Rosacea 1.0 To Newly Diagnosed Like Me

Ah yes age 54 soon to be 55 and suddenly develop skin problems.

You would think by age 50 after working all your life and dealing with Osteonecrosis Osteoarthritis Spondylolisthesis Being a former Battered woman from my 1st marriage

I could at least remain free and clear from skin problems I mean at age 50 we deserve at least 10 years of nothing else as a diagnosis

So here I am learning more stuff.
Exhausting……

1.0 Rosacea (said rose-ay-shah) is a potentially progressive neurovascular disorder that generally affects the facial skin and eyes. The most common symptoms include facial redness and inflammation across the flushing zone – usually the nose, cheeks, chin and forehead ; visibly dilated blood vessels, facial swelling and burning sensations, and inflammatory papules and pustules.
Rosacea can develop gradually as mild episodes of facial blushing or flushing which, over time, may lead to a permanently red face.
Ocular rosacea can affect both the eye surface and eyelid. Symptoms can include redness, dry eyes, foreign body sensations, sensitivity of the eye surface, burning sensations and eyelid symptoms such as chalazia, styes, redness, crusting and loss of eyelashes.
A panel of experts have agreed on a standard classification system for Rosacea. This system is a brief text that is not intended to be exhaustive, but is a place to start.
“Rosacea is a chronic cutaneous disorder, primarily of the central face. It is often characterized by remission and exacerbation and it encompasses various combinations of such cutaneous signs as flush, erythema, telangiectasias, edema, papules, pustules, ocular lesions, and rhinophyma. Primary features considered as necessary for diagnosis include flushing, erythema, papules, pustules, and telangiectasias. A variety of secondary features are listed that may be absent or present as a single finding or in any combination.”

Are there different types of Rosacea ?
The panel of Rosacea experts agreed on the following broad, non exclusive text (i.e. there may be other factors and types that come into play).
“The system divides rosacea into four subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. As presently worded, papulopustular rosacea is noted as often being observed following or with erythematotelangiectatic disease and phymatous rosacea as following or occurring together with either erythematotelangiectatic or papulopustular rosacea. However, Dr. Wilkin emphasized that while those descriptions are consistent with common concepts about rosacea natural history, they are provisional and subject to change.”
“In its current iteration, the classification system excludes rosacea fulminans, steroid-induced acneiform eruptions, and perioral dermatitis without rosacea signs from the diagnosis of rosacea.”

What is the difference between acne and rosacea ?
As rosacea is a neurovascular disorder it affects the flushing zone.
Is is common that Rosacea does not present with blackheads that are seen with Acne Vulgaris. Also the age of onset, and the location of redness is a clue. Rosacea is commonly an adult disease, and is generally restricted to the nose, cheeks, chin and forehead. It can coexist with acne vulgaris.
Some rosacea sufferers have a significant acne component in their symptoms so it can be easily confused with acne vulgaris. The papules and pustules of rosacea tend to be less follicular in origin.
Rosacea will probably have an underlying redness that is related to flushing and thus looks different to acne vulgaris. Acne sufferers normally do not have the accompanying redness.
Rosacea usually begins with flushing, leading to persistent redness.
As both conditions are inflammatory, the treatment for rosacea and acne vulgaris can be somewhat similar, but some of the acne vulgaris regimes are too harsh for rosacea affected skin and can severely aggravate the condition.
Rosacea sufferers are cautioned against using common acne treatments such as alpha hydroxy acids (glycolic and lactic acids), topical retinoids (such as tretinoin, Retin-A Micro, Avita, Differin), benzoyl peroxide, topical azelaic acid, triclosan, acne peels, chemical peels. Additionally the caution extends to topical exfoliants, toners, astringents and alcohol containing products.

What is the difference between Rosacea and Seborrheic Dermatitis ?
Seborrheic Dermatitis and Rosacea are closely related, they both involve inflammation of the oil glands. Rosacea also involves a vascular component causing flushing and broken blood vessels.
Seborrheic Dermatitis may involve the presence of somewhat greasy flaking involving the T zone, crusts, scales, itching and occasionally burning, and may also be found on the scalp, ears and torso. It does not usually involve red bumps as in Rosacea.
The T zone is the area shaped like a `T’ composed of your forehead, nose and around your mouth.
Just to confuse things further, the two conditions are often seen together. See also: seb derm, elidel and protopic : a warning.

1.4 What causes Rosacea ?
There are a few theories, but none are yet conclusive. Popular theories include rosacea being caused by how frequently we flush and how our blood vessels cope with this flushing ; an over active inflammatory response to some unknown pathogen.
The fact that rosacea’s cause is unknown thankfully hasn’t stopped the development of some excellent treatment regimes.

How does rosacea progress ?
“Rosacea normally progresses in the same generalised fashion, frequent dilation of facial blood vessels leads to vascular hyper-responsiveness
and structural damage.”
Rosacea experts talk about rosacea symptoms appearing in 4 stages. Over time rosacea can progress from one stage to the next.
From Dr. J Wilkin:
“Most textbooks and literature citations characterize rosacea as a disease that gradually evolves from early to later subtypes. However, there is not conclusive evidence to substantiate that course and we want to know if it really occurs. Nevertheless, the individual features within a subtype can get worse, so early treatment is advocated, even if there is not progression from one stage to the next,”

How can Rosacea be treated ?
The best answer is “working with the support of your registered health professional”. There are medications available that control the redness and reduce the number of papules and pustules associated with rosacea.
Current run-of-the-mill treatment might include oral antibiotics and topical metronidazole. One study showed that the use of topical metronidazole alone can help some sufferers to reduce rosacea flare-ups once the rosacea is brought under control.
For those sufferers that do not benefit from the metronidazole based treatments, there are many other options. Quite a few treatments options are often discussed on the rosacea-support email group.
Experts agree that a gentle cleansing regime is very important. Avoiding chemicals that aggravate the rosacea, but will clean and moisturise the skin is a step in the right direction. See also: mild cleanser is important.
As the sun is a strong trigger for many rosacea sufferers, a good non-irritating sunscreen used daily is very important. For those who react badly to chemical sunscreens, a physical sunscreen may be more suitable. Physical sunscreens rely on the reflective properties of the main ingredients (rather than the ability of some chemicals to absorb the sun’s energy). The most common physical sunscreens are based on zinc oxide or titatinium dioxide.
The vitamin A derivative isotretinoin (known as Accutane or Roaccutane), has been shown to be effective against severe papopustular rosacea. It works by inhibiting sebaceous gland function and physically shrinking the glands. It also has potent anti-inflammatory properties, making it ideal to treat resistant rosacea. At low doses, accutane has also been shown to reduce other symptoms such as facial burning and redness. Accutane is a strong drug, and even at the low doses found beneficial to rosacea, should be used under strict supervision of your doctor.
Low does accutane may be more suitable than the regular dose, as there are less side effects and lesser chance of aggravating redness. See also dramatic results with low dose accutane and focus on low-dose accutane.
The mixed light pulse laser – Photoderm is showing promise as a treatment for the vascular component of rosacea. It works by targeting facial microvessels that are damaged.
One treatment that has been shown to help some is Rosacea-LTD III. It is the third generation of topical mineral salt based treatment. The minerals shrink facial vessels as well as reduce papules and pustules. More information is available at http://www.rosacea-ltd.com
For those wanting to treat the flushing side of their rosacea, 2 drugs are worth investigating. Monoxidine and Clonodine are 2 anti-hypertensives that you could look at with your doctor.
From a subjective view of the rosacea-support list members it would appear that one person’s treatment does not necessarily suit another, so your mileage may vary with any recommended treatment. Experiment a little and find what helps you. Depending on the stage of your rosacea, some treatments may be aggravating, while for others the same treatment may not cause problems. Every rosacea patient is unique and needs individual treatment.
Whatever path you choose, the support of a doctor or dermatologist that is willing to work with you will be very important, so shop around until you
are happy with your health professional.

What about steroids ?
Steroids have long been prescribed for rosacea because of their perceived quick relief. Milder (1% hydrocortisone) over the counter preparations are also popular as they are thought to be safer than the prescription strength treatment.
It is worth bearing in mind the following warnings:
over the counter steroids can cause steroid induced rosacea.
“After observation of long-term facial application of even low-dose corticosteroids, we have see many adults and children with a rosacea diathesis in whom severe burning and itching develop, along with bright red papules and nodules.This may occur after long-term application of even low-potency topical corticosteroids.
Application of topical corticosteroids causes immediate vasoconstriction and reduces the redness seen in rosacea and many other skin conditions. However, when patients discontinue usage of the topical corticosteroid, symptoms immediately reappear, and the symptoms are often much worse than those seen in the original condition.”

Can you be cured of Rosacea ?
Perhaps not cured in the sense of cured of a cold, but you can reduced your symptoms to a manageable level. There are plenty of treatment options out there, you may just need to experiment with a few.

Are there any Books about Rosacea I should read ?
There are very few books about Rosacea. In the last year of so there has been a couple of `self help’ books written about rosacea. You can find a
review of a couple of these at http://rosacea-support.org/book-reviews

Are there any non-profit organisations devoted to Rosacea ?
The National Rosacea Society is a non profit organisation set up to provide information about Rosacea. You can find them at http://www.rosacea.org/ They publish newsletters online as well as conduct surveys about rosacea sufferers. Also they make published information available to sufferers via regular mail. The National Rosacea Society are an introductory organisation that are a good first point of contact for information. In the past the NRS has awarded grants for 37 studies into rosacea.

Are there any support groups related to Rosacea ?
There is an email support group that you can subscribe to. This email group is free and unmoderated. Currently there are about 7000 users. To find out more information about the list, visit http://rosacea-support.org or I'm sure there are some on fb.

Info on Soolantra https://www.galderma.com.au/Portals/4/PIs%20and%20CMIs/Soolantra%20Consumer%20Medicine%20Information_150910.pdf