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Rosacea begins very insidiously, often as a prominent, evanescent facial flush. The rosy condition may involve only the lower half of the nose or may spread to cover the “blush zone,” over the central face, forehead, and chin. The bouts of redness gradually become more frequent and intense, leading to persistent changes in skin color. The end result is permanent facial redness along with numerous enlarged blood vessels. Rosacea may be accompanied by crops of inflamed pus‑filled pimples.
According to the National Rosacea Society, the condition affects over fourteen million Americans. Over 75 percent of patients responding to their annual survey admitted that rosacea lowered their self-confidence and self-esteem. Rosacea usually occurs in middle-aged women, those between ages thirty and fifty-five. The condition seems to affect people who, since childhood, have blushed easily, as well as those who develop intense redness following only brief sun exposure. The most severe form of rosacea most commonly affects men and afflicts the nose. Medically termed rhinophyma, the disorder is characterized by uneven, progressive nasal swelling (the “W. C. Fields nose”) and may cause significant cosmetic deformity.Rosacea may also affect the eyes (ocular rosacea). Individuals so afflicted may experience itching, stinging, dryness, foreign body sensation, and a watery, bloodshot appearance.
The exact cause of rosacea is unknown. Postulated etiologies include vein hypersensitivity in genetically predisposed individuals and inflammation secondary to bacteria and/or microscopic facial mites (Demodex). The condition is aggravated by the ingestion of hot beverages and alcohol, both of which dilate blood vessels and promote facial redness. Extremes in temperature, as well as excessive sunlight, worsen rosacea.
Persons with rosacea should avoid harsh cleansers, toners, and astringents. The mainstay of the medical treatment for rosacea is the oral antibiotic tetracycline or its derivative, doxycycline, which often must be taken for years. Topical preparations containing the antibiotic metronidazole (Metrogel, Noritate) may prove useful in both the treatment of acute flares and long-term maintenance, as may sulfur-containing compounds (Avar, Klaron, Plexion, Rosanil, Rosula, Sulfacet-R), and medications containing azelaic acid (Azelex, Finacea).
The best way to cover up the redness associated with rosacea is to apply a green tinted foundation or concealer. The dilated blood vessels characteristic of rosacea respond poorly to oral and topical therapies. The treatment of choice is either lasers or IPL (intense pulsed light). Both are simple office procedures with a primary risk of temporary bruising. Results are quite rewarding. Some patients remain clear following a single session whereas others require treatment two to three times per year. Insurance companies do not cover light therapies, as they are considered cosmetic in nature.