LaserVision.gr | What Causes Rosacea? Further Research Offers New Hope to Rosacea Sufferers

Although rosacea today can be controlled with long-term therapy, a cure has yet to be found and its cause is still unknown. Fortunately, growing interest among medical researchers now offers hope that the approximately 13 million Americans who suffer from rosacea will reap the benefits of new scientific insights into this embarrassing and potentially disfiguring disease.

"Perhaps nowhere else in dermatology is so little known about a condition that affects so many" said Dr. Jonathan Wilkin, director of Dermatologic and Dental Drug Products at the U.S. Food and Drug Administration and chairman of the medical advisor board for the National Rosacea Society's new research grants program. "Theories about its origins abound, and increased research funding should result in more studies to better define the best approaches for its treatment, control or prevention."

Rosacea is now widely considered a vascular disorder because of the hallmarks of frequent flushing and facial redness that plague its victims. However, the root cause or causes of this flushing are uncertain, and it may result from numerous factors.

Some doctors have recently speculated that the flushing associated with rosacea might be prompted by a defect in the nervous system. Supporting this theory is the observation that the worst rosacea outbreaks may occur when patients are under emotional stress, according to Dr. Neil Shear, director of Clinical Pharmacology and deputy director of Dermatology at the University of Toronto Medical School.

The increased blood flow during flushing may also lead to swelling, some experts have noted. If the dilated blood vessels become "leaky," extra fluid may accumulate in the tissues faster than the lymphatic system can remove it. In addition, the immune response often triggered by inflammation may result in a thinning of the skin, causing tiny blood vessels to become more prominent and visible.

Beyond vascular factors, various external causes have been considered potential contributors to rosacea. In the past, the bacterium Helicobacter pylori, which plays a role in duodenal ulcers, was believed to be potentially implicated in rosacea - possibly by raising gastrin levels that may stimulate flushing. However, a recent study of 204 patients found that the prevalence of H. pylori is similar in patients with rosacea and in those without the disor- der. Another recent study also found no significant difference in H. pylori between the two groups, but noted that the rosacea patients complain signifi- cantly more often of "indigestion" and use more antacids unrelated to H. pylori infection.

Another potential external cause of rosacea is Demodex folliculorum, a microscopic mite that is a normal inhabitant of human skin. Some studies have found that Demodex exist in greater numbers in rosacea patients than in people without rosacea. However, experts have noted that it is unclear whether the number of mites is a cause or a result of rosacea. They alternately suggest the possibility that the Demodex mites can stimulate an inflammatory reaction, or that the mites may simply find the lesions of rosacea an attractive home.

The National Rosacea Society's research grants program will provide funding for important scientific research on the potential causes and other key aspects of this poorly understood disorder.

Once thought of as a rare mysterious malady, rosacea is now the fifth most common diagnosis made by dermatologists, according to figures recently pub- lished in Skin and Allergy News. Although the frequency of rosacea diagnosis ranks only behind that of such well-known skin disorders as acne, dermatitis, psoriasis and actinic keratosis, it was not until recent years that rosacea has become widely identified as one of the most common dermatological conditions.

"Although symptoms of this facial disorder have been depicted in art and literature over the ages, diagnosis and treatment of rosacea are now playing catch-up as medical knowledge and awareness have increased substantially" said Dr. Jerome Litt, assistant clinical professor of Dermatology at Case Western Reserve University. "It is not so much that rosacea is occurring at a higher rate, but rather physicians and patients alike are recognizing what it is - a distinct, chronic and often progres- sive medical disorder that can be successfully treated with proper therapy."

He noted that another force behind the rise in rosacea diagnoses is the fact that the populous baby boom generation has entered the most susceptible ages for developing this common condition.

Rosacea typically first appears between the ages of 30 and 60 as a flushing or redness on the cheeks, nose, chin or forehead that comes and goes.

Gradually the redness becomes ruddier and more persistent, and small blood vessels may become visible. Left untreated, bumps and pimples often develop, and in advanced cases the nose may become swollen and bumpy from excess tissue.

For some 700 years, the telltale signs of rosacea have been portrayed by various artists in their paintings. A well-known medical journal recently observed that Rembrandt's self-portrait with blotchy patches of red skin on his face - including one with aJading halo of spider veins - suggests he suffered from rosacea.' Rosacea symptoms are also vividly described in early literature, including Chaucer's Canterbury Tales and Shakespeare's Henry V

A French surgeon living in the 14th century. Dr. Guy de Chauliac, was the first person known to medically describe rosacea as "red lesions in the face." Rosacea was commonly attributed to the excessive consumption of alcohol, even earning the French name, "pustule de vin" meaning pimples of wine. However, while alcohol may aggravate the condition, rosacea symptoms can be just as severe in a teetotaler.

In the 19th century, medical refer- ences to rosacea usually listed it as a form of acne. Today dermatologists have learned that rosacea is a different disease from acne, and that therapy for acne can often make it worse.

Q.Sometimes my rosacea flareups look like mosquito bites and itch. Is this common?

A. rosacea flare-up is characterized by a more intense outbreak of redness, bumps or pimples. For some sufferers, the bumps caused by rosacea may resemble mosquito bites. For others, these bumps are generally redder in appearance. It is not uncommon for rosacea patients to itch from dry skin, which can be helped by using a moisturizer.

A. Although mild topical steroids are sometimes prescribed for short periods to help control redness in rosacea patients - especially during initial treatment - the long-term use of steroids has been found to aggravate rosacea and even induce rosacea-like symptoms in many patients. In a study by Dr. Jerome Litt, 60 patients using fluorinated topical steroids of mid to high potency developed the redness, pimples and spidery veins associated with rosacea. When the steroids were discontinued and topical antibiotics prescribed, the symptoms improved.

Also, in a survey conducted by the National Rosacea Society, 10 percent of 837 respondents said they experienced flare-ups in reaction to topical steroids. In some instances, their health care providers had to change their therapy.

If you are concerned about a medication you are taking, discuss your rosacea with your physician.

Such diverse items as chocolate, tomatoes and citrus fruits ranked surprisingly high along with such well-known rosacea tripwires as hot spices, alcohol and heated beverages in the first comprehensive survey to detail specific foods that frequently aggravate the symptoms of this disorder.

In the survey of 3,151 rosacea sufferers affected by foods and beverages, conducted by the National Rosacea Society, more than 48 percent of the respondents said wine irritated their condition - often citing red wine. Hard liquor was a rosacea trigger for 37 percent, and beer was cited by 26 percent. Thermally hot beverages such as coffee or tea were also high on the list, affecting 35 percent and 30 percent of the respondents, respectively.

Hot spices were also frequently reported as rosacea culprits. Survey respondents implicated such specific spices as cayenne pepper (36 percent of those surveyed), red pepper (34 per- cent), black pepper (18 percent), white pepper (9 percent) and paprika (9 percent) as rosacea triggers. Chocolate was named as a rosacea tripwire by 33 percent of the respondents and vinegar was cited by 15 percent.

For 71 percent of the respondents, dairy products were not a factor with their rosacea. Cheese was listed as a trigger factor by 14 percent, yogurt by 8 percent, sour cream by 7 percent and milk by 6 percent.

In other categories, citrus led the fruit group by an overwhelming margin, affecting 27 percent of the respondents. Tomatoes (technically a fruit) were the most-cited vegetable at 31 percent, while less than 5 percent were affected by such vegetables as eggplant, spinach and avocados. Liver was the only meat mentioned with much frequency at 5 percent, but 14 percent of the survey participants said they were affected by meat prepared with a marinade.

Despite the fact that some very common foods and beverages appear on the list, 82 percent of the respondents reported they are successful or somewhat successful at avoiding the dietary tripwires that affect their individual conditions. More than 78 percent said eliminating these trigger factors had helped reduce their rosacea flare-ups.

A diary checklist is available to help rosacea sufferers identify and avoid their individual rosacea tripwires. A booklet with tips on lifestyle management, called "Coping with Rosacea," was also recently produced. Copies of these materials may be obtained free of charge by writing the National Rosacea Society.

Socializing can be intimidating any time of year for rosacea sufferers worried about flare-ups. The fast pace of the holidays can intensify the anxiety. Here are some tips to make "good vibrations" during this festive season.

Don't minimize the importance of consistent medical therapy and lifestyle changes to avoid factors that may aggravate your individual condition. Patients who use medication as prescribed and avoid rosacea tripwires report the best success in controlling their symptoms.
Be especially watchful of seasonal pitfalls. Protect your face from wind and cold weather. Avoid alcohol and spicy food at parties. Relax and enjoy the holiday season.
Experiment with makeup. Foundations in sheer green or yellow can counter redness and hide blemishes. Try enhancing other features such as your eyes and lips.
Take pride in your overall attire and grooming. The way you dress says a lot about the way you feel.
Make eye contact when you meet or talk with others. It is a sign of confidence and interest. Also smile, it will help put people at ease.

Source: Rocasea Review, Winter 1999
National Rosacea Society
800 South Northwest Highway, Suite 200
Barrington IL, 60010