Diagnosis:

Diagnosis of rosacea is made by the presence of clinical symptoms. There is no specific test for the disease. Episodes of persistent flushing, redness (erythema) of the nose, cheeks, chin, and forehead, accompanied by pustules and papules are hallmarks of the disease. A dermatologist will attempt to rule out a number of other diseases that have similar symptoms. Acne vulgaris is perhaps the disorder most commonly mistaken for rosacea, but redness and spider-like veins are not observed in patients with acne. Blackheads and cysts, however, are seen in acne patients, but not in those with rosacea. Other diseases that produce some of the same symptoms as rosacea include perioral dermatitis and systemic lupus erythematosus.

Treatment:

The mainstay of treatment for rosacea is oral antibiotics. These appear to work by reducing inflammation in the small blood vessels and structure of the skin, not by destroying bacteria that are present. Among the more widely used oral antibiotics is tetracycline. In many patients, antibiotics are effective against the papules and pustules that can appear on the face, but they appear less effective against the background redness, and they have no effect on telangiectasia. Patients frequently take a relatively high dose of antibiotics until their symptoms are controlled, and then they slowly reduce their daily dose to a level that just keeps their symptoms in check. Other oral antibiotics used include erythromycin and minocycline. Some patients are concerned about long-term use of oral antibiotics. For them, a topical agent applied directly to the face may be tried in addition to an oral antibiotic, or in its place. Topical antibiotics are also useful for controlling the papules and pustules of rosacea, but do not control the redness, flushing, and telangiectasias. The newest of these topical agents is metronidazole gel, which can be applied twice daily. Like the oral antibiotics, topical preparations appear to work by reducing inflammation, not by killing bacteria.

Vitamin A derivatives, called retinoids, also appear useful in the treatment of rosacea. An oral retinoid, called isotretinoin, which is used in severe cases of acne also reduces the pustules and papules in severe cases of rosacea that do not respond to antibiotics. Isotretinoin must be taken with care, however, particularly in women of childbearing age. They must agree to a reliable form of contraception, because the drug is known to cause birth defects.

Topical vitamin A derivatives that are used in the treatment of acne also may have a role in the treatment of rosacea. Accumulating evidence suggests that topical isotretinoin and topical azelaic acid can reduce the redness and pimples. Some patients who use these medications experience skin irritation that tends to resolve with time. For later stages of the disorder, a surgical procedure may be needed to improve the appearance of the skin. To remove the telangiectasias, a dermatologist may use an electrocautery device to apply a current to the blood vessel in order to destroy it. Special lasers, called tunable dye lasers, can also be adjusted to selectively destroy these tiny blood vessels.

A variety of surgical techniques can be used to improve the shape and appearance of a bulbous nose in the later stages of the disease. Surgeons may use a scalpel or laser to remove excess tissue from the nose and restore a more natural appearance.

Alternative treatment:

Alternative treatments have not been extensively studied in rosacea. Some reports advocate gentle circular massage for several minutes daily to the nose, cheeks, and forehead. Scientifically controlled studies are lacking, however.

Many people are able to avoid outbreaks by reducing things that trigger flushing. Alcoholic beverages, hot beverages, and spicy foods are among the more common factors in the diet that can provoke flushing. Reducing or eliminating these items in the diet can help limit rosacea outbreaks in many people. Exposure to heat, cold, and sunlight are also known triggers of flushing. The specific things that provoke flushing vary considerably from person to person, however. It usually takes some trial and error to figure these out.

A deficiency in hydrochloric acid (HCl) in the stomach may be a cause of rosacea, and supplementation with HCl capsules may bring relief in some cases.

Prognosis:

The prognosis for controlling symptoms of rosacea and improving the appearance of the face is good. Many people require life-long treatment and achieve good results. There is no known cure for the disorder.

Prevention:

Rosacea cannot be prevented, but once correctly diagnosed, outbreaks can be treated and repeated episodes can be limited.

Use mild soaps:

Avoiding anything that irritates the skin is a good preventive measure for people with rosacea. Mild soaps and cleansers are recommended. Astringents and alcohol should be avoided.

Learn what triggers flushing:

Reducing factors in the diet and environment that cause flushing of the face is another good preventive strategy. Alcoholic and hot beverages, and spicy foods are among the more common triggers.

Use sunscreen:

Limiting exposure of the face to excesses of heat and cold can also help. A sunscreen with a skin protection factor (SPF) of 15 or greater used daily can limit the damage to the skin and small blood vessels caused by the sun, and reduce outbreaks.

Aggravating Factors

The hereditary, chronic skin disorder of rosacea is aggravated by many factors, including sunlight, physical exercise, mental stress, sinus & allergy conditions, hot liquids, spicy foods, extremes in temperature, and alcohol that is either topically applied or orally consumed. It is important to note that what aggravates one person's rosacea may have no effect on another person's rosacea.

To get a clear picture of rosacea, you may wish to start with a clinical definition of rosacea. Rosacea is a hereditary, chronic (long term) skin disorder that most often affects the nose, forehead, cheekbones, and chin. Groups of tiny microvessels (arterioles, capillaries, and venules) close to the surface of the skin become dilated, resulting in blotchy red areas with small papules (a small, red solid elevated inflammatory skin lesion without pus, that is minor when the size is of a small measles lesion, moderate when about the size of a pencil eraser, and severe when the papule is the size of a small currency coin or the tip of the little finger) and pustules (pus-filled inflammatory bumps). The redness can come and go, but eventually it may become permanent. Furthermore, the skin tissue can swell and thicken and may be tender and sensitive to the touch. Note: Pustules are NOT pimples. Pimples have a bacterial component to their pathogenesis and are also mainly localized in and around the hair follicles. This implies that there can be no cure for rosacea or even an effective treatment for your rosacea and yet many have found ways to control their rosacea through effective treatment and lifestyle changes.

The inflammation of rosacea can look very much like acne, but blackheads and whiteheads are almost never present. Rosacea is a fairly common disorder -- about one in every twenty Americans is afflicted with it. Rosacea usually begins with frequent flushing of the face, particularly the nose and cheeks. This facial flushing is caused by the swelling of the blood vessels under the skin. This "red mask" can serve as a flag for attention. Telangiectasis is easy to recognize, characterized by the visible presence of capillaries, bright red in color. Diffuse redness frequently precedes the appearance of telangiectasis and is a constant flushed appearance. True diffuse redness is quite different from a localized erythema as seen in cases of sunburn, inflammation or over stimulation. With both telangiectasis and diffuse redness, the redness is not transitory and there generally is not an increase in skin temperature, but particularly there are no alterations in the tissue structure or biochemistry as seen in rosacea. The circulatory network of the skin is extensive and the capillaries are the smallest, most delicate vessels. During normal blood circulation the capillaries undergo constant changes. In between beats the pressure is relieved and the vessels constrict back to their normal size. This return to normal size is accomplished by the natural elasticity in the structure of the capillary. If telangiectasis is present, the capillaries' elasticity is deteriorated so they remain slightly dilated. The constant influx of blood perpetuates this slight dilation. The skin gradually becomes congested and eventually the capillaries become visible through the skin's surface. When it comes to telangiectasis, sometimes a person's lifestyle and habits can be the skin's worst enemy. In a fair, delicate skin predisposed to telangiectasis, a steady diet of hot, spicy food, chronic alcohol consumption and eating meals too quickly will promote telangiectasis. And many retinoids used for acne as well as many harsh soaps continue to aggravate the skin. Then there's cigarette smoking, which depletes the skin of vitamin C, essential for the formation of collagen, accelerates the crosslinkage of collagen and the hardening of elastin and furthermore creates a trillion free radicals, which destroy the capillary structure. Smoking, which additionally robs the skin of oxygen, is a potent initiator of telangiectasis. Also, the smoker may have a variety of medical problems such as high blood pressure, and mineral deficiencies, which can cause the appearance of telangiectasis.

Ocular Rosacea:

Rosacea can also cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps, eyelashes sometimes fall out, compounded by bloodshot eyes. (Dr. Thiboutot). The ocular signs of rosacea are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ocular rosacea covers all these signs. The ocular complications are independent of the severity of facial rosacea. Rosacea keratitis has an unfavorable prognosis, and in extreme cases can lead to corneal opacity with blindness. The most frequent sign of ocular rosacea, 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.

Stages - Plewig and Kligman Classification of Rosacea

Stage I: The erythema may persist for hours and days, hence the old term erythema congestivum. Erythema lasting only a few minutes is not early rosacea. Telangiectases becomes progressively prominent, forming sprays on the nose, nasolabial folds, checks, and glabella. Most of these patients complain of sensitive skin that stings, burns, and itches after application of a variety of cosmetics, especially certain fragrances and sunscreens. Trauma from abrasives and peeling agents readily induces long-lasting erythema, thus the facial skin is unusually vulnerable to chemical and physical stimuli..

Stage II:

Inflammatory papules and pustules crop up and persist for weeks. Some papules show a small pustule at the apex, justifying the term papulopustular. The lesions are always follicular in origin, mainly in sebaceous follicles but also in the smaller and more numerous vellus follicles. Comedones do not occur. The deeper inflammatory lesions may heal with scarring, but scars are inconspicuous and tend to be shallow. Facial pores become larger and prominent. If there has been much solar exposure over decades, the stigmata of photodamaged skin becomes superimposed, namely yellowed, leathered skin (elastosis), wrinkles and solar comedones. The papulopustular attacks becomes more and more frequent. Finally, rosacea may extend over the entire face and even spread to the scalp, especially if the patient is balding. Itchy follicular pustules of the scalp are typical. Eventually, the sides of the neck as well as the retroauricular and presternal area may be affected.

Stage III:

A small proportion of patients goes on to develop more serious expressions of the disease, namely large inflammatory nodules, furunculoid infiltrations, and tissue hyperplasia. These derangements occur particularly on the cheeks and nose, less often on the chin, forehead, or ears. The facial contours gradually become coarse, thickened, and irregular. Curiously, patients may not notice these disfigurements. The deranged appearance becomes evident when photographs from previous years are reviewed. Finally, the patient shows diffusely inflamed, thickened, edematous skin with large pores, resembling the peel of an orange. These coarse features are due to extensively inflammatory infiltration, connective tissue hypertrophy, massive fibrosis and elastosis, diffuse sebaceous gland hyperplasia, and extreme enlargement of individual sebaceous glands forming dozens of yellowish umbilicated papules on the cheeks, forehead, temples, and nose. Thickened folds and ridges may create a grotesque appearance mimicking leonine facies of leprosy or leukemia. The ultimate deformity is the phymas, of which rhinophyma is the prototype.

Rosacea results primarily from an overly acidic body and skin. The pH scale (potential of hydrogen) as you remember from your high school general science or chemistry class, ranges from 0 to 14 with 7 being neutral. As you think of your past rosacea history, you will see that ‘all’ the rosacea triggers have come from ‘acidic triggers’ regardless of whether they are foods, drinks, stress, or out of breath due to not enough oxygen (oxygen is an alkaline) and not able to exhaust enough carbon dioxide (carbon dioxide is acidic). We all know that if we hold our breath for 30 seconds or 60 seconds, we will all notice that our face turns pink or red. We all know, but hardly think that the cause is a build up of carbon dioxide which is an ‘acid’ gas and we have a shortage of alkaline oxygen. Very similarly, when we exercise for a short period, we have a build up of ‘lactic acid’ which is a body waste of muscle and fat tissue which is obviously acidic. Likewise, those with rosacea need to be very concerned about the build up of acids in our blood stream due to the foods and beverages that we consume.

We all know of our triggers such as alcohol, coffee, pizza, candy/cookies, various medications, etc. which all have a pH below 7.0 or is termed acidic. Our objective therefore should be to balance, buffer or neutralize the acids with alkaline. And always remember that rosacea is more than a red face as it affects all the body organs from the brain to your intestines, and from your muscles and skin to your tongue. For a educational trial, the next time that you are very red faced, simply look into a mirror and stick out your tongue and you will quickly see that this internal muscle is more red also. You will easily recognize that rosacea is beyond the skin, eyes, and tongue.

Water is alkaline and drinking more 'alkaline water with a pH of about 7.3 is the best and easiest way to neutralize, buffer or balance our rosacea pH bank account. Bottle water is "acidic" to keep it from 'going flat' or growing bacteria during the bottling process, storage in warehouses, and distribution to stores. Likewise more alkaline foods of vegetables and fruits are needed with a pH above 7.0 are needed to offset the lactic acid of even mild body use at the office (and even more in strenuous labor jobs),carbon dioxide, adrenaline stress hormones, etc. Or, to keep the "rosacea bank account" balanced, the rosacea sufferer may choose to simply try to minimize the acid foods and drinks and exercise. The key is everything in moderation to 'balance the body'. The biggest offenders always seem to be alcohol, coffee,pastries, donuts, pizza, etc. and most of these are easily. However understanding alcohol is slightly more difficult. Beer has an average pH between 2.0 to 2.5 while wines are around 3.0, while whiskey, gin, and vodka are 'most interesting with a pH of about 4.0 straight from the bottle. So if one wants to "stay sober and really drink to his or her health", they should drink 'small portions of gin, vodka or whisky or a jigger containing 1.0 to 1.5 ounces of gin, vodka or whiskey (2 ounces mixed with 5 ounces of water at 7.3 averages, and adding enjoyable taste with 2 ounces or or so of their favorite tasty orange, grape, strawberry juice (or other healthy tasty alternate). This combination with gin, vodka, or whiskey yields a drink with a pH of about 6.5 or so which is a good drink with less 'hang over' or sickness potential while 'making the consumer' happier. Also the consumer is less likely to become 'intoxicated' as the drink has a higher pH or less acids and therefore less toxic and therefore less intoxicating! The opposite is true when gin, vodka, or whiskey is mixed with soft drinks which have a pH of about 2-2.5 pH. And obviously do 'not forget that party foods are very acidic and cause 'fat to accumulate' on the body.

The accumulation of acids have different names depending on the location where it is noticed. When a heavy intake of acid or party foods and drinks, we flush and call it 'rosacea' on our face. With more accumulation and less exercise to burn the acids, it accumulates on the stomach or backside and we call it body fat and purchase bigger clothes over the years. When acids accumulate on the teeth, we call it "tooth plague" which does break down the tooth enamel resulting in a tooth cavity, When acids or plague builds up in the arteries, we again call it artery plague or cholesterol which can lead to artery blockages and heart attacks. Certainly it makes for a more difficult time for the blood flow to move through the facial area resulting in more rosacea symptoms, thus a facial exercise is needed often that you will read on the Lifestyle Changes page. An accumulation of food or body acids affects the bones very much as our bones are the biggest sources of alkaline minerals. The alkaline mineral of iron, zinc, copper, iodine, calcium, phosphorus, magnesium, fluoride, sodium chloride and potassium chloride are vital to bones, organs, brain and skin tissue life. When the pH balance becomes more "acidic" the minerals shift or move by the process of osmosis from the bones to the kidney and gall bladder for very uncomfortable kidney stone, gall stones or "bone stones".

Selecting the best foods to add pH (primarily fruits and vegetables) by the use of greens to your Rosacea Flushing Bank Account to prevent overdraw or going into red or flushing is most important. To improve your total body and skin condition, eat and drink 90% of the alkaline foods with 10% meats while avoiding or reducing breads, pastas, sugars, desserts, etc. The acidic/alkaline scale is logarithmic; meaning that each number is ten times "stronger or more potent" than the preceding number. For example, a pH of 2 is ten times more acidic than a pH of 3 and one hundred times more acidic than a pH of 4. So you will now be able to more easily understand why a rosacea sufferer needs to minimize the acidic foods and drinks (and longer a longer time for damaged rosacea skin to heal) as it takes so many more alkaline foods and drinks to balance or buffer or neutralize the acids. In do so, you will have eliminated the cause or etiology and will have found both the "cure for rosacea" and the "best rosacea treatment".

The body has several different ways to ensure that the pH balance stays in the normal range of 7.35 to 7.45. These are referred to as buffer systems. Through normal day to day activity in the body, acids are formed as waste products that need to be neutralized, alkalized, or buffered and eliminated. Some of the acids are released with CO2 from exhaling; others are excreted via the kidneys. With acidic foods and drinks, there is always more carbon dioxide (acidic) while alkaline foods produce much more oxygen (think of your high school classes of the tree, grass, and plants giving off oxygen). These systems work together in the healthy human body to keep the pH level within normal ranges. Sometimes with extreme intake of acidic foods and drinks, the normal system can not compensate and the body becomes even more stressed resulting in more stress hormones which are also acidic in nature causing more of a blush/flush. Likewise, simple illnesses such as influenza, minor surgery, or emotional and mental stress continue to lower the pH of the body and with more resulting skin blushing and flushing. Almost all medications are acidic except anti-acid medications such as Zantac, Milk of Magnesium, etc. So as you see, the 'cause or etiolgoy' can easily be understood and is helpful in understanding the "cure".

You can make sure that your water and many foods are alkaline by purchasing pH paper at most drug stores at a cost of $12 to measure the pH of the water, drink or foods. Your urine should be in the 6.6, 6.8, and up to a 7.0 pH range most often as the culmination of the body process. As you can imagine if you drink and eat many acidic foods, the result will be deterioration of the skin, body organs & bones. The adrenal cortex secretes cortisol, a natural body hormone of about 10 mg of cortisol daily, with peak cortisol levels occurring early in the morning and therefore the rosacea flushing and rosacea papules along with seborrheic dermatitis face will look best in early mornings after this natural anti-inflammatory drug. The hormone that will report back to the original brain centers together with other body organs to tell it to stop the whole cycle. But since cortisol is a potent hormone, the prolonged secretion of it will lead to health problems such as the break down of cardiovascular system, digestive system, musculoskeletal system with resulting osteoporosis and arthritis - rheumatism, and the immune system. "Rosacea is more than a red face."

Also, when any organism, system or body does not have a chance for recovery, it will lead to both catecholamine and cortisol depletion. The entire concept is "not to keep" the body in a 'fight or flight' system with stress, stimulation, or the use of 'acidic' food/drinks which you will learn more about on the page entitled "Flushing: Types, Patterns & Systems". The pH of foods, drinks and stress hormones affects "rosacea, the entire body and brain of the rosacea sufferer" and sometimes affects the family and co-workers and there ability to function proficiently.

Facial Muscle Exercises For Rosacea Reduction:

The Sobye's Massage or 'non surgical face lift' as a rosacea treatment relaxes the muscles giving the skin of the red rosacea facial area a chance to smooth out and allows the restricted blood to 'flow out' resulting in a very useful function for the rosacea sufferer. The past has been problematic for the rosacea sufferer as the facial artery system supplies blood through a network of curves and angles around the mouth, lips, tongue, around the eyes, across the cheeks, and along the nose, and across the forehead with these later three being the prominent areas for rosacea sufferers seeking treatment. The medical mechanism of action as a rosacea treatment is the accelerated lymphatic drainage with reduction of redness shortly after the massage and futuristic days if the rosacea treatment massages continue. The rosacea sufferer very often thinks of redness and blood flow and would love to have normal skin. Rosacea suffers really desire for a better blood flow and return movement system as the best rosacea treatment.

Medical Patents:

A United States patent for Rosacea-Ltd was issued in August 1997, a New Zealand patent was issued in September 1998, an Australian patent was received in March 1999, and patents were issued in November 2002 in the following countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Monaco, Netherlands, Portugal, Spain, Sweden, Switzerland (including Liechtenstein), United Kingdom, Slovenia, Lithuania, Latvia, Albania, and Romania. Patents are pending in other countries according to the International Patent Cooperation Treaty.

Definition:

Rosacea is a skin disease typically appearing in people during their 30s and 40s. It is marked by redness (erythema) of the face, flushing of the skin, and the presence of hard pimples (papules) or pus-filled pimples (pustules), and small visible spider-like veins called telangiectasias. In later stages of the disease, the face may swell and the nose may take on a bulb-like appearance called rhinophyma.

Description:

Rosacea produces redness and flushing of the skin, as well as pustules and papules. Areas of the face, including the nose, cheeks, forehead, and chin, are the primary sites, but some people experience symptoms on their necks, backs, scalp, arms, and legs.

The similarity in appearance of rosacea to acne led people in the past to erroneously call the disease acne rosacea or adult acne. Like acne, the skin can have pimples and papules. Unlike acne, however, people with rosacea do not have blackheads. In early stages of rosacea, people typically experience repeated episodes of flushing. Later, areas of the face are persistently red, telangiectasia appear on the nose and cheeks, as well as inflamed papules and pustules. Over time, the skin may take on a roughened, orange peel texture. Very late in the disorder, a small group of patients with rosacea will develop rhinophyma, which can give the nose a bulb-like look.

Up to one half of patients with rosacea may experience symptoms related to their eyes. Ocular rosacea, as it is called, frequently precedes the other manifestations on the skin. Most of these eye symptoms do not threaten sight, however. Telangiectasia may appear around the borders of the eyelid, the eyelids may be chronically inflamed, and small lumps called chalazions may develop. The cornea of the eye, the transparent covering over the lens, can also be affected, and in some cases vision will be affected.

Causes and symptoms:

There is no known specific cause of rosacea. A history of redness and flushing precedes the disease in most patients. The consensus among many experts is that multiple factors may lead to an overreaction of the facial blood vessels, which triggers flushing. Over time, persistent episodes of redness and flushing leave the face continually inflamed. Pimples and blood-vessel changes follow.

Certain genetic factors may also come into play, although these have not been fully described. The disease is more common in women and light-skinned, fair-haired people. It may be more common in people of Celtic background, although this is an area of disagreement among experts.

Certain antibiotics are useful in the treatment of rosacea, leading some researchers to suspect a bacterium or other infectious agent may be the cause. One of the newest suspects is a bacterium called Helicobacter pylori, which has been implicated in causing many cases of stomach ulcers but the evidence here is mixed. Other investigators have observed that a particular parasite, the mite Demodex folliculorum, can be found in areas of the skin affected by rosacea. The mite can also be detected, however, in the skin of people who do not have the disease. It is likely that the mite does not cause rosacea, but merely aggravates it.