Hello tmacewen-ga,
To answer this question, I went to Medline Plus, at the National
Library of Medicine, since this resource provides links to reliable
information from high-quality sites. I selected “health topics”
(http://www.nlm.nih.gov/medlineplus/healthtopics.html) and clicked R
to find topics beginning with that letter. Rosecea is the fourth from
the bottom of the list. The results page at
http://www.nlm.nih.gov/medlineplus/rosacea.html gives links to 14
relevant web sites. I have summarized the most pertinent information
from these sites for you:
Possible triggers:
A trigger that causes a flare up in one person might have no effect on
someone else. It is suggested that patients keep a diary to try to
identify what might be causing flare ups in their particular case.
“In a survey of 1,221 rosacea sufferers by the National Rosacea
Society, 96 percent of those who believed they had identified personal
trigger factors said avoiding those factors had reduced their
flare-ups.”
The National Rosacea Society has a printable diary check-list to help
with keeping daily records, which can be obtained at
http://www.rosacea.org/patients/materials/checklist.html
Possible aggravating factors that are mentioned include: heat
(including hot baths, saunas and hot food and drinks), strenuous
exercise, sunlight, wind, very cold temperatures, spicy foods and
drinks, alcohol, menopause, feverish illnesses, coughs and cold, high
blood pressure, emotional stress, anger, and long-term use of topical
steroids on the face or vasodilator drugs for cardiovascular disease.
Also, if the person is otherwise allergic to anything, exposure to
that substance could aggravate the rosacea as well as producing the
usual allergic symptoms. Caffeine is also mentioned, although the Mayo
Clinic information says that it is caffeine withdrawal, rather than
caffeine itself, which can aggravate rosacea.
A survey of over 400 patients by the National Rosacea society found
the following to be the most common triggers: “sun exposure for 61
percent of the respondents; stress for 60 percent; hot weather for 53
percent; alcohol for 45 percent; spicy foods for 43 percent; exercise
for 39 percent; wind for 38 percent; hot baths, cold weather and hot
drinks for 37, 36 and 36 percent, respectively; and skin-care products
for 24 percent.”
Specific foods reported by individual rosacea patients to the National
Rosacea Society as causing flare-ups include: “Examples have included
cheese, sour cream, yogurt, citrus fruit, liver, chocolate, vanilla,
soy sauce, yeast extract (though bread is OK), vinegar, eggplant,
avocados, spinach, broad-leafed beans and pods, and foods high in
histamine or niacin.” The Society suggests that “Taking an
antihistamine about two hours before a meal may counter the effects of
histamine, while aspirin may reduce the effects of niacin-containing
foods in sufferers affected by these substances.”
Treatment:
There is no cure, but it is possible to control the symptoms. It might
take weeks or months for noticeable improvement. Treatment is often
with topical (applied to the affected skin) antibiotics such as
metronidazole, but more severe cases are also treated with oral
antibiotics, most commonly tetracycline, minocycline, erythromycin,
and doxycycline. Such treatment will be effective against the pimples
and pustules, but less likely to help with the redness and flushing.
For long-term treatment, it is preferable to use topical antibiotics,
because oral antibiotics are more likely to give rise to unwanted side
effects.
Oral antibiotics are used if there are any eye symptoms, and these can
be supplemented with steroid eye drops.
The National Rosacea Society makes the point that although antibiotics
are used, rosacea is not an infectious disease that can be spread by
contact. It is thought that the antibiotics are effective mainly
because of their anti-inflammatory effects. While some people have
suggested that that changes in normal skin bacteria, infection of the
stomach by Helicobacter pylori , the presence of microscopic skin
mites, or a fungus could be responsible, none of these theories have
been proven.
Cortisone cream can also help, but should not be used for more than
two weeks at a time. Medications containing containing a sulfur drug,
benzoyl peroxide or azelaic acid are sometimes used instead of, or in
addition to antibiotics therapy, and cardiovascular medication is
sometimes used to control severe flushing.
Glycolic acid peels are used successfully in combination with
antibiotic therapy. These are done every 2-4 weeks and low
concentration glycolic acid washes and creams can be used in between.
The peels take 3-5 minutes. Afterwards, the skin will initially look
redder.
The powerful acne medication, Isotretinoin (Accutane) is sometimes
used for more severe cases of rosacea to reduce the nodules. However,
this drug can have significant side effects and is known to cause
severe birth defects, so women of childbearing age have to be careful
to avoid becoming pregnant while using it.
It is important to continue with medication between flare-ups. A
study carried out over 6 months found that a relapse occurred in 42%
of patients who had stopped using medication after the last flare-up
had resolved, as compared to 23% of patients who continued with
medication.
Red lines caused by dilated blood vessels, rhinophyma (red and
enlarged nose, more common in men than women) and extensive redness
can be treated with laser surgery, pulsed dye laser therapy, intense
light therapy, or electrosurgery. At least three treatments are
usually needed. Surgery is sometimes required to remove the excess
tissue in cases of rhinophyma.
Daily use of a sunscreen of SPF 15 or higher is recommended, as well
as protecting the skin from sunlight with hats. In summer, it is
recommended to minimize the time spent out of doors between 10 am and
2 pm. In hot weather, people with rosacea should try to stay as cool
as possible, by using air-conditioning, sipping cold drinks, chewing
ice chips spraying the face with cool water and avoiding exertion.
In the winter, the face should be protected from cold and wind with a
scarf or ski mask.
The National Rosacea Society suggests the following daily facial care
routine:
“A rosacea facial care routine recommended by many dermatologists
starts with a gentle and refreshing cleansing of the face each
morning. Sufferers should use a mild soap or cleanser that is not
grainy or abrasive, and spread it with their fingertips. A soft pad or
washcloth can also be used, but avoid rough washcloths, loofahs,
brushes or sponges.
Next, rinse the face with lukewarm water several times and blot it dry
with a thick cotton towel. Never pull, tug, scratch or treat the face
harshly. Sufferers should let their face air dry for several minutes
before applying a topical medication. Let the medication soak in for
an additional five or 10 minutes before using any makeup or other skin
care products.”
Men should use an electric shaver in preference to a blade and avoid
irritating shaving lotions.
Mild facial moisturizers can help, especially in cold weather,
provided that they do not further irritate the skin. Green-tinted
make-up can be used to conceal redness, being applied under a
skin-colored foundation. Vigorous rubbing, scrubbing or massage of
the face should be avoided. Avoid irritating cosmetics, eg those
which contain alcohol, witch hazel, menthol, peppermint, eucalyptus
oil or clove oil, and be careful when using hairspray etc.
Fragrance-free products are preferred. Powder make-up can make the
skin look worse.
Exercise should not be too strenuous and should be done in a cool
environment. Low-intensity workouts are preferable to high-intensity
ones. It is better to exercise more frequently for shorter periods.
If exercising outdoors, early morning or early evening are the best
times. Staying cool during exercise is important eg by placing a cool
damp towel around the neck, drinking cold drinks, chewing ice chips
and spraying the face with cool water.
Stress control can help: healthy diet, moderate exercise, sufficient
sleep can help to combat stress, as well as more focused methods such
as deep breathing, visualization and relaxation techniques.
According to the National Rosacea Society, the condition can sometimes
clear itself: “A retrospective study of 48 previously diagnosed
rosacea patients found that 52 percent still had active rosacea, with
an average ongoing duration of 13 years. The remaining 48 percent had
cleared, and the average duration of their rosacea had been nine
years.”
I hope this information is useful to you. Please ask for
clarification if you think I have omitted anything.
Resources used:
Questions and Answers about Rosacea (National Institute of Arthritis
and Musculoskeletal and Skin Diseases)
http://www.niams.nih.gov/hi/topics/rosacea/rosacea.htm
American Academy of Dermatology Patient Information:
http://www.aad.org/pamphlets/rosacea.html
FAQ from the National Rosacea Society
http://www.rosacea.org/patients/faq.html
Mayo Clinic http://www.mayoclinic.com/invoke.cfm?id=DS00308
Coping with Rosacea. Tips on Lifestyle Management for Rosacea
Sufferers by the National Rosacea Society
http://www.rosacea.org/patients/materials/coping/index.html
Combination Therapies Offer New Management Options for Acne and
Rosacea – American Academy of Dermatology
http://www.aad.org/PressReleases/combination.html |
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