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Dr. Manley : Services : Detail
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| Rosacea |
Rosacea is a common but often misunderstood disease of the facial blood vessels affecting an estimated fourteen million Americans. Rosacea is more common in patients of Northern or Eastern European descent. Most patients with rosacea do not know they have it.
Rosacea starts as an occasional mild flushing of the face. As time goes on, more and more “triggers” develop that cause facial flushing. The disease gradually worsens over time as the flushing becomes more frequent, the redness becomes constant, broken blood vessels appear, and an acne-like rash develops. Patients spend much of their day avoiding “triggers.” Eventually, some patients with severe rosacea develop disfiguring swelling of the facial and nasal skin.
Rosacea can also have serious social and occupational consequences. Many patients report lowered self-esteem and self-confidence. Rosacea patients sometimes avoid public, work, and social engagements.
The underlying problem in rosacea is hyper-reactivity of the facial blood vessels. Normal facial blood vessels dilate in warm temperatures to cool the face. Normal patients do not have redness of the face even in very warm temperatures. The facial vessels in rosacea patients, however, over react to normal stimuli causing abnormal flushing and redness. Over time, the vessels dilate more and more until they are permanently damaged. When vessels are damaged, they begin to leak fluid and immune complexes into the skin causing permanent skin damage.
The Stages of Rosacea
Pre-rosacea: In the earliest stage of rosacea, patients have frequent episodes of facial flushing and blushing. Episodes of flushing are brief and completely resolve when the trigger has passed. Common causes of flushing are heat, exercise, facial cleansing, or embarrassing situations. These patients do not realize they have a disease and other people often think the “blushing” is cute.
Mild rosacea: Flushing episodes become persistent and last a half hour or more after a trigger is over. These patients usually still do not realize they are developing a serious medical condition. Treatment at this stage may prevent progression to worse rosacea.
Moderate rosacea: Redness persists for days or weeks and may become semi-permanent around the nose and cheeks. Swelling and burning sensations may occur. Many patients have outbreaks of inflammatory papules (red bumps) and pustules (pimples). Patients may also develop telangiectasia (broken blood vessels). These patients are very aware of their triggers and spend much of the day avoiding them.
Severe rosacea: A minority of patients go on to this stage. It is characterized by severe episodes of debilitating flushing, swelling, burning, and pain. Skin papules and pustules are more numerous. Some patients develop rhinophyma (permanent swelling of the nose).
Rosacea Triggers
The following are some of the common triggers for rosacea flushing:
- Warm environment
- Hot foods
- Hot drinks
- Spicy foods
- Embarrassment
- Anger
- Stress
- Exercise
- Mental concentration
- Crying
- Chewing
- Smiling
- Facial pain
- Heat
- Sun
- Wind
- Skincare products
- Alcohol
Patients may also have flushes for no reason at all.
Treatment
Intense Pulsed Light (Photoderm™): IPL is an advanced type of laser that uses a broad-spectrum pulse of light that focuses on facial blood vessels without damaging surrounding facial tissue. IPL is the mainstay of rosacea treatment today because it is safe, effective, and the only type of therapy that treats the underlying diseased blood vessels. Most patients get dramatic improvement with 3-5 treatments at 3-4 week intervals. Patients have minimal discomfort and little if any downtime during therapy. Déjà vu is the only clinic in the area with IPL.
Oral and topical antibiotics: Antibiotics are often effective in the treatment of the skin damage of rosacea. Antibiotics are probably effective because of their anti-inflammatory properties rather than their anti-bacterial effects. A common topical antibiotic is MetroGel® (metronidazole). A commonly used oral antibiotic is doxycycline.
Accutane®: Low dose Accutane is effective in the treatment of the skin damage of rosacea. Since IPL cannot be performed within six months of the use of Accutane, IPL treatments are recommended first to treat blood vessels before Accutane therapy is commenced. The manufacturer of Accutane must certify physicians before they can prescribe the drug. Dr. Manley is an authorized Accutane prescriber.
Skincare therapy: Stop using irritating skincare products. Especially avoid steroids as they will thin and damage the skin. Micronized zinc oxide (at least 8%) or dimethicone may help. Patients should use sunscreens but only if they are well tolerated. If not, the face should be shielded from the sun whenever possible.
Oral antihypertensives (clonidine, nadolol): Certain blood pressure medications may reduce flushing with physical activity. These drugs may be used in combination with IPL in patients who have problems with exercise-induced flushing.
More information: Get more information on Rosacea by reading Beating Rosacea by Dr. Geoffrey Nase or go to the following web sites:
www.drnase.com
www.rosacea.org
http://www.acnesoft.com/rosaceatreatment
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