UNDERSTANDING FACIAL REDNESS - ROSACEA

Introduction

Rosacea means the abnormal reddening of the face, particularly the nose and cheeks. It is a fairly common skin complaint, possibly affecting one person in a hundred, although usually in only a mild form. Rosacea is not a life-threatening condition, but because it affects the appearance, it can be very distressing. Many sufferers lose self-confidence and feel embarrassed in social situations.

Fortunately, over the last few years, doctors have found out much more about rosacea. We now know that modern drug treatment can be effective in relieving symptoms and preventing permanent damage to the skin.

Facial redness

There are several other causes of a red face apart from rosacea:

• too much exposure to the sun and strong winds (for example, in an outdoor worker, such as a farmer); this also causes thickening and wrinkling of the skin
• seborrheic dermatitis, where the skin becomes dry and flaky, particularly around th
• e nose and under the eyebrows, may also cause reddening of the face
• contact dermatitis, which can cause itching and blistering of the skin as well as redness, may occur on the face because of an allergic reaction to a cosmetic or perfume
• photosensitive dermatitis also causes a red itchy rash on the face; some medicines, such as sulphonamides, may cause the skin to be sensitive to light; the redness and itching come on after exposure to the sun
• perioral dermatitis, where the skin around the mouth becomes inflamed, may look like rosacea; it is usually caused by using too much steroid cream around the mouth
• systemic lupus erythematosis (SLE) is a fairly rare disease in which the body's immune system starts to attack its own tissues; although it does cause a red rash in the shape of a butterfly across the nose, there will usually be other symptoms, such as joint pains and muscle weakness
• alcoholic flush is the red complexion that heavy drinkers tend to develop; in severe cases, the facial redness caused by rosacea may look very similar

Rosacea

Rosacea is a condition which only affects the skin. It causes persistent or recurring inflammation, mostly of the skin on the face, and it often has a similar pattern either side of the nose. Occasionally, the skin will become inflamed elsewhere on the body, for example on the chest or back.

Rosacea can affect most age groups. Its exact cause is unknown. However, it is thought to be due to a problem with the tiny blood vessels which supply the skin. In some people, rosacea seems to be part of a more general disorder of blood vessels. This also causes migraine headaches brought on by changes in blood flow in the brain.

Overuse of a steroid cream on the face to treat some other skin problem may cause rosacea, due to damage to some of the skin blood vessels.

Because the rash in rosacea often includes spots that look like ordinary acne, and because most sufferers are between the ages of 30 and 50, rosacea has been described as "adult acne". But, in fact, there is no connection between acne and rosacea. Rosacea typically starts during the teen years, with occasional attacks of intense flushing of the skin around the nose, cheeks, chin and ears. This often happens more in embarrassing or anxious situations, when drinking alcohol, or eating hot or spicy food.

During the early twenties, these flushing attacks tend to become worse and cover a wider area of skin. The affected skin will often feel burnt. In mild cases of rosacea, each attack only lasts for a few minutes and the skin returns to normal in between attacks. However, some rosacea sufferers develop a persistently red face, which is especially noticeable on the forehead, cheeks and nose. The rash can also extend to the scalp and down to the chin and neck.

Once into their thirties, people with rosacea will usually start to notice the appearance of papules (small raised bumps) and pustules (small white blisters filled with pus), in addition to redness. These crops of papules and pustules, which look like bad acne, tend to come and go.

Other symptoms of more severe rosacea can include painful eye irritation, blood-shot eyes, swelling of the face and tiny spidery blood vessels visible under the skin. Occasionally, rosacea causes unsightly bumps on the nose, a problem which doctors call rhinophyma. This often starts with the tip of the nose going red, but the redness may spread to the rest of the nose, which may turn a bright or purplish-red. In addition, the skin over the nose may thicken to become coarse and irregular and may become very oily. Rhinophyma is sometimes the only sign of rosacea.

Prevalence

Doctors now realise that rosacea is much more common than they first thought. It affects more women than men, with as many as one in 10 middle-aged women suffering from mild symptoms. The risk of rosacea is greater for fair-skinned people. Although rosacea is relatively rare in men, it tends to be more severe in those men that are affected. Rhinophyma almost exclusively occurs in men in their late fifties or older.

Rosacea is not infectious, it cannot be caught or passed on from one person to another. People with facial skin complaints, whose jobs include working with VDUS, often blame their symptoms on their machines. However, there is no evidence to confirm that skin disorders, such as rosacea, are more common in regular VDU users.

Prevention

Certain factors are known or thought to make rosacea worse, at least in some sufferers. Avoiding particular foods, drinks and any situation that tends to trigger a flushing attack can be a great help in controlling the unpleasant symptoms and complications.

Use cosmetic products that are not oil-based. Cut down on alcohol. It may even be necessary to stop top drinking altogether. Avoid too much exposure to the sun, strong winds and extremes or sudden changes in temperature.

Change to decaffeinated tea and coffee, and caffeine-free cola. Take steps to reduce any build-up of stress in your life. So take up sports and hobbies, or try regular relaxation exercises.

Consulting your doctor

Because rosacea tends to run. in families, many people mistakenly believe that their reddish complexion is simply a family characteristic that they must learn to live with, rather than a skin disorder that can be effectively treated. Anyone with symptoms of rosacea should see their doctor, however mild those symptoms might be.

Do not wait for the appearance of damaged blood vessels or a swollen nose. There are treatments available which not only clear the skin, but also help prevent the more serious problems from developing. Remember, without proper treatment, rosacea may worsen and cause permanent damage to the skin.

Treatment

Antibiotic treatments (either orally or topically) are the most commonly prescribed medicines. Menopausal flushing, which sometimes affects women in their late forties and early fifties, can make rosacea worse, in which case other medicines to control this flushing may be prescribed, e.g. HRT.

Unfortunately, there is no drug treatment which will help enlargement and deformity of the nose. In bad cases, some form of cosmetic surgery may be necessary to restore the nose to a satisfactory shape. must learn to live with, rather than a skin disorder that can be effectively treated.