Rosacea, a chronic skin condition, affects at least 15 million Americans. Its primary is facial redness, often accompanied by red bumps and vessels on the face. It leads visibly dilated blood to both physical discomfort and social embarrassment.

For the more than 40% of rosacea patients who develop the ailment in their 30s and 40s, this is a chronic disease, so they will have to deal with it for years. Some of the afflicted first seek treatment after age 50.

Reason for the delay: Research has found that 78% of Americans are not aware of the symptoms of rosacea, and therefore, many people tend to ignore the problem until symptoms become advanced.

The biggest news in the rosacea field is that we are learning more about the biochemical substances and microorganisms that are associated with rosacea symptoms-which will hopefully lead to more effective medical treatments.

While various factors are known to trigger rosacea flare-ups, the condition's underlying cause is still unknown. Though it can occur in all ethnic groups, it is most prevalent among fair-skinned people of Celtic or Scandinavian origin.

Rosacea cannot be cured, and the symptoms may grow worse if not treated.

Good news: In most cases, rosacea symptoms can be effectively controlled through a combination of lifestyle changes and medical treatment.

What Are The Signs?

There is no lab test for rosacea. Instead, diagnosis is based on a visual inspection by a dermatologist who is familiar with the spectrum of symptoms. Early signs of rosacea include a flushing or redness in the cheeks, chin, nose and/or forehead that comes and goes.

Over time, this redness persists for increasingly longer periods until, eventually, it is always present. Fine, dilated blood vessels may also appear in the face, and red bumps and pus bumps ("pimples") can develop as well.

Sometimes patients may also experience a burning, stinging or itching sensation in the affected areas. In severe cases, the skin may become thick and swollen, especially around the nose. Actor W.C. Fields had a classic case of this type of advanced rosacea called rhinophyma. Rosacea also may cause watery, bloodshot or irritated eyes, a condition known as ocular rosacea. Someone who has ocular rosacea may feel as though there is a foreign body or something gritty in his/her eyes. He may also have feelings of burning, stinging, itching or dryness similar to eye allergies.

Environmental Triggers

Once rosacea has been diagnosed, the next step is to begin identifying any environmental factors that may be triggering outbreaks. Your doctor might ask you to keep a diary recording foods consumed and other daily details, such as your exposure to light, heat and wind...stressful events or situations...and what skin-care products you used. Wile different individuals will have different environmental triggers, common ones include...

Ultraviolet (UV) light. Cumulative exposure to sunlight creates changes in the skin-such as the production of a substance called vascular endothelial growth factor (VEGF), which dilates blood vessels-and damages the structural integrity of the skin, predisposing it to redness and dilated blood vessels.

To protect against ultraviolet damage: Always apply sunscreen (SPF 15 or higher) to your face when you are out in the sun, and wear a wide-brimmed hat that shades your face before going out for extended periods (when playing golf or tennis or when you are at the beach, for example).

Heat. Flare-ups of rosacea are often triggered by exposure to heat, including drinking hot beverages.

Prevention: Limit the amount of time you spend outdoors in hot weather, avoid steam rooms and saunas, and keep your showers as short as possible. Also, drink coffee and other heated beverages warm, not hot.

Skin-care products. Because many people who have rosacea have sensitive skin, rosacea flare-ups are often triggered by excessively harsh soaps and other skin-care products.

Prevention: Use only facial cleansers formulated for sensitive skin, such as Cetaphil liquid cleanser...Dove Sensitive Skin Bar...or the gentle-care products of Neutrogena, purpose, Aveeno and Oil of Olay. You can also ask your dermatologist for recommendations. Wash your face gently in the morning and evening using lukewarm water and blot your face dry with a soft cotton towel to avoid irritation.

Also use a moisturizer designed for sensitive skin, such as one offered by the brands listed above. Make sure it contains no fragrances or the potentially irritating ingredients alpha- hydroxy acid, retinol or salicylic acid.

Other potential triggers include spicy foods, stress, wind and humidity.

Rosacea is not a sign of heavy alcohol use. However, because consuming alcohol causes blood vessels to dilate, it may temporarily intensify existing symptoms.

Certain medications can also cause rosacea like symptoms. Vasodilators and topical steroids have been known to cause rosacea outbreaks.

Rosacea Medications

While patients often experience significantly less redness once they switch from soap to a mild cleanser and make the other changes suggested above, many will also need to use medication to bring their symptoms fully under control.

A variety of topical rosacea medications can help reduce bumps and pimples and, to some extent, redness. These include metronidazole 0.75% gel (including Metro Gel as well as other brands)...azelaic acid 15% gel (Finacea)...and sulfacetamide-sulfur (including Rosae, which also contains SPF 18 sunscreen, and other brands). Sulfur-based prescription cleansers such as Plexion and Rosanil can also be helpful. Metronidazole gel is an antibiotic-but it is prescribed here for its anti-inflammatory properties rather than its antibiotic effects.

Your dermatologist will choose the medication to try based on his evaluation of you. A combination of two different topical medications may also be prescribed. Their effectiveness varies from person to person-some patients will see dramatic results, and others only a slight reduction in symptoms. It's important to apply medication consistently as directed, and recognize that it may take two to three months to see substantial improvement.

To eliminate bumps and pimples, rosacea patients may also be put on oral antibiotics, such as tetracycline, doxycycline or minocycline. Doxycycline in very low doses (20 milligrams [mg] of Periostat twice daily) is actually subantimicrobial, meaning that there is no antibiotic effect, but inflammation is still reduced, and therefore, signs and symptoms improve.

Reason: Rosacea's bumps and pimples are due to inflammation, possibly caused by microscopic skin mites that live in everyone's facial skin but that are found in greater numbers in the skin of rosacea patients. Typically, oral medication is used together with topical medication for three to six months. The oral medication is then tapered off, while topical medication is continued as part of a long-term maintenance regimen.

Whatever approach is used, the types and dosages of the medications may need some adjustment at first. For this reason, it's important to alert your doctor if you experience any new skin irritation or other problems after starting treatment.

Laser And Light Treatments

Despite medication and changes in lifestyle, some patients may still have persistent facial redness and dilated blood vessels. In these cases, laser treatments and light treatments, such as intense pulsed light (IPL), can help eliminate the enlarged blood vessels and redness.

Caution: These treatments should be performed by a highly skilled dermatologist. If not done properly, they can lead to complications. Since these treatments typically are not covered by insurance, it is also a good idea to establish the cost of the treatments in advance.

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