Rosacea, sometimes incorrectly called “acne rosacea” is a common, but poorly understood condition of the skin of the face that is characterized by excessive flushing, persistent redness, broken capillaries, and in one of the subtypes, bumps and pimples. In another of the subtypes, called ocular rosacea, it affects the skin and blood vessels around the eyes and can result in reduced vision. It affects well over 16 million Americans, but according to a Gallup poll, 78% of Americans had never heard of it.
It is most often seen in women between 30 and 50, but can affect older women as well. Men don’t get it as often, but when they do, they usually develop a more serious and destructive subtype. The incidence has been growing dramatically as Baby Boomers have moved into the most susceptible age.
Rosacea occurs most frequently in people of Celtic (Ireland, Scotland, Wales) and Slavic (Eastern European) descent. While fair skinned people seem to develop it most often, it occurs fairly commonly in Native Americans. Among this population, it appears more purplish than red. Asians also suffer from it, but in Asian skin it tends to appear light orange, or deep red depending on the skin tone.
Rosacea is Treatable
Rosacea is considered chronic, but treatable. Typically it affects the nose, cheeks, chin, and forehead, and the outbreaks may come and go. Outbreaks are often triggered by sun exposure, alcohol consumption, eating spicy food, emotional stress and heat. According to a study by the National Rosacea Society the most common triggers are:
| Factors | Percent Affected |
|---|---|
| Sun exposure | 81% |
| Emotional stress | 79% |
| Hot weather | 75% |
| Wind | 57% |
| Heavy exercise | 56% |
| Alcohol consumption | 52% |
| Hot baths | 51% |
| Cold weather | 46% |
| Spicy foods | 45% |
| Humidity | 44% |
| Indoor heat | 41% |
| Certain skin-care products | 41% |
| Heated beverages | 36% |
| Certain cosmetics | 27% |
| Medications | 15% |
| Medical conditions | 15% |
| Certain fruits | 13% |
| Marinated meats | 10% |
| Certain vegetables | 9% |
| Dairy products | 8% |
| Other factors | 24% |
For more information about triggers for individuals, visit http://www.rosacea.org/patients/materials/triggers.php for a full description.
If left untreated, the redness tends to get ruddier, the broken capillaries appear larger, and bumps and pimples appear. In severe cases, particularly among men, the nose may grow swollen and bumpy from excess tissue. The old movie comedian W.C. Fields suffered from it, as does Bill Clinton.
No one knows for sure the cause, though research is on-going. If you are interested in learning more about the research studies, visit http://www.rosacea.org/grants/research.php#Steinhoff2.
Rosacea Hypothesis
One hypothesis is that rosacea results from a disorder in the immune system. The body responds to the classic rosacea triggers as to an allergen. When a normal immune system is faced with any of a broad range of potential dangers — including sun exposure, emotional stress, heat and spicy foods, — receptors recognize the potential danger and protect the body by prompting the production of protective substances, called cathelicidins, that isolate and neutralize any harmful effects. In rosacea patients, however, these protective substances turn the body on itself, leading to inflammation. In a study done in San Diego, rosacea patients were discovered to have the defective cathelicidins that lead to skin inflammation. The defect in this protective substance is caused by the overabundance of yet another substance, kallikrein, which spurs the defective cathelicidins into action. The combination of these two excess substances leads to the formation of rosacea signs and symptoms.
(Publication of results: Yamasaki K, DiNardo A, Bardan A, et al. Increased serine protease activity and cathelicidins promotes skin inflammation in rosacea. Nature Medicine 2007;13:975-980).
It has been well-established that people suffering from rosacea have an abundance of the normally-occurring skin mite Demodex, but whether the mite was causing the rosacea, or the conditions of rosacea skin created an enhanced breeding environment for the mite, was in dispute – did the excess Demodex cause the rosacea, or did the rosacea cause the excess Demodex?
To complicate matters further, it has been noted by a research team in Dublin, Ireland that in rosacea sufferers, the Demodex harbor bacteria, Bacillus oleronius, that do not appear in the Demodex mites in non-rosacea sufferers. This discovery is supported by the fact that rosacea patients are helped by antibiotics that can destroy this bacteria, but not by antibiotics that can’t.
It was also noted that anti-inflammatory drugs are useless against rosacea, and immunosuppressive agents, like steroids, lead ultimately to further inflammation.
(Dr. Kevin Kavanagh, Department of biology, National University of Ireland, Maynooth, and Dr. Frank Powell, Consultant Dermatologist, Mater Misericordiae Hospital, Dublin. Publication of results: Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. British Journal of Dermatology 2007;157:474-481).
A pronounced link between rosacea and acne has been noticed as well. In a study done at the University of Pennsylvania, Drs. YaXian Zhen and Albert Kligman discovered that 30-40% of woman who suffered acne as teenagers developed rosacea as adults, and 40% of rosacea sufferers had experience severe acne as teenagers. They also noted that rosacea sufferers had more characteristics in common with acne sufferers than did people without rosacea, including 40% more oil production, twice as many microcomedones (those little plugs that end up either as pimples or blackheads) and nearly twice as much p.acnes bacteria as non-rosacea sufferers.
Success Treating Rosacea
Skin therapists are having success treating early stages of rosacea with a protocol that has been successful against acne, which makes sense given the role bacteria may play in the development of rosacea, and the link to acne characteristics. Skin therapists will always refer certain rosacea subtypes to a medical specialist.
At The Acne Treatment Center we are having significant success with early rosacea. It is not as reliable as with acne, but with about 65% of patients presenting we are able to effect clearing. It happens quickly, in usually two or three visits and a simple home care routine.
©2011 Jane Neville Dudik; The Acne Treatment Center; www.acnetreatmentcenterWA.com