Rosacea diagnosis

The diagnosis of Acne rosacea is made by fulfilling one of several primary and one of many secondary criteria. Primary criteria for Acne rosacea include transient erythema/flushing, persistent facial redness, papules and pustules, and increased facial telangiectasias. Secondary criteria include burning/stinging, elevated red facial plaques with or without scale, dry/scaly skin, persistent facial edema (subtypes of solid facial or soft facial type), phymatous changes, and ocular manifestations such as burning/itching, conjunctival hyperemia, lid inflammation, styes, chalazia, and corneal damage.
There are four subtypes and one variant of Acne rosacea that have been defined by the National rosacea Society committee on the classification and staging of Acne rosacea: (i) erythematotelangiectatic, (ii) papulopustular, (iii) phymatous, and (iv) ocular. Erythematotelangiectatic rosacea is characterized by flushing and persistent central facial erythema with or without telangiectasia. The papulopustular type has persistent central facial edema and transient papules, pustules, or both. Phymatous rosacea occurs most often on the nose (rhinophyma) and is characterized by thick skin with an irregular surface, nodularities, and bulbous enlargement. Careful evaluation of a nose with the changes of rhinophyma should be undertaken because basal cell carcinomas may be present, as well as less common tumors. Lastly, the ocular type of rosacea has many symptoms, of eye affection. Granulomatous rosacea is a variant characterized by noninflammatory, hard, brown, yellow, or red papules/nodules of the central face. It is of note that rosacea fulminans (pyoderma faciale), steroid-induced acneiform eruption, and perioral dermatitis are not considered Acne rosacea variants but separate entities.
Ocular changes (blepharitis, conjunctivitis, and keratitis) and sebaceous hyperplasia of the nose (rhinophyma) may be associated with ocular rosacea. Differential diagnostic considerations include (i) acne vulgaris, which is characterized by a wider distribution of lesions and the presence of comedones, (ii) periorificial dermatitis, (iii) seborrheic dermatitis, (iv) malignant carcinoid syndrome, (v) lupus erythematosus, and (vi) photodermatoses. Ocular rosacea has been theorized to be secondary to increased local levels of interferon-1 that is pro-inflammatory and leads to lid irritation and erythema. Lipid breakdown in the tears releases fatty acids that are also irritating. Some studies have also shown a more alkaline pH of tears in patients with Acne rosacea.

Acne rosacea causes

Acne rosacea is a chronic disorder of unknown cause that affects the central face. At least 13 million people are affected by this noncurable disorder. It is characterized by two clinical components: a vascular change consisting of intermittent or persistent erythema and flushing and an acneiform eruption with papules, pustules, cysts, and sebaceous hyperplasia. There is no correlation between the sebum excretion rate and the severity of Acne rosacea. Lesional blood flow as measured by laser Doppler is three to four times that of controls. Onset is most often between the ages of 30 and 50; pediatric cases have also been reported. Although women are affected three times as frequently as men, the disease may become more severe in men. Acne rosacea is much more common in light-skinned, fair-complexioned individuals but may also occur in darker skin types. It is estimated that 10% of individuals in Sweden have Acne rosacea.
There is speculation that a defect in the trigeminal afferent nerve pathway contributes to a predisposition to facial flushing. Over time, after repeated bouts of flushing, the vessels become ectatic and there is permanent vasodilatation. Hot liquids are thought to promote erythema and flushing when they heat up the tissues of the oral mucosa, leading to a countercurrent heat exchange with the carotid artery. A further signal from the carotid body is then relayed to the hypothalamus (the body's thermostat), which signals the body to dissipate heat through flushing and vasodilatation because of the perceived increase in core body temperature.
Helicobacter pylori, a microaerophilic gram-negative bacteria implicated in gastric ulcer disease, has been theorized to be the inciting organism in Acne rosacea on the basis of an increased incidence of dyspepsia in this population and the responsiveness of Acne rosacea to metronidazole. Fifty percent of the world's population and 25% of the US population may have antibodies to this organism. Colonization is associated with increased levels of serum gastrin, which can cause flushing. Also, H. pylori infection can increase levels of histamine, prostaglandins, leukotrienes, and various other cytokines. Therapy to eradicate this organism usually consists of a combination of oral metronidazole, amoxicillin, and omeprazole. Conflicting studies regarding this association with Acne rosacea have recently been in the literature. In general, it is felt that strong support for a link between H. pylori infection and Acne rosacea is lacking. Large case control studies would be needed to prove this association because of the high baseline incidence of this exposure.
Infection with Demodex mites is common, with infection approaching 100% in sensitive tests of healthy adults. Some have hypothesized that infection with Demodex is a cause of Acne rosacea. There is controversy within the literature whether this is the case. In one study, there was a link between higher mite counts and papulopustular but not erythematotelangiectatic Acne rosacea. It is unclear whether Demodex is pathologic or just normal skin flora.

Acne Rosacea FAQ

What is Acne Rosacea?
Acne Rosacea is a common pustular eruption with flushing and telangiectasias of the butterfly area of the face may occur in adults especially in the 40- to 60-year-old age group.

What are the primary Acne Rosacea lesions?
Diffuse redness, papules, pustules, and, later, dilated venules, mainly of the nose, cheeks, and forehead, are seen.

What are the secondary Acne Rosacea lesions?
Severe, longstanding cases eventuate in the bulbous, greasy, hypertrophic nose characteristic of rhinophyma.

What about the course of Acne Rosacea?
The pustules are recurrent and difficult to heal. Rosacea keratitis of the eye may occur.

What are the causes of Acne Rosacea?
Several factors influence the disease:
heredity (oily skin);
excess ingestion of alcoholic beverages, hot drinks, and spicy foods;
Demodex mites (may be causative);
increased exercise;
increased exposure to hot or cold environment; and
topical or systemic corticosteroids.
Excess sun exposure and emotional stress can aggravate some cases of Acne Rosacea.

What are the conditions that have some similarities to Acne Rosacea?
Systemic lupus erythematosus: No papules or pustules; positive ANA blood test.
Boils: Usually only one large lesion; can be recurrent but may occur sporadically; an early case of Acne Rosacea may look like small boils. Bacterial culture shows Staphylococcus aureus or group A hemolytic streptococci. Responds to anti-Staphylococcus antibiotics.
Iodide or bromide drug eruption: Clinically similar, but drug eruption usually is more widespread; history positive for drug.
Seborrheic dermatitis: Pustules uncommon; red and scaly; also in scalp.
Acne Rosacea-like tuberculid of Lewandowsky: Mimics small papular Acne Rosacea clinically and tuberculids histologically, rare; biopsy helpful.

Outline Acne Rosacea treatment?
* Prescribe avoidance of these foods: chocolate, nuts, cheese, cola drinks, iodized salt, seafood, alcohol, spices, and very hot drinks.
* Metronidazole gel (MetroGel, Metrocream, Metrolotion or Noritate cream)
Apply thin coat b.i.d. Response to therapy is slow, taking 4 to 6 weeks to benefit.
* Sulfur, ppt. 6%
Resorcinol 4%
Colored alcoholic shake lotion q.s. 60.0
Apply to face h.s.
Similar proprietary lotions are Sulfacet-R lotion Rosac Cream (contains a sunscreen), Rosula (contains urea to decrease irritation), sodium sulfacetamide topical preparations, Plexion topical preparations, Novacet lotion, Avar Green (contains green tint to hide redness).
* Tetracycline, 250-mg capsules
Take 1 capsule q.i.d. for 3 days, then 1 capsule b.i.d. for weeks, as necessary for benefit. Other antibiotics that can be used, as for acne, include doxycycline, minocycline, and erythromycin.
* Therapy for Helicobacter pylori in the same treatment regimens as for peptic ulcer disease has been tried with some benefit in severe cases.
* Azeleic acid (Azelex, Finacea) in thin coat b.i.d.
* Crotamiton (Eurax) lotion in thin coat b.i.d.

Acne Rosacea

Acne Rosacea is a chronic inflammatory skin condition of unknown cause. It occurs in persons whose skin is prone to flushing therefore it has been postulated that the underlying defect is vascular in nature. Acne Rosacea affects 1–10% of the population, it is more predominant in the middle aged and females.

Paler skin types, such as celts, northern European and the fair skinned are more prone to developing Acne Rosacea. It is characterised by the development of a red rash on the cheeks. The nose, forehead, scalp and eyes can become affected. The facial redness becomes persistent often with the presence of dilated blood vessels over cheeks. Acute attacks of papules,

pustules and edema can occur in response to various triggers. These attacks can persist for weeks.

Three distinct phases are recognised in the development of Acne Rosacea:

* phase 1

– Persistent facial redness

– Telangiectasia on cheeks, nose, forehead

– Sensitive, irritable skin

– Stinging and burning sensation on application of cosmetics and treatment creams

* phase 2

– Development of papules, pustules and lymphedema

– Skin follicles affected and sebaceous glands enlarged

– Prominent facial pores

– Extension of rash over face and scalp

* phase 3

– Persistent edematous, inflamed facial skin

– Facial contours become thickened, coarse and irregular

– Tissue overgrowth especially nose, chin, eyelids, ears and forehead

– Eye involvement with inflammation, irritation, redness, discomfort,

photosensitivity

– Inflamation of the cornea with disturbed vision

Triggers to acute flares

Certain substances and conditions are thought to trigger acute attacks of Acne Rosacea:

* Foods triggers

– Coffee, tea, chocolate, cold drinks, alcohol, soy sauce, cheese, citrus fruits,

curries, vinegar, tomatoes, red meat, yogurt

– Large meals

– Thermal heat

– Highly spiced foods, pickled foods, smoked foods, fermented foods

* Chemical triggers

– Caffeine, vasodilators, perfumes, aftershaves, astringents, cosmetics

* Environmental triggers

– Resident Demodex skin mite in follicles and sebaceous glands

– Gastrointestinal upset (e.g. diarrhoea, cholecystitis, gastritis)

– Weather conditions (e.g. Sunlight, wind)

– Heat and cold

* Other triggers

– Topical corticosteroids

Rosacea: Make-Up Techniques

For those who have red splotches caused by rosacea or natural light skin pigment, Eve delivers a method that ensures a quick fix.

Ocular Rosacea

Ocular Rosacea
The exact prevalence of ocular involvement in patients with Acne Rosacea is unknown, although it has been reported to be as low as 3 percent and as high as 58 percent. The disease may begin in the eye and escape diagnosis for a long time, even years, and be accompanied by inappropriate treatments. Ocular manifestations may develop prior to cutaneous manifestations in up to 20 percent of patients with Ocular Rosacea. Approximately half of these patients develop skin lesions first, and a minority develop both manifestations simultaneously. The Ocular complications are independent of the severity of facial rosacea. However, there is a strong correlation between the degree of eye involvement and tendency to flushing.
The Ocular signs are variable including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis The term Ocular rosacea (ophthalmorosacea) covers all these signs, also discourteously referred to as rabbit eyes.
Rosacea keratitis has an unfavorable prognosis, and in extreme cases can lead to blindness because of corneal opacity. The most frequent eye sign, which may never progress, is chronically inflamed margins of the eyelids, with scales and crusts, quite similar to seborrheic dermatitis, with which it is often confused. Pain and photophobia may be present. It is instructive to ask rosacea patients how their eyes react to bright sunlight. All patients with progressive rosacea should be seen by an ophthalmologist for a thorough examination to detect other subclinical complications. Indeed, such rosacea patients are ideally managed by the cooperative efforts of the dermatologist and the ophthalmologist.
Management of the Ocular disease requires both systemic and topical treatment, including lid hygiene, lubrication, and, occasionally, short-term topical corticosteroids.

Topical Rosacea Treatment

Topical Rosacea Treatment
Acne Rosacea patients have a skin that is unusually vulnerable to chemical and physical insults. All sources of local irritation, such as soaps, alcoholic cleansers, tinctures, astringents, abrasives, and peeling agents must be avoided. Only mild soaps or cleansers are advised. Protection against sunlight must be emphasized.
Antibiotics, as used in acne, are sometimes effective. Topical tetracyclines, clindamycin, and erythromycin, usually in concentrations from 0.5% to 2.0%, are commercially available. Erythromycin and clindamycin seem to be superior. Tetracycline is effective orally, but a disappointment topically. An inhibition of chemotaxis or inflammatory cells or a direct effect on vascular endothelium may be responsible for its action.
Metronidazole has become an important addition to the Anti-Rosacea repertoire. The observation that topical metronidazole was comparable in its effects to oral tetracycline (250 mg bid) led to placebo-controlled double-blind clinical studies demonstrating its effectiveness. In many countries throughout the world there is a 0.75% gel, cream, or lotion, as well as a 1% cream available. It is applied once or twice daily and has its greatest effect on papules and pustules, and reduces erythema to a lesser degree. It does not alter telangiectases or flushing. Topical metronidazole may be used as monotherapy or, in more severe forms, in combination with oral antibiotics. One study found that 0.75% metronidazole gel rapidly reduced inflammatory lesions during the first 3 weeks of treatment, potentially allowing quick tapering and discontinuation of oral medication. Long-term use of 0.75% metronidazole gel has been shown to keep Acne Rosacea in remission. A study involving 88 patients whose Acne Rosacea was initially controlled with a combination of oral tetracycline and metronidazole found that more than 80 percent of those patients given metronidazole remained in remission after 6 months, while 40 percent of those patients given placebo relapsed. The mechanism by which metronidazole ameliorates the inflammatory lesions and erythema of Acne Rosacea may be related to anti-inflammatory or immunosuppressive actions of the drug.
Imidazoles are also gaining popularity with the treatment of Acne Rosacea. Best results are with ketoconazole cream applied once or twice daily. The imidazoles are anti-inflammatory agents, affect gram-positive bacteria, and, above all, are well tolerated by most Acne Rosacea patients with sensitive skin.
Old-time remedies should not be forgotten, even though their use is not supported by evidence-based trials. Drying lotions fall into this category, with a very thin application at night recommended. Lotions with 2% to 5% sulfur have been used successfully. Because they are messy, we no longer use them. Other topical medications proven effective for treating Acne Rosacea include sulfacetamide sodium 10% lotion, as well as sulfacetamide sodium 10% and sulfur 5% lotion, which may be tinted or tint free. They are used in a similar fashion and for the same purpose as metronidazole.
Retinoids are worth a trial. In an uncontrolled clinical study, women with Acne Rosacea used 0.025% tretinoin cream over a period of several months. After a predictable early exacerbation of symptoms, the patients then appeared to develop hardening and side effects diminished. Gratifying long-term results were reported, including a reduction in erythema. Alternative topical retinoids may prove easier to use. There is preliminary evidence that 0.2% isotretinoin in a bland cream is helpful. It is less irritating than tretinoin, and suppresses inflammatory lesions in stage II and III Acne Rosacea. No data exist for adapalene, which seems to be the least irritating of all topical retinoids.
In a clinical study, 20% azelaic acid cream was more effective than its vehicle cream in reducing the number of inflammatory lesions and degree of erythema associated with Acne Rosacea. In a recent study, 20% azelaic acid cream gave results comparable to 0.75% metronidazole cream with the added benefit of increased patient satisfaction. The efficacy of azelaic acid in Acne Rosacea may be due to the anti-inflammatory properties of this compound.
As stated earlier, Demodex folliculorum mites are not considered to play a causative role in Acne Rosacea, although massive infestation of Demodex folliculorum mites may sometimes aggravate the condition. Nevertheless, it is good to check for mites. This is best done with the skin-surface biopsy technique of placing a drop of cyanoacrylate on a glass slide that is covered with immersion oil and analyzed with the 10 or 20 × objective in the light microscope. The mites are hard to control with any of the antiparasitic drugs such as lindane (hexachlorocyclohexane), crotamiton, permethrin, or benzyl benzoate. The effect of treatment on the mite population can be monitored by cyanoacrylate skin-surface biopsies.
Sunscreens, preferably of the broad spectrum UVA plus UVB and infrared type, with a skin protection factor (SPF) of 15 or higher are always recommended to Acne Rosacea patients and should be used every day of the year. The sunscreens with a base of micronized zinc oxide or titanium oxide are nonirritating and work well for anyone with the sensitive skin of Acne Rosacea, but they leave sometimes an opaque hue on the skin, especially in the spacious facial pores. For this reason patients often turn away from these products.
Glucocorticoids should never be used. The only exception is with Acne Rosacea conglobata and Acne Rosacea fulminans. In these patients, short courses of oral and topical glucocorticoids are a reasonable option because of their anti-inflammatory properties.

Systemic Rosacea Treatment

Systemic Rosacea Treatment
ANTIBIOTICS
The most agreeable feature of Acne Rosacea is that it generally responds well to oral antibiotics. Tetracycline-HCl, oxytetracycline, doxycycline, and minocycline are usually quite effective in controlling papulopustular Acne Rosacea and even reducing erythema. It is important to start with full doses, for example, 1.0 to 1.5 g tetracycline-HCl or oxytetracycline per day. Likewise 50 mg of minocycline (our own choice) or doxycycline twice daily can be given. If tetracyclines are ineffective or not tolerated, erythromycin or other macrolides such as clarithromycin 34 or azithromycin 35 may be used. As soon as full control of papulopustules is achieved, usually after 2 to 3 weeks, maintenance doses of 250 to 500 mg tetracycline-HCl or oxytetracycline, or 50 mg minocycline or doxycycline per day or every other day are generally sufficient. Acne Rosacea sufferers often know how to titrate disease activity and vary dosage accordingly. Some get by with 250 mg tetracycline-HCl every other day. The sufferer's input should be encouraged and antibiotic usage should be carefully monitored. The disease has exacerbations and remissions and topical drugs may be sufficient during inactive periods. Some sufferers seem to become “addicted” to oral antibiotics and find ways to get them without prescription. Tetracycline therapy is mandatory for ophthalmic Acne Rosacea.
ISOTRETINOIN
This drug is exceptionally effective, although accompanied by far greater risks than tetracyclines. Before using it, one has to consider indications, contraindications, and all risks. Isotretinoin may be appropriate for all forms of severe or therapy-resistant Acne Rosacea, especially the variants which are unresponsive to antibiotics, such as lupoid Acne Rosacea, stage III Acne Rosacea, Acne Rosacea conglobata, gram-negative Acne Rosacea, and Acne Rosacea fulminans. It is particularly helpful in sufferers who have oily, wide-pored skin and multiple, often many dozens of sebaceous gland hyperplasias. Furthermore, all forms of phymas are worthwhile indications. The dose required for the control of severe Acne Rosacea varies. Tailored doses are recommended. The standard dose of isotretinoin is lower than in acne, namely 0.2 to 0.5 mg/kg body weight per day. Side effects on the eyes make this low dose unbearable for some sufferers. Ophthalmic Acne Rosacea may get worse, complaints of dry eyes can increase, and so can blepharitis. This may lead to the inability to use contact lenses. The standard dose is only used in Acne Rosacea fulminans, or preoperatively for a couple of months to shrink rhinophyma before surgical reduction of the bulbous nose. More recent studies demonstrate the efficacy of low-dose isotretinoin in the treatment of Acne Rosacea. In this schedule, initially 10 mg or 20 mg daily (not adjusted to body weight) are used. This dose is helpful in many forms of the disease, especially stage III Acne Rosacea, lupoid Acne Rosacea, and persistent edema in Acne Rosacea. After 1 to 2 months, this is further reduced to 10 mg every other day or even to two or three of seven days per week. Side effects on the eyes are minimal. Duration of therapy is longer as with the standard dose, for about 6 months. The cumulative dose, however, is very low. The usual precautions apply as in the therapy of acne. Isotretinoin is a teratogen and is contraindicated for women of childbearing age unless the sufferer meets all the requirements printed in detail in the package insert. Laboratory monitoring includes liver transaminases, bilirubin, cholesterol, and triglycerides before therapy and at monthly or bimonthly intervals thereafter.
METRONIDAZOLE
This is a synthetic nitroimidazole-derivative antibacterial and antiprotozoal agent for the treatment of infections caused by Trichomonas vaginalis, Entamoeba histolytica, and several anaerobic organisms. The usual dose is 500 mg twice daily for 6 days. Oral metronidazole is generally effective in all types of Acne Rosacea, including stage II and III. However, it may require 20 to 60 days to achieve control with a daily dose of 500 mg. The use of oral metronidazole is limited by concerns over adverse systemic effects and toxicity with long-term therapy, and it is not approved for Acne Rosacea treatment. Consequently, oral metronidazole is a second-line drug that may be tried when other methods are not working. It is very helpful for the treatment of Demodex folliculitis, even its worst form, such as Demodex-associated abscesses and furunculoid nodules. The dose is 750 to 1500 mg daily in divided doses for 10 to 14 days.

what is Rhinophyma?

Rosacea Rhinophyma
It occurs almost exclusively in men. Fortunately, only a few acne rosacea sufferers develop this complication. The bulbous nose develops over many years as a result of progressive increase in connective tissue, sebaceous gland hyperplasia, ectatic veins, and chronic deep inflammation. Rosacea Rhinophyma may accompany stage III rosacea; in other sufferers surprisingly the signs of rosacea in the rest of the face may be rather mild. Four variants of Rosacea Rhinophyma are recognizable.
GLANDULAR FORM
The nose is enlarged mainly because of enormous lobular sebaceous gland hyperplasia. The surface is pitted, with deeply indented and mildly distorted follicular orifices. The tumorous expansions of the nose are often asymmetric and of varying size. Humps and sulci occur. Sebum excretion is increased. Compression by the fingers yields a white pasty substance consisting of an amalgam of corneocytes, sebum, bacteria, and Demodex folliculorum mites.
FIBROUS FORM
Diffuse hyperplasia of the connective tissue dominates this picture. A variable amount of sebaceous gland hyperplasia may be seen.
FIBROANGIOMATOUS FORM
The nose is copper-red to dark red, greatly enlarged, edematous, and covered by a network of large, ectatic veins. Pustules are frequently present.
ACTINIC FORM
Nodular masses of elastic tissue distort the nose. These are rather similar to the elastomas that occur in older individuals who have markedly photodamaged skin as a result of overexposure to sunlight. This variety is mainly observed in subjects of Celtic origin who burn easily and tan poorly.

Rosacea: Lasers and Your Skin

Facial redness and birthmarks—lasers can treat them all. Let's look at how.

WHAT IS ROSACEA?

Acne Rosacea
Acne Rosacea is a chronic inflammatory facial eruption characterized by papules and pustules on a background of erythema and telangiectasia.
Epidemiology
Acne Rosacea is common. peak age at presentation is the third or fourth decade and the condition has been more frequently observed in patients with fair skin. It has an equal sex incidence but men often have more severe disease.
Pathology
The pathogenesis of Acne Rosacea is unknown. Histologically there is a non-specific perifollicular and perivascular inflammatory infiltrate with dilated capillaries in the superficial dermis.
Clinical features
Acne Rosacea is a persistent disease with episodic inflammatory flares. Patients usually have a long history of episodic facial flushing, which may be exacerbated by heat, emotional upset, hot drinks, spicy foods and alcohol. During these episodes, there is intense erythema symmetrically over the cheeks, nose, forehead and chin. There are three stages in the evolution of this disease.
Chronic Acne Rosacea can be associated with marked sebaceous hyperplasia, most commonly on the nose giving a bulbous craggy appearance. This is known as rhinophyma. There may also be lymphoedema resulting in swelling of the central part of the face. Approximately 50% of patients have minor degrees of ocular involvement, most commonly conjunctivitis, blepharitis and keratitis leading to corneal scarring.
Investigations
Acne Rosacea can be diagnosed clinically; investigations are not usually required.
Skin biopsy
If the diagnosis is in doubt a skin biopsy may be required for histopathology.



Stages in the evolution of Acne Rosacea
Stage Clinical features
I Persistent erythema with telangiectasia
II Persistent erythema, telangiectasia, papules and tiny pustules
III Persistent deep erythema, dense telangiectasia, papules, pustules and nodules


Management
Identify and address precipitating factors
Patients are advised to avoid factors that provoke facial flushing. Reduction of alcoholic and hot beverages is helpful in some cases.
Concealing agents
Camouflages can be used for the erythema, and laser treatment is helpful in the treatment of telangiectasia.
Antibiotic therapy
Papules and pustules of Acne Rosacea respond well to topical metronidazole or to oral oxytetracycline or tetracycline 500 mg twice daily. Courses usually last 6-12 weeks and are repeated intermittently. Alternatively doxycycline or minocycline 100 mg daily can be given.
Oral retinoids
Isotretinoin is occasionally given in refractory or severe cases. Despite topical and systemic treatment the redness and telangiectasia may not improve.
Surgery
Rhinophyma is treated by surgery or laser surgery, shaving the hypertrophic tissue from the nose. Unfortunately regrowth of this tissue frequently occurs.
Prognosis
Despite optimal treatment, recurrences are common.

Rosacea: treatment with laser

A patient's view on the treatment of his rosacea and broken capillaries with the gemini laser.

Rosacea Treatment

Acne Rosacea Treatment
Oral antibiotics and isotretinoin.
Both the skin and eye manifestations of Acne Rosacea respond to either tetracycline or erythromycin. One gm/day is used in divided doses. Resistant cases can be treated with 100 to 200 mg/day of minocycline or doxycycline and with 200 mg of metronidazole twice daily. Medication is stopped when the pustules have cleared. The response after treatment is unpredictable. Some sufferers clear in 2 to 4 weeks and stay in remission for weeks or months. Others flare and require long-term suppression with oral antibiotics. Treatment should be tapered to the minimum dosage that provides adequate control. Sufferers who remain clear should periodically be given a trial without medication. However, many sufferers promptly revert to the low-dose oral regimen. Isotretinoin, 0.5 mg/kg/day for 20 weeks, was effective in treating severe, refractory Acne Rosacea; 85% had no relapse at the end of a year.
Topical therapy.
Topical metronidazole (Metrogel) is not as effective but may be used for initial treatment for mild cases or for maintenance after stopping oral antibiotics. Metronidazole is not very effective in inhibiting anaerobic P. acnes, but it may exert its therapeutic effect by inhibiting oxidative tissue injury by neutrophils. One study showed that clindamycin in a lotion base produced clinical results similar to those of oral tetracycline (250 mg four times a day for 3 weeks, then 250 mg twice a day for 9 weeks) and was superior in the eradication of pustules.
Sulfacetamide/sulfur lotion (Sulfacet, Novacet) controls pustules. Sulfacet-R is flesh colored and hides redness. They are effective alone or when used with oral antibiotics.
Sufferers with rhinophyma may benefit from specialized procedures performed by plastic or dermatologic surgeons. These include electrosurgery, carbon dioxide laser, and surgery. Unsightly telangiectatic vessels can be eliminated with careful electrocautery.
sufferers who do not respond to antibiotics may have Demodex folliculorum mite infestation or tinea, in which the facial pustules and scales are usually localized to one cheek; a potassium hydroxide examination confirms the diagnosis. Crotamiton (Eurax) is reported to be effective. Lindane lotion or Sulfur & Salicylic Acid soap should also be effective.

Rosacea symptoms

Skin manifestations.
Acne Rosacea occurs after the age of 30 and is most common in people of Celtic origin. The resemblance to acne is at times striking. The cardinal features are erythema and edema, papules and pustules, and telangiectasia. One or all of these features may be present. The disease is chronic, lasting for years, with episodes of activity followed by quiescent periods of variable length. Eruptions appear on the forehead, cheeks, nose, and occasionally about the eyes. Most sufferers have some erythema, with less than 10 papules and pustules at any one time. At the other end of the spectrum are those with numerous pustules, telangiectasia, diffuse erythema, oily skin, and edema, particularly of the cheeks and nose. Granuloma formation occurs in some sufferers (granulomatous Acne Rosacea). Chronic, deep inflammation of the nose leads to an irreversible hypertrophy called rhinophyma.
Ocular Acne Rosacea.
Manifestations of this disease range from mild to severe. Symptoms frequently go undiagnosed because they are too nonspecific. The prevalence in sufferers with Acne Rosacea is as high as 58%, with approximately 20% of those sufferers developing ocular symptoms before the skin lesions. A common presentation is a sufferer with mild conjunctivitis with soreness, grittiness, and lacrimation. sufferers with ocular Acne Rosacea have been reported to have subnormal tear production (dry eyes), and they frequently have complaints of burning that are out of proportion to the clinical signs of disease. These signs include conjunctival hyperemia, telangiectasia of the lid, blepharitis, superficial punctate keratopathy, chalazion, corneal vascularization and infiltrate, and corneal vascularization and thinning. The conjunctival epithelium is infiltrated by chronic inflammatory cells.

what is Rosacea ?

Acne Rosacea is a chronic inflammatory disease affecting the blood vessels and pilosebaceous units of the face in middle-aged individuals. sufferers with Acne Rosacea have papules and pustules superimposed on diffuse erythema and telangiectasia over the central portion of the face. An important component is easy flushing and blushing of the face often accentuated when alcohol, caffeine, or hot spicy foods are ingested. Hyperplasia of the sebaceous glands, connective tissue, and vascular bed of the nose sometimes causes rhinophyma, which is a large, red, bulbous nose. Ocular complications, which occur in a significant number of Acne Rosacea sufferers, include blepharitis, chalazion, conjunctivitis, and progressive keratitis that can lead to scarring and blindness.
Acne Rosacea can usually be differentiated from adult acne by the lack of comedones and the prominent vascular (flushing/telangectasia) component. Other causes of a red face in adults such as the malar eruption of acute systemic lupus erythematosus and the heliotrope rash of dermatomyositis, seborrheic dermatitis, and perioral dermatitis must be considered. Acne Rosacea and the eye complications usually respond well to tetracycline and/or oral metronidazole, but the antibiotic must be continued for life (at the lowest dose that suppresses the condition) because Acne Rosacea recurs when therapy stops. Topical antibiotics (metronidazole [MetroGel] or Noritate) can be helpful alone or in combination with low-potency topical steroids (e.g., hydrocortisone 1% lotion) once or twice a day; higher-potency steroids can actually worsen the disease.

what is rosacea?

Rosacea causes (2)

Acne Rosacea is usually preceded by degenerative changes of the perivascular, and possibly vascular, collagen and elastic tissues in inherently susceptible individuals exposed to climatic factors. These dermal changes are believed to lead to small vessel dilatation resulting in flushing, apparent vessels under the skin surface, and redness. Eventually, the dilated vessels become incompetent with perivascular leakage of potentially inflammatory substances.
Different mediators, including the neurotransmitter peptide substance P, histamine, serotonin, and prostaglandins, have been proposed to be involved in the erythematous response. It is also possible that none of these is responsible but that the reaction is triggered by another, still unknown mechanism.
The presence of microorganisms has also been examined as a potential contributing factor to Acne Rosacea, but results have been inconclusive. Demodex folliculorum mites are merely commensals and do not, in contrast to former belief, play a significant part in the development of Acne Rosacea, although an inflammatory reaction to the mites may be important in this condition. This is different from Demodex folliculorum folliculitis (demodicosis, demodicidosis). Some reports suggest that patients with Acne Rosacea have an increased prevalence of Helicobacter pylori infection, although other reports fail to confirm this association. Eradication of H. pylori has been occasionally associated with an improvement of Acne Rosacea symptoms. Study results are inconsistent, but it has been suggested that H. pylori synthesizes gastrin, which may stimulate flushing.
Acne Rosacea is considered by some authors as a seborrheic disease. Many patients with Acne Rosacea, however, do not show signs of excessive sebaceous activity although others do. One report says that there is no significant association between Acne Rosacea and seborrhea. It is not a primary disease of sebaceous follicles in contrast to acne vulgaris. Comedones are absent and the initial findings are not related to follicles, though papulopustules are follicular bound.
No acceptable evidence of genetic predisposition has been reported so far, although more than one case in a family is often encountered.

WHAT IS ROSACEA?

Acne Rosacea is a chronic disease involving the central face including the cheeks, chin, nose, and central forehead. There are various combinations of flushing, redness, apparent vessels under the skin surface, edema, papules, pustules, ocular changes, and deep inflammation of the nose.

These symptoms may be temporary and each may occur independently. One or more of the features may be present. There are remissions and exacerbations. The causes and mechanism of development are unknown and there are no tissue or serum markers.

Acne Rosacea is common with a prevalence as high as 10% in some populations. It appears to be more common in people with fair skin. Acne Rosacea may occur at any age but most patients are over 30.

Acne Rosacea has been divided into four types. Progression from one subtype to another may occur. It is important to treat Acne Rosacea to prevent development of disease.

Rosacea symptoms

Rosacea causes

Acne Rosacea is a relatively common disease, especially in fair-skinned people of Celtic or northern European heritage, hence the term curse of the Celts. It is rarer in dark-skinned people, particularly so with American and African blacks. The disease is estimated to affect at least 5 percent of Americans, or some 13 million people. Although it is said that women are more often affected than men in earlier stages (3:1 ratio), men develop the tissue and sebaceous gland hyperplasia leading to rhinophyma much more frequently. Although Acne Rosacea tends to be milder in women, it can lead to severe emotional distress owing to its chronic course.
The importance of sun-damaged skin in Acne Rosacea cannot be stressed enough. Acne Rosacea is always associated with solar elastosis and often with heliodermatosis. This is a consistent background on which Acne Rosacea is superimposed. However, an increase in ultraviolet sensitivity has not been demonstrated in Acne Rosacea sufferers, nor is the disease more common in outdoor workers.
There is also a wide spectrum of Acne Rosacea manifestations. Especially in young sufferers there may be a history of acne giving rise to variants of two independent facial diseases that are difficult to recognize and treat. It is important to realize that Acne Rosacea and acne can coexist, though normally Acne Rosacea begins and reaches its peak incidence decades after acne declines.
Although the precise cause of Acne Rosacea remains a mystery, various factors have been suspected to contribute to this condition. None of them, however, has been definitely confirmed. Acne Rosacea sufferers are constitutionally predisposed to flushing and blushing. Migraine headaches have been shown to be two or three times more common in Acne Rosacea sufferers than among age- and gender-matched control subjects, suggesting the possibility of a more generalized vascular pathogenesis. The fact that vasomotor lability is especially pronounced during menopause and that a significant number of Acne Rosacea sufferers are perimenopausal women supports this hypothesis. Experimental studies show that the involved skin responds normally to various vasoactive chemicals, with facial blood vessels maintaining their capacity for dilatation and constriction. The basic abnormality seems to be a microcirculatory disturbance of the function of the facial angular veins directly involved in the brain-cooling vascular mechanism.

How to Cover Redness & Rosacea

This video to learn how to cover redness and rosacea in a natural way. You aren't going to cover all of it, but it just makes your face look better.

WHAT IS ROSACEA?

The disease was originally called acne rosacea. Papules and pustules occur in the central region of the face against a livid erythematous background with telangiectases. Later, there may occur diffuse hyperplasia of connective tissue with enlarged sebaceous glands. The disease evolves in stages. The early signs are recurrent episodes of blushing that finally become persistent dark red erythema, particularly on the nose and cheeks, often before the age of 20 years. These persons are the so-called flushers and blushers. Rosacea is common in the third and fourth decades and peaks between the ages of 40 and 50 years. In the worst cases, nonpitting edema (fibrosis), particularly of the nose (rhinophyma), may develop after many years. Early diagnosis and appropriate management are required to minimize patient discomfort and psychological distress.