Moderate erythematotelangiectatic and mild papulopustular rosacea.
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Acne rosacea

Rosacea (IPA:ɹəʊ.ˈzeɪ.ʃʌ) is a common but often misunderstood condition that is estimated to affect over 45 million people worldwide. It begins as flushing and redness on the central face and across the cheeks, nose, or forehead but can also less commonly affect the neck, chest, scalp or ears. more...

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As rosacea progresses, other symptoms can develop such as permanent redness, red bumps (some with some pus), red gritty eyes, burning and stinging sensations, small blood vessels visible near the surface of the skin, and in some advanced cases a bulbous nose. The disorder can be confused and co-exist with acne vulgaris and/or seborrheic dermatitis. People that are fair-skinned are disproportionately affected. Rosacea affects both men and women of all ages, but middle-aged women are more susceptible because of hot flushes caused by menopause.

Subtypes and symptoms

There are four identified rosacea subtypes1 and patients may have more than one subtype present.

  1. Erythematotelangiectatic rosacea: Permanent redness (erythema) with a tendency to flush and blush easily. It is also common to have small blood vessels visible near the surface of the skin (telangiectasias) and possibly burning sensations.
  2. Papulopustular rosacea: Some permanent redness with red bumps (papules) with some pus filled (pustules), this subtype can be easily confused with acne.
  3. Phymatous rosacea: This subtype is most commonly associated with rhinophyma, an enlargenent of the nose. Symptoms include thickening skin, irregular surface nodularities, and enlargement. Phymatous rosacea on appear on the nose, chin, forehead, cheeks, and ears. Small blood vessels visible near the surface of the skin (telangiectasias) may be present.
  4. Ocular rosacea: Red, dry and irritated eyes and eyelids. Some other symptoms include foreign body sensations, itching and burning.

Causes

The precise pathogenesis of rosacea still remains unknown, but most experts believe that rosacea is a disorder where the blood vessels become damaged when repeatedly dilated by stimuli. The damage causes the vessels to dilate too easily and stay dilated for longer periods of time or remain permanently dilated, resulting in flushing and redness. Immune cells and inflammatory mediators can leak from the microvascular bed causing inflammatory pustules and papules, especially with those with papulopustular rosacea.

Rosacea has a hereditary component and those that are fair-skinned of European or Celtic ancestry have a higher genetic predisposition to developing it. Women are more commonly affected but when men develop rosacea it tends to be more severe. People of all ages can get rosacea but there is a higher instance in the 30-50 age group. The first signs of rosacea are said to be persisting redness due to exercise, changes in temperature, and cleansing.

Triggers that cause episodes of flushing and blushing play a part in the development of rosacea. Exposure to temperature extremes can cause the face to become flushed as well as strenuous exercise, heat from sunlight, severe sunburn, stress, cold wind, moving to a warm or hot environment from a cold one such as heated shops and offices during the winter. There are also some foods and drinks that can trigger flushing, these include alcohol, foods high in histamine and spicy food.

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Acne Rosacea: Treatments Have Limited Efficacy
From Healthfacts, 2/1/00 by Maryann Napoli

A new preliminary study shows promise for one type of antibiotic called Zithromax (azithromycin) in the treatment of people with acne rosacea. This common skin condition, which causes a persistent facial blush and acne-like bumps, is notoriously resistant to effective treatment. Antibiotics, either topically or orally, have been the standard for years, but this treatment does not work for everyone. Results of a new pilot study were announced at the Fifth International Conference on the Macrolides, Azalides, Streptogramins, Ketolides and Oxazolidinones by Dr. Adolfo Fernandez-Obregon of the Hudson Dermatology and Skin Cancer Center in Hoboken, New Jersey.

The ten study participants, aged 32 to 76 years, had been previously and unsuccessfully treated with antibiotics. They either wanted to try another type of oral antibiotic or their skin was too sensitive for a topical version. They were told to take a single dose of 250 mg Zithromax three times a week. All were instructed to wash the affected skin with an over-the-counter soap-free cleanser. Dr. Fernandez-Obregon reported that all the participants showed a moderate to marked improvement in their condition within four weeks.

It is noteworthy that Dr. Fernandez-Obregon said that his results point to the need for clinical trials to determine the long-term efficacy and tolerability of Zithromax. No antibiotics/rosacea studies have lasted more than a few months; participants are not followed long enough to know whether the condition returns unchanged once antibiotics are stopped. Life-long antibiotic therapy clearly presents more health risks than the skin condition itself. Moreover, most of the studies, like this one, have only a small number of participants. Some doctors tell their patients that antibiotic therapy will prevent worsening of the condition, but only a well-designed long-term clinical trial will prove this contention.

At its most extreme, rosacea can cause enlargement of certain blood vessels in the face and/or the red, bulbous nose that distinguished W.C. Fields. Though rosacea mostly affects women, especially those who are fair-skinned and blush easily, its most detrimental cosmetic damage, the bulbous nose, is most likely to occur in men. It is a chronic and progressive condition with frequent remissions and flare-ups, which makes treatment effectiveness all the more difficult to assess in trials that last only a few months. Since antibiotics are not a cure, people with rosacea should first try avoiding conditions that precipitate facial reddening. The triggers are individual and can include spicy foods, hot or cold environments, stress, menopausal hot flushes, sun, wind, chocolate, tomatoes, and citrus fruits.

More Information:

For a free newsletter from the National Rosacea Society, call the toll-free number (888) 662-5874. The newsletter is supported by a grant from Galderma Laboratories, Inc., which makes a soap-free cleansing product. Back issues of the newsletter can be read on-line at their Web site (www.rosacea.org).

COPYRIGHT 2000 Center for Medical Consumers, Inc.
COPYRIGHT 2001 Gale Group

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