Introduction to Rosacea

Rosacea is a relatively common skin disorder which can include:

1. Facial redness
2. Telangiectasia (dilated blood vessels which are red and can be thread-like in
appearance)
3. Unusually reactive skin
4. Uneven skin texture (lumps and bumps)
5. Flushing
6. Acne-like lesions (papules, pustules, and nodules)
7. Burning sensations
8. Swelling
9. Rhinophyma (a deformity more frequently occurring in men which is characterized
by redness, inflammation, and excess tissue growth around the nose)
10. Chronic ocular redness, scaling or crusting of the eyelids and lashes, and eye
irritation

The exact causes of rosacea are unknown, though genetics and environmental damage are thought to be factors. Some research indicates that the demodex mite could be responsible for rosacea symptoms, while other research suggests rosacea is caused by a chronic bacterial infection in the gastrointestinal system.
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Rosacea Subtypes

There are five different subtypes of rosacea. A person can have a combination of more than one subtype at a time.

1. Erythematotelangiectatic Rosacea:

Primarily involves facial redness in the central portion of the face and frequent flushing. Telangiectasia commonly can occur in those with this rosacea subtype. The skin tends to be unusually reactive and stinging and burning sensations often occur, as well as facial roughness.

2. Papulopustular Rosacea:

Involves chronic central facial redness and short-lived papules and/or pustules that tend to resemble acne. Stinging and burning sensations are not unusual.

3. Phymatous Rosacea:

Involves a thickening of the skin on the nose, nodules, and strange tissue growth. Although rhinophyma is the most common manifestation of this rosacea subtype, phymatous rosacea can be seen elsewhere such as on the chin, forehead, cheeks, and ears.

4. Ocular Rosacea:

A rosacea subtype occurring in the eye area which affects over half of those with other rosacea subtypes. Symptoms include watery, bloodshot eyes, the feeling that a foreign object has made its way into the eye, burning and/or stinging, dryness, itching, sensitivity to light, blurry vision, and telangiectasia of the eye and lid. Blepharitis (inflammation of one or both eyelids), conjuctivis (inflammation of the conjunctiva, the mucous membrane which covers the internal portion of the eyelid and is attached to the cornea), and irregularity of the eyelid margins can also sometimes be seen.

5. Neuropathic Rosacea:

A rosacea subtype which has yet to be officially recognized yet is thought to be the most severe. It involves fits of burning in the central facial region, often lasting for longer than a half hour, as well as pain following exposure to rosacea triggers (see below section). Severe cases can semi-permanently or permanently activate sensory nociceptors (pain receptors).

If you think you have rosacea, it is very important not to self-diagnose and to get a professional opinion from a dermatologist. The reason being is that some symptoms that appear to be caused by rosacea can actually be indicative of other, more serious conditions. For example, one symptom of lupus (an autoimmune disease) is what appears to be a red rash spread over the nose and cheeks that is often mistaken for rosacea. Also, many of the symptoms of rosacea cannot be addressed by over-the-counter products and require medical intervention.
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Rosacea Triggers:

Rosacea flare-ups are often worsened by various things (triggers) which are unfortunately not always easy, or even possible, to avoid. These triggers vary from person to person. Below some possible triggers are listed.

Emotional Triggers:

Anxiety
Concentration
Crying
Embarrassment
Excitement
Intimacy
Laughing
Stress

Environmental Triggers:

Cold Climates
Heat
Sun
Wind
Hormonal Triggers:
Birth control pills
Estrogen
Perimenopause
Premenstrual
Postmenopause

Foods:

Large meals
Spicy foods
Hot foods

Beverages:

Alcohol
Hot beverages

Physical Triggers:

Exertion (light or heavy)
Lying down
Migraines
Overheating
Pain

Oral Medications:

Vasodilating drugs (drugs which widen blood vessels and can therefore worsen rosacea) used for the treatment of cardiovascular disease

Topical Triggers:

Products containing skin irritants (see section below)
Exfoliants
Moisturizers
Sunscreens containing synthetic sunscreen agents

Other Triggers:

Spontaneous (if you suspect something is triggers a flare-up, avoid it if possible)
Fluorescent lighting
Computers
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Irritants Commonly Found in Cosmetics

Here is a list of common skin irritants you may wish to avoid:

Alcohols. Ethanol (grain alcohol), denatured alcohol, ethyl alcohol, methanol, benzyl alcohol, isopropyl, and SD alcohol should be avoided. (Exceptions: Ingredients like cetyl alcohol or stearyl alcohol are fatty alcohols. Some alcohols like SD alcohols can be used in small amounts. An ingredient is in a small amount if it appears at the end of an ingredients list).
Ammonia
Arnica
Balm mint
Balsam
Bar cleansers and soaps
Bentonite (can be used in the occasional clay mask, but avoid frequent use or formulations which contain other "actives")
Benzalkonium chloride (if it is one of the main ingredients)
Benzyl Alcohol (if it is one of the main ingredients)
Bergamot
Camphor
Cinnamon
Citrus juices and oils
Clove
Clover blossom
Coriander
Cornstarch
Essential Oils
Eucalyptus
Eugenol
Fennel
Fennel oil
Feverfew
Fir needle
Fragrance (may be listed as "Parfum")
Geranium
Ginger
Grapefruit
Horsetail
Jasmine
Lavender
Lemon
Lemongrass
Lime
Linalool
Marjoram
Melissa (lemon balm)
Menthol, Menthyl Acetate, and Menthyl PCA
Mint
Oak bark
Orange
Oregano
Papaya
Peppermint
Phenol
Rose
Sandalwood oil
Sodium C14-16 olefin sulfate
Sodium lauryl sulfate
TEA-lauryl sulfate
Thyme
Wintergreen
Witch hazel
Ylang-ylang

If you are uncertain about an ingredient, information about it might be found here in this online ingredients dictionary:

http://www.cosmeticscop.com/learn/dictionary.asp?TYPE=MAIN
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Treatment Options

Rosacea can be very difficult to treat for numerous reasons. First, rosacea is not very well-understood, so only the symptoms of the disease can be addressed. Second, because rosacea increases the reactiveness of one's skin, what may work for one rosacea patient may be much too irritating for you. Third, some popular rosacea treatments, like oral antibiotics, can only be used in the short-term. Fourth, products which claim to be designed for sensitive skin or to treat rosacea often contain skin irritants. If they do contain ingredients which would be beneficial to rosacea-prone skin, those ingredients are often found in minute concentrations. And lastly, there is much disagreement among dermatologists as to what should and should not be used for the treatment of rosacea. When treating rosacea, monitor how your skin reacts. If a treatment seems to worsen facial redness and cause irritation, don't use it.

Some Prescription-Only Treaments:

Standard treatment options for rosacea involve oral antibiotics and metronidazole (found in MetroGel), a topical antibiotic effective against anaerobic bacteria and some parasites. This can be effective, but keep in mind that bacteria can become resistant against oral antibiotics, making them effective only for the short-term, and metronidazole doesn’t work for everyone. Finacea, a 15% azelaic acid gel, was approved for the treatment of rosacea in 2002. It is an antimicrobial product which has some research indicating that it is more effective for rosacea treatment than MetroGel; however, other research indicates that it is more irritating, which can cause problems for many patients. Another popular rosacea treatment is a sodium sulfacetamide and sulfur lotion (such as Rosula). It has antimicrobial properties, though irritation can occur.

Isotretinoin, found in Accutane, can be a very effective rosacea treatment (I won't say "cure," but an Accutane course can solve rosacea problems for many), though it is not understood why.

Some Over-the Counter Treatments:

Some rosacea sufferers benefit from the use of benzoyl peroxide, an antibacterial treatment commonly used for acne sufferers that is effective against anaerobic bacteria. However, this is recommended with caution since benzoyl peroxide can be extremely irritating to rosacea patients and ultimately make the skin worse. Tea tree oil exhibits antimicrobial properties and is thought to be less irritating than benzoyl peroxide, but again is recommended with caution. One should use between a 5 and 15% concentration; anything more might be too irritating and anything less might be ineffective. The only leave-on tea tree oil treatment (I don't recommend medicated cleansers because the treatment gets rinsed away) I know of is Derma E Tea Tree and E Antiseptic Cream, which contains 5% tea tree oil. Salicylic acid, a chemical exfoliant, may be beneficial to rosacea sufferers as well since it has some antimicrobial and anti-inflammatory properties; however, most salicylic acid products are poorly formulated and contain unnecessary skin irritants like drying alcohols. Exfoliants of any kind can aggravate rosacea symptoms, so again approach the use of salicylic acid cautiously. The best and most economical salicylic acid products are those made by Paula's Choice. Topical hydrocortisone treatments can be beneficial for relieving rosacea-related irritation and inflammation, but these should be used sparingly as long-term use can thin the skin and actually exasperate rosacea symptoms.

Many skincare lines are coming out with products marketed to rosacea sufferers. They might be advertising that their products calm and cool the skin. Usually products claiming to cool the skin use ingredients like menthol and peppermint to produce the sensation of coolness. This cooling sensation is actually a sign of irritation, so it's best to avoid these products. You may have heard of the Aveeno Ultra-Calming and Eucerin Redness Relief lines. The Ultra-Calming line by Aveeno uses feverfew as its active ingredient, which acts as an anti-inflammatory agent when taken orally but a skin irritant when applied topically. The Ultra-Calming Foaming Cleanser is probably OK to use since the feverfew is in contact with the skin for only a short time, but otherwise one should avoid this line. Eucerin's Redness Relief line uses licorice extract, which does act as an anti-inflammatory agent when applied topically. However, Eucerin's products don't contain that much of it. Your best bet is to use products featuring anti-inflammatory ingredients without the use of unnecessary skin irritants like fragrance. You don't have to stick to just one product line.

Laser Treatments:

Although many of the above-mentioned treatments can help with some rosacea symptoms, particularly those which resemble acne, they tend to be ineffective against telangiectasia and facial redness overall. Avoiding rosacea triggers can help with these problems, they are usually inevitable in the long-run. Laser treatments, like V-Beam, can be very effective for treating telangiectasia and overall facial redness. Consult with your dermatologist on this matter if you are interested.

Additionally, combinations of laser treatments are being used in new ways to treat facial redness, flushing, swelling, and neuropathic pain that other treatment options have not been able to address. You can read more about this here:

http://www.drnase.com/rosacea_photoderm.htm

Ocular Rosacea Treaments:

Treating ocular rosacea can be tedious. Hygienic ocular care is essential. Many rosacea patients find the use of artificial tears beneficial (though don't use products like Visine, which will ultimately make the dryness and redness of the eye worse). You can read more about ocular rosacea treatments here:

http://lycos.cs.cmu.edu/info/rosacea--ocular-rosacea.html

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Other Important Information:

WEAR SUNSCREEN. Sun damage is thought to play a role in the development of rosacea because it is a vasodilator. Make sure your sunscreen is broad-spectrum, meaning that it provides sufficient protection from both UVA and UVB rays. If your sunscreen does not contain titanium dioxide, zinc oxide, avobenzone, mexoryl sx, and/or tinosorb, it does not provide sufficient UVA protection and is not broad-spectrum. Synthetic sunscreen ingredients can be irritating to those with rosacea, so look for sunscreens using the physical sunscreen ingredients of titanium dioxide and zinc oxide.

This article discusses the importance of sun protection and proper sunscreen application:

http://www.cosmeticscop.com/learn/sun.asp?ID=163
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Recommended Websites:

http://www.drnase.com/
http://www.rosacea.org/index.php
http://www.nlm.nih.gov/medlineplus/rosacea.html
http://www.about-rosacea.com/

Good post! Thanks a lot.

I have neuropathic rosacea. In other words me = fucked forever.

Kanmi, you might find this article interesting:

http://www.drnase.com/rosacea_photoderm.htm

It discusses a new treatment option which involves combining laser treatments to address "the facial redness, flushing intensity & duration, swelling and neuropathic pain (italics mine) that no other single pass traditional treatment or pharmacological agent has ever been able to successfully treat."

Yeah, he trained Dr. Darm. I've already met and spoken with Dr. Darm. He said that at first I need 3 treatments that will cost $2500, and then i'll have to get 1 treatment every 3 months for the rest of my life. So that's $4500 the first year, and $2,000 every year after that.

And even then, it isn't guaranteed to work for everyone.

It is expensive, but you seem pretty depressed right now. I would say that if you can afford it it's worth a try. Doing what you can to try and help yourself is better than feeling sorry for yourself.

Some health care plans might cover the costs. It would be beneficial to look into that.

Yeah, Dr. Darm told me it's incredibly rare that insurance companies would cover the cost. Besides that he doesn't accept insurance. I don't see the point in trying for that. And i'm going to do laser soon enough, i'm just afraid to so i'm waiting.

What laser procedure does he do that costs so much?

He does a combination of IPL and Yag laser.

It's unfortunate that having rosacea has been such an ordeal for you. When you do get the laser treatment done I hope all goes well for you.

very nice post snow queen.

STICKY THIS

you are a sweet heart snow queen...I too am one of those unfortunate newbies to the wonderful disease which is called rosacea. I am still not entirely sure if accutane is what "caused" it, but I think it did expose it to the full extent. I never flushed before, but i always had a rosey complexion. My skin was very very sensitive for years, due to my experiementing with aggressive acne washes and the beautiful tane 2x before. my mother has mild rosacea. But it seems that the 3rd day of being on the medication...I get out of work, and my face is on fire. My derm says it should pass...it never has. Now its 3 or 4 months down the road, and my skin is angry. Irritated, very sensitive, flushes constantly, that warm hot feeling that emitts off the face, ears. ect. I just dont get it. I do know that my skin is extremely sensitive, and I have read a lot about rosacea, and it seems that all the symptoms point to it. So I am unsure of what to do. My derm tried me with some premethrin? I guess to see if its dermodites causing the problem, but it seems like I over did and only ended up irritating my face in the process ...she also put me on bactrim, oral anti...Not sure where im going with this, but I am very upset as many are, esp. those who are new to the world of rosacea. I feel that soon I can come to acceptance with it, and now get so bent out of shape. It is a struggle to accept the fact, and move on when dealing with such an unfair sentance. Yet this is life. Things happen, and all I can do is be greatful that im alive, right? Life is beautiful, even though your skin sometimes isnt. okay. Well...one more question for the queen...

I found this calming redness cleanser, created by a company called skin effects...supposedly their new...the cleanser does say it has arnica in it, supposedly helping with irritation, yet I have read that you say it can be an irritant. At the moment, my skin is very irritated, so its difficult to really know. But its either that or neutrogena gentle cleanser...if you had to choose, which one would you decide?

how fast does it take to clear up this redness when you go the derm and he prescribes soemthing?

oh well, roaccutane is not supposse to give rosacea or acne rosacea. I hate hearing that!

Accutane clears up acne and redness in 5-6 months. your 3-4 months in quit your complaining. I'm starting my 5th month on accutane and my redness is light I don't think I have rosacea or whatever the fuck you call it. None of the symptons you have listed don't suit me but I hate flourescent lighting My faces redness looks alot better when its not in flourescnet lighting but all the other symptoms don't suit me....mmmm these are confusing days for us all.

Another choice:

Rosacea Research & Development Institute

Actually roaccutane has a lot of side-effects and unless the problem is not big I would be very picky in order to use it

It might be a good idea to remove "Dr" Nase's website. I'm not completely familiar with his history, but there are quite a bit of people that regard him as a fraud on the other rosacea forum I read. There is even a website dedicated to all of the controversy surrounding him:

http://debunkingnase.org/index.php?title=Main_Page

Gee what can I eat or do. It seems like EVERYTHING effects rosacea!! I've been living with it for over 15 years, ever since I was 14 and started puperty. My faced changed that summer and hasn't been the same ever since. I've spent literally THOUSANDS of dollars on oral, topical, lasor, diet, supplements.....and truely nothing takes it away completely. My best luck has been with IPL laser treatments. But they are $$$, temporary and work just alittle....blah....it depresses me to know end! I feel like I can't live a normal life. Constantly covering it up, making excuses to friends, boyfriends or compete strangers as to WHY my face is either red, OR why do you where so much makeup....I'm screwed no matter what way you look at it. I wish uneducated people would educate them selves about the different skin types in the world and stop making us feel so islolated......=(