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.