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Rosacea Information, Treatments & More - An Overview

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#1 AKL

AKL

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Posted 15 May 2011 - 02:35 PM

NOTE: To keep this thread organized, it is not open for discussion. If you have information that you think should be added here, please PM a moderator with a link and a short description of the (scientific) article about rosacea. We will post it here for easy access if we find it relevant. If you find a broken link in this article, please PM a moderator, so it can be fixed.

Rosacea
an overview


The Basics

Acne.org's Information about Rosacea (Acne.org)

Frequently Asked Questions about Rosacea (American Academy of Dermatology)
Rosacea (Mayo Foundation for Medical Education and Research)
Rosacea (Medscape)
Rosacea (National Library of Medicine)
Rosacea (download PDF) (The New England Journal of Medicine)
Understanding Rosacea (National Rosacea Society)
What Is Rosacea? (National Institute of Arthritis and Musculoskeletal and Skin Diseases)

What Rosacea Looks Like (American Academy of Dermatology)

Ocular Rosacea (Mayo Foundation for Medical Education and Research)
What Is Ocular Rosacea? (American Academy of Dermatology)

Rhinophyma (National Library of Medicine)

Rosacea Has Many Signs and Symptoms (American Academy of Dermatology)


More Information

Factors That May Trigger Rosacea Flare-Ups (National Rosacea Society) - See also: "Coping with Rosacea: Tripwires" in the "Coping with Rosacea" section.
Heat Regulation and the Warm Room Flush Phenomenon - PDF (Australian Sciences)
Standard Grading System for Rosacea (download PDF) (National Rosacea Society Expert Committee)

Articles about Rosacea from the Skin&Aging website: Overview 1, Overview 2


Treatments

Advances Changing Face of Rosacea Treatment (American Academy of Dermatology)
Gentle Skin Care Helps Control Rosacea (American Academy of Dermatology)
Is Laser Treatment Right for Your Rosacea? (American Academy of Dermatology)
Ocular Rosacea Treatment (American Academy of Dermatology)
Rosacea Treatments (American Academy of Dermatology)
Surgery Can Correct Distortion of Nose (National Rosacea Society)
Treatment Options for Acne Rosacea (download PDF) (American Academy of Family Physicians)

Women May Need Added Therapy for Rosacea (National Rosacea Society)

Good and Bad of "All Natural" Therapy for Rosacea (American Academy of Dermatology)


Coping with Rosacea

Controlling Rosacea Flare-Ups Can Boost Self-Esteem (American Academy of Dermatology)
Coping with Rosacea: Managing Psychosocial Aspects of Rosacea (National Rosacea Society)
Coping with Rosacea: Tripwires (National Rosacea Society)
Managing Rosacea (National Rosacea Society)


Research

An overview of studies and articles from PubMed
Double-blind comparison of azelaic acid 20% cream and its vehicle in treatment of papulo-pustular rosacea (PubMed)
Effect of Treatment of Helicobacter pylori Infection on Rosacea (Archives of Dermatology)
Isotretinoin treatment of rosacea (PubMed)
Oral thermal-induced flushing in erythematotelangiectatic rosacea (PubMed)
Rosacea Trigger Aids Medical Research (National Rosacea Society)
What Causes Rosacea? Research May Offer New Clues (American Academy of Dermatology)

Clinical Trials related to Rosacea (National Institutes of Health)


Product Ingredients

Use one or more of the following links to verify the safety of your product ingredients. Remember that the further down on the list of ingredients, the less percentage of that ingredient is in the product.

Cosmetics Cop
Environmental Working Group's Skin Deep
Face Reality (download PDF)
Zerozits


Miscellaneous

Other Skin Disorders Also Afflict Patients Diagnosed with Rosacea (National Rosacea Society)
Seborrheic Dermatitis (National Rosacea Society)

Diary Checklist: Identify your personal rosacea triggers (National Rosacea Society)

Find a Dermatologist


Resources

American Academy of Dermatology
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Rosacea Society
RosaceaNet

_________________________________________________________________________

Thank you, The_Snow_Queen, for the following information:

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.
_________________________________________________________________________

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.
_________________________________________________________________________

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
_________________________________________________________________________

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 in one of the online ingredients dictionaries posted above ("Product Ingredients" section).
_________________________________________________________________________

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.

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).
_________________________________________________________________________

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.

"When I was 5 years old, my mother always told me that happiness was the key to life. When I went to school, they asked me what I wanted to be when I grew up. I wrote down ‘happy’. They told me I didn’t understand the assignment. I told them they didn’t understand life.” - John Lennon





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