Many rosacea patients report burning, stinging, and itching of the face. Certain rosacea patients may also experience some swelling (edema) on the face that can be noticed from the initial stage of the disease. It is also believed that in some patients this swelling process may contribute to the development of excess tissue in the nose (rhinophyma), the condition that gave the late comedian WC Fields his signature nose.
Fair-skinned patients who tend to blush or blush easily are often believed to be at higher risk, while in fact facial flushing from rosacea is simply more obvious on lighter skin. A normal flush or sunburn may look the same, as can flushing caused by medications such as niacin or some antihypertensive medications. Redness occurs when a large amount of blood flows through the vessels rapidly and the vessels expand under the skin to handle the flow. However, people with extensive sun damage, certain skin types, and even patients treated with rosacea can still have a red face or streaks in blood vessels, which is often misdiagnosed as active rosacea. This is because visible blood vessels (telangiectasia) not only develop with rosacea (or were probably always there), but there may be some residual persistence of redness due to dilation of the blood vessels during active disease. Unfortunately, these patients continue their medications unnecessarily, while the most appropriate treatments include camouflage makeup, sunscreens, a vascular laser, or an intense pulsed light source.
Unlike some conditions, there are no histological, serological, or other diagnostic tests for rosacea. A thorough examination of the signs (appearance of bumps or pimples) and symptoms (redness, redness, and swelling, burning, itching, or stinging), as well as a medical history of possible triggers, leads to the diagnosis. The National Rosacea Society suggests that the most common rosacea triggers were sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, vigorous exercise, hot baths, hot drinks and certain skin care products. In other words, almost anything that is potentially stimulating is bad news for rosacea. Unfortunately for some, certain conditions such as lupus, seborrheic dermatitis, drug rashes, and even rare forms of lymphoma can resemble rosacea and are often overlooked or worsened by the untrained eye when patients are diagnosing themselves.
Rosacea is not an infectious disease and there is no evidence that it can be spread by skin contact or by inhaling airborne bacteria. However, it has long been theorized that parasites in hair follicles or sebaceous glands or on the face can stimulate inflammation by their activity or even by their presence. One such organism is the Demodex folliculorum mite, which studies have found to be more prevalent and active in rosacea patients than in control groups. Early changes in vascular and connective tissue probably create a favorable environment for the growth of Demodex folliculorum. This may represent an important cofactor, especially in papulopustular rosacea, in which a delayed hypersensitivity reaction is suspected, but is not the cause of rosacea. On the other hand, elimination of the signs of rosacea after a tetracycline or sulfur oral ointment may not affect the resident demodex population.
The incidence of demodex is related to age. It was found up to 20 years in approximately 25%, up to 50 years in approximately 30%, up to 80 years in approximately 50% and in all those aged 90 and over. In healthy people, one or more Demodex can be found in every tenth tab. This index increases with age. In blepharitis or other external eye diseases, demodex is found in about one in six tabs. Treatment of chronic blepharitis in association with demodex may include antibiotics, steroids, Quecksilber 2%, or lindane. Massage of the eyelid margins is essential because local treatment has no effect as long as the mite remains deep in the pilosebaceous complex.
Since rosacea is characterized by flare-ups and remissions, and research has shown that long-term medical therapy significantly increases the rate of remission in rosacea patients, it is advisable for patients to use a maintenance regimen. In a six-month multicenter clinical study, 42 percent of those not using medication had relapsed, compared with 23 percent of those who continued to use a topical antibiotic. Therefore, treatment between flare-ups can prevent them. A facial care routine for rosacea often begins with a gentle, refreshing cleansing of the face each morning. Victims should use a mild soap or cleanser that is not granular or abrasive and spread with their fingertips. A soft pad or washcloth can also be used, but avoid rough washcloths, loofahs, brushes, or sponges. The face should be rinsed with warm water several times and dried with a thick cotton towel.
A new treatment available is sea buckthorn oil (Hippophae rhamnoides), which is the active ingredient in facial soap. Its activity is directed against the mite to reduce inflammation under the skin and therefore provide relief from the mechanisms that cause the rosacea symptom complex. The advantage that patients find with the soap is the elegance of the cleansing vehicle on otherwise sensitive skin, the presence of vitamin E and aloe vera that provide additional healing properties, and other active ingredients such as astragalus membrane and spirodella polyrhiza, useful yeasts that increase the activity of sea buckthorn oil.
My patients have found this to be well tolerated and useful as monotherapy or in addition to their other topical and / or systemic medications. We conducted a small double-blind, placebo-controlled office study that showed that most patients had a reduction in symptomatic erythema, as well as a reduced response to triggers.