Jun 11
14
The Angry Face
Rosacea, a facial inflammatory disorder, is a common dermatologic problem and can have a significant negative impact on quality of life of women over 50. The condition affects men and women and usually makes its first appearance in midlife. It is more common in fair skinned individuals, but can occur in darker skin types as well. Clinical manifestations can range from mild to severe and can include facial redness and flushing, sensations of burning and stinging, pimple like bumps, or in severe cases, painful cysts and rough thickened skin. The most common areas of involvement are the forehead, nose, and cheeks. (A variant called ocular rosacea affects the eyelids and oily tear glands.) Rosacea was inaccurately called “adult acne” in the past, but we now know that it is a totally different disease than acne. Its origins have historically been a mystery, and we’ve been reduced to blaming genetics (i.e. it’s your parents’ fault!).
We still tend to blame genes, but in the past few years, new research has been done to shed some light on this mysterious disease. We now know, for example, that the skin has its own immune system, called the “innate immune system.” Think of this as an army, ready to fight off foreign invaders (like bacteria, fungi, etc.). The army is made up of immune cells that live in the top layers of skin. When something foreign appears on the scene, these cells decide if the foreigner is friend or foe. If it is deemed to be a threat, the cells produce chemical messengers called cytokines, which cause an inflammatory response to kill the foreigner. Inflammation is a term that encompasses the classical clinical signs of heat, redness, swelling, and pain. Inflammation is our body’s way of fighting infection, but is also how we respond to trauma and initiate wound healing. Thus, inflammation serves a good purpose.
But sometimes inflammation can get out of hand. Sometimes the chemical signals that normally turn off inflammation do not happen. In the case of rosacea, it appears that the cells responsible for initiating the inflammatory process are overly sensitive and tend to get turned on at the drop of a hat, either from infectious, physical, or internal triggers. I think of this as skin that is always ticked off. Every little insult, whether it is a bacteria or fungus, or a break in the skin barrier due to heat, dryness or irritation, or even some internal factors such as stress or certain foods, can set these cells off. This creates a vicious cycle of inflammation, manifesting as redness, heat, swelling, bumps, and pustules.
The cytokines that mediate all this inflammation are the subject of much study and may lead to more effective treatments in the future. For now, prescription topical and oral antibiotics are the mainstay of therapy. They seem to work via anti-inflammatory mechanisms (although their bacteria fighting activity may play a role after all.) Pulsed dye laser and intense pulsed light therapy can be helpful in reducing the redness caused by chronically dilated blood vessels.
Beyond medical and laser therapy, skin care and lifestyle modification are just as important in the management of rosacea. Here are some important tips I give my patients:
1. Sun exposure is one of the triggers that sets off rosacea skin. Protect your skin from the sun with a good sunscreen. If you have chronic redness, you might want to try a moisturizing sunscreen with an herbal anti-redness ingredient, such as Aveeno Ultra Calming or Eucerin Redness Relief. If you have super sensitive skin and cannot tolerate chemical sunscreens, a physical sunblock such as Neutrogena Pure and Free Liquid Daily Sunblock is a good choice.
2. Extremes of temperature, either hot or cold, can trigger the inflammatory response. Try to protect your skin from the elements. Avoid overly hot showers and facial steaming. Protect your skin from cold and wind with a soft scarf or a layer of rich moisturizer.
3. Anything that disrupts the skin’s surface can trigger rosacea. Avoid harsh cleansers, scrubs, microdermabrasion, even washcloths. Avoid astringents, alcohol containing toners, and products containing witch hazel, camphor, or menthol. Avoid products with long lists of ingredients. For cleansing, try Aveeno Ultra Calming cleanser or Cetaphil non-soap cleanser. Use your fingertips and lukewarm water.
4. Dry skin aggravates rosacea! If your skin tends to be dry, find a good moisturizer you can tolerate (preferably without irritating fragrances) and use it religiously. CeraVe facial moisturizer is a good choice.
5. Try to avoid alcohol, spicy foods, and hot foods (such as hot soup), as they tend to dilate your blood vessels, making the redness worse.
6. Avoid the “pro-inflammatory” foods, especially sugar and simple starches. These foods stimulate insulin release, which in turn stimulates the inflammatory cascade.
7. Use an anti-dandruff shampoo two or three times a week. Many rosacea patients also suffer from seborrheic dermatitis (also known as dandruff) and the Malassezia yeast that triggers dandruff may also serve as a trigger for rosacea.
8. Chill out! Try to manage your stress levels. Studies have shown complex interactions between the neuroendocrine system and the innate immune system of the skin.
Rosacea can share symptoms with other conditions, such as contact dermatitis, acne, lupus, and others. See your dermatologist to get a correct diagnosis. Rosacea, while not curable, can be managed with a combination of the therapies and lifestyle modifications discussed above. For more information, visit the website of the National Rosacea Society at www.rosacea.org.
