Rosacea Facts, Fiction, and Fantasy

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RosaceaFacts, Fiction, and Fantasy

• Michael Q. Martin
• Circadia, by Dr Pugliese
• Reading, Pa

Saxifraga Rosacea
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What is Rosacea?

• Rosacea is a chronic (long-term) disease that
  affects the skin and sometimes the eyes. Rosacea
  usually affects the face.
• The disorder is characterized by
• 1. Diffused Redness
• 2. Pimples and pustules
• 3. In advanced stages, thickened skin.

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Who Gets Rosacea?
Approximately 14 million people have
Rosacea. Women are more often afflicted than
men. Peak age of onset is between 30-60. More
cases after menopause.
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Rosacea in Men vs. Rosacea in Women

• Rosacea appears to be much more prevalent among
  females, however rosacea in men is probably
  under-reported.
• When men do get Rosacea it is usually far more
  severe.
• Rhinophyma is one of the most severe rosacea
  symptoms, and is usually only present in men.
• There is a much higher incidence of Rosacea in
  fair-skinned individuals irrespective of gender.

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Variations of Rosacea

• Rosacea is a skin disorder that affects
  approximately 5 of the population.
• Physicians and professionals in the field of skin
  care are seeing rapidly increasing numbers
  Rosacea with the"over 40" population continuing
  to grow. Younger people seen with rosacea is also
  growing.
• Rosacea is an often baffling skin disease --
  difficult to treat and able to cause severe
  emotional distress due to the visibly
  deteriorating facial involvement.

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Characteristics of rosacea include

• A red face due to persistent redness and/or
  telangiectasia (broken capillaries)
• Dry and flaky facial skin
• Red, sore or gritty eyelids including papules and
  styes (blepharitis and/or conjunctivitis)
• Enlarged unshapely nose with prominent pores
  (sebaceous hyperplasia) and fibrous thickening
  (rhinophyma)

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Clinical Features

• Rosacea is usually symmetrically distributed over
  the face and the nose, cheeks, chin, and
  forehead.
• Occasionally, lesions are seen at the
  retroauricular areas, the V-shaped area of the
  chest, the neck, the back, and the scalp and
  extremities.
• The hallmarks of rosacea are papules and
  papulopustules, vivid-red erythema, and
  telangiectases and a history of flushing.
• Open Comedones are notably absent. Episodic
  erythema with most rosacea patients reacting with
  transient erythema on the central areas of the
  face, less often the neck and the V-shaped area
  of the chest.

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Histopathology of Rosacea
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Histology of Rosacea
Hyperplasia of epidermis
Lymphocytic infiltration
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Histology of Rosacea
Hyperplasia of epidermis
Granulomatous reaction
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Classification of Rosacea

• The condition of Rosacea can differ
  significantly from person to person, but
  generally is divided into four Subtypes based on
  the severity of the symptoms.
• Subtype 1 Facial Redness (Erythematotelangiectati
  c Rosacea)
• Subtype 2 Bumps and Pimples (Papulopustlar
  Rosacea)

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Classification of Rosacea (cont.)

• Subtype 3 Enlargement of the Nose (Phymatous
  Rosacea)
• Subtype 4 Eye Irritation (Ocular Rosacea)
• (National Rosacea Society)

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Subtype 1 (Erythematotelangiectatic Rosacea)

• Individuals who suffer from subtype 1 experience
  flushing and facial redness small blood vessels
  may also become visible
• Singing, burning, swelling and roughness or
  scaling may occur.
• In addition, the skin is more reactive to most
  physical and chemical stimuli.

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Subtype 1 (cont.)

• The most common characteristics of subtype one
  Rosacea is persistent redness.
• While this redness (erythema) may be
  intermittent, it is usually present for hours or
  days at a time.
• Capillaries dilate and form vascular spray like
  designs on the nose, nasolabial folds and cheeks.

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Clinical Picture
The Many Faces of Rosacea
Erythema
Mild Papules
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The Many Faces of Rosacea
Moderate papules
Moderate Pustules
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Telangiectasia in natural light.
Augmentation of red areas.
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Subtype 2 (Papulopustular Rosacea)

• Subtype Two Rosacea includes the outward
  characteristics of Stage One Rosacea, along with
  acne-like papules and pustules.
• These lesions can be present intermittently or
  may persist for weeks at a time.
• While, once again, it is important to remember
  that these are not actual acne lesions, the
  deeper inflammatory Rosacea lesions can produce
  shallow scars.

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Subtype 2 Rosacea cont

• As stage Two Rosacea progresses, the sebaceous
  follicles become larger and more prominent,
  further contributing to the formation of papules
  and pustules.
• It is also important to note that pustules and
  papules are a result of inflammatory causes and
  not bacteria.
• The larger Rosacea lesions contribute more to
  shallow scarring, further adding to the
  devastating effect that Rosacea can have on the
  Rosacea patient's self-image.

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The Many Faces of Rosacea
Severe Erythema
Pustules and Papules
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Subtype 3 (Phymatous Rosacea)

• Generally, only a small number of individuals
  will progress into Subtype Three Rosacea.
• In stage three, patients exhibit all of the
  characteristics of Rosacea Stages One and Rosacea
  Stage Two, along with a gradual deformation of
  facial features.
• As Stage Three Rosacea progresses, facial
  features may become thicker, coarser and
  irregular.

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Stage 3 Rosacea cont

• The sebaceous glands continue toward extreme
  enlargement, contributing further to extensive
  large inflammatory nodules.
• The appearance of someone with Stage Three
  Rosacea can be similar to individuals presenting
  with the most severe cystic acne.

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The Many Faces of Rosacea
Inflammatory rosacea With early rhinophyma
Early scarring
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The Many Faces of Rosacea
Marked hypertrophic scarring
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Very severe rhinophyma
Note involvement in areas of sebaceous gland
activity.
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Subtype 4 (Ocular Rosacea)

• This type affects the eyes. They may appear
  watery or blood shot and sufferers may experience
  irritation burning and stinging. The eyelids may
  also become swollen and styes are common.

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So what causes Rosacea?

• Even though the pathology of Rosacea is not
  fully understood, many theories and connecting
  factors are shedding light on the subject.

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The cause of rosacea is unknown. There are
several theories There may be genetic
factors. It may be environmental. There may
be a vascular etiology. There are inflammatory
factors. (bacteria, fungus, mites)
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What about Genetics?

• Although no scientifically proven link has been
  found between heredity and Rosacea, 40 of
  suffers surveyed said they had relatives with the
  same symptoms.
• Around 30 reported Irish, English, Scottish,
  Welsh, or Scandinavian descent.

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Environmental Triggers

• Non-specific stimuli such as ultraviolet
  radiation, heat, cold, chemical irritation,
  strong emotions, alcoholic beverages, hot drinks,
  and spicy foods can trigger flares. Tea and
  coffee are not precipitants, but heat is.

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What on Earth is that?
Living within a hair follicle
Crawling on skin surface
Front view with eight legs
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Demodex follicularum

• Demodex is the name given to tiny mites that live
  in the hair follicles. In humans, demodex is
  found on facial skin especially the forehead,
  cheeks, sides of the nose, eyelashes and external
  ear canals.
• May be feeding on keratin, sebum, or bacteria.

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While the link between the Demodex mite and
Rosacea has not been fully explained it is most
definitely real. We find that increased numbers
of demodex mites have been observed in the
following conditions Pityriasis folliculorum (
rough, dry and scaly skin) Rosacea Blepharitis
-(inflammation of the eyelid margins) Male
pattern baldness.
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Inflammatory Reaction

• Could be bacteria
• Could be auto-immune
• Could be an antigen (foreign body)
• Inflammation caused by environmental factors (sun
  exposure)

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Treating Rosacea

• Now that we know more about the condition of
  Rosacea, we can get an idea about how to treat
  it.
• Remember, since the true cause is still unknown,
  there is no cure. Therefore we treat the
  symptoms.

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Treating Rosacea
1. Control the inflammation, swelling and
redness. 2. Reduce production of the Demodex
Mite 3. All sources of local irritation, such as
soaps, alcoholic cleansers, tinctures and
astringents, abrasives and peeling agents must be
avoided.
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A Suggested Treatment Plan

• Use a mild Cleanser
• The use of a product with anti inflammatory and
  vasoconstriction ingredients is recommended.
• Mild exfoliation can be done preferably with an
  enzyme, never with a chemical peel or manual
  exfoliant.
• Circadia Oxygen Rx has vaso constricting and anti
  microbial effects.
• The use of topical antibiotics is sometime
  required.

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Treating Rosacea

• Protection against sunlight is important
  sunscreens with a protecting factor (SPF) of 15
  or higher are always recommended, preferably of
  the broad spectrum UV-A plus UV-B type.