such as epinephrine, acetylcholine or histamine. Vasoactive intestinal peptide  and its receptor are important for blood flow regulation. An increased concentration of the receptor was found in rhinophyma and therefore it is suggested that this may contribute to vascular and dermal alterations in rosacea.

 

·       Genetic:

 The evidence for a genetic predisposition in rosacea is growing. 30-40% of patients with rosacea have a relative with this condition.

 

·       Seborrhoea:

 Experimental studies did not approve an association between rosacea and seborrhoea. Due to the localisation and the effectiveness of isotretinoin some authors suspect that seborrhoea is a factor of rosacea, though sebum production is often not increased in rosacea patients (apart of Rosacea fulminans).

 

·       Light:

 Ultraviolet light plays a major role in rosacea development. It affects the dermal connective tissue as well as lymphatic and blood vessels and could contribute to passive vasodilation. Actinically affected skin is a consistent background of rosacea. Photodamage is common in fair-skinned rosacea patients.

 

·       Endocrine Disease:

 Increases in rosacea during pregnancy, menses or perimenopausal have been noted.

 ·       Lymphatic system:

 Lymphedema is suspected to play a major role especially in the severe form of rhinophyma. A fibrotic dermatitis with many similarities with elephantiasis has been found in rhinophyma patients. Sometimes a chronic facial skin lymph oedema is recognised.

 ·       Medications:

 Some drugs such as amiodarone or nitro-glycerine-like drugs (e.g. nifedipine) may affect rosacea through vasodilatation which induces flushing.

 

·       Immunological factors:

 Investigations indicate a higher incidence of immune abnormalities like different types of antinuclear antibodies in the blood. Also IgG antibodies to Demodex folliculorum mites were detected in rosacea skin.

 

·       Gastrointestinal disturbances:

 An association of gastrointestinal symptoms like gastric hyperchlorhydria, dyspepsia, diarrhoea, constipation or alimentary symptoms and rosacea has been suspected, but there is no strong evidence for any relation.

·       Aggravating factors

Aggravating factors are all possible trigger of flushing and blushing. People who suffer from rosacea should avoid these factors.

 

What treatments are available?

Treatments can always control and often cure rosacea. They include a correct skin care regimen, photoprotection, identifying aggravating factors, topical drugs, systemic antibiotics, roaccutane, anti-demodex therapies, photodynamic therapy and laser/IPL where appropriate. Medications can also be used to reduce flushing.

 Laser/IPL therapy is a fast way to reduce both inflammation and redness and to remove broken blood vessels. Men are particularly bothered by red skin and broken blood vessels as they don’t have the luxury of covering up the redness with make-up.

LED therapy has been used to treat acne and other skin conditions that have resulted in hyper pigmentation of the skin. The light waves penetrate the skin’s top layer to break down damaged skin tissues and trigger collagen production, which helps to rapidly restore the skin.

Antyage is an increasingly popular LED light system that offers a gentle but effective solution for skin rejuvenation.  This one has been proven to help with treating rosacea and significantly reduces redness after a few sessions.