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More than 13 million Americans are now believed to suffer from rosacea. yet few are aware that the redness, bumps and pimples are not just a temporary complexion problem but rather a chronic medical condition that tends to grow worse without medical treatment. During Awareness Month in March, the National Rosacea Society focuses on educating the public about this conspicuous and embarrassing disorder and dispelling the myths and misconceptions surrounding it.

Now that the oldest members of the massive baby boom generation are 51 and the youngest are 33, they have fully reached the prime years for acquiring this increasingly widespread and potentially disfiguring condition. Rosacea usually first strikes adults in their 30s, 40s or 50s as a redness on the cheeks, nose, chin or forehead that comes and goes.

Left untreated, the redness becomes ruddier and more permanent. Spidery dilated blood vessels known as telangiectasia may appear, and bumps and pimples called papules and pustules often develop. In some individuals, the eyes may feel gritty and become watery or bloodshot. In advanced cases, the nose may grow swollen from excess tissue, a condition called rhinophyma.

Because it affects the face, rosacea can have a profound effect on a victim's psychological well-being, self-esteem and social and business relationships. Those who suffer from this condition know that the myths surrounding rosacea - that the red nose is due to excessive drinking, for example, or the bumps and pimples result from poor hygiene - are untrue. Rosacea is unrelated to hygiene and, while alcohol may aggravate the condition, the symptoms can bejust as severe in a teetotaller.

Moreover, sufferers themselves often mistakenly perpetuate yet other myths. Some feel they somehow may be to blame for rosacea's unexplained appearance. Some may think the symptoms will go away by themselves, especially since in the early stages the symptoms tend to come and go. Others may believe they just have a complexion problem and that nothing can be done.

"Fortunately, medical treatments can now arrest the progression of rosacea and reverse its symptoms," said Dr. Mark Dahl, chairman of the Department of Dermatology at the University of Minnesota. "Rosacea rarely simply disappears," he explained. "It is a chronic condition that tends to grow worse if it is not treated."

He noted that sufferers are not at fault for rosacea's first appearance, but they should comply with medical therapy and changes in lifestyle to avoid risk factors that may trigger a flare-up.

While rosacea can affect all segments of the population, it most often occurs in those with fair skin who tend to flush or blush easily. Dermatologists treat the disorder more frequently in women, but it is often found to be more severe in men. This may be because men are less likely to seek medical help before the condition reaches advanced stages.

"The keys to controlling rosacea are early intervention and compliance with long-term therapy," Dr. Dahl said. "A dermatologist can properly diagnose rosacea and prescribe therapy and lifestyle modifications that are tailored to each rosacea patient's particular needs."

Beginning with Rosacea Awareness Month, rosacea sufferers or those who suspect they have the condition may call the Society at a new toll-free hotline at 888/NO BLUSH to receive materials by mail, including general information on rosacea. R6sacea Review, a tripwires chart and a patient diary checklist to help sufferers identify and avoid their own personal risk factors for flare-ups.

In addition, the Society now offers help on the Internet. A broad range of information on rosacea as well as support materials and Rosacca Review are available on the World Wide Web at www.rosacea.org.

Unlike most disorders, rosacea tends to affect men and women somewhat differently. According to a National Rosacea Society patient survey on the pattern of rosacea symptoms, women are more likely to experience symptoms on the cheeks and chin while men are more commonly affected on the nose.

In fact, 21 percent of the men surveyed reported swelling of the nose associated with advanced rosacea, versus 8 percent of the women. On the other hand, nearly half of the women suffered symptoms on the chin, compared with only 20 percent of the men.

While their rosacea may appear differently, both men and women can now benefit from medical help to eradicate a broad range of symptoms.

While emotional stress is one of the most common tripwires for rosacea flare-ups, using stress reduction techniques may help reduce flare-ups for the great majority of rosacea sufferers, according to a recent survey of Rosacea Review readers.

In a survey of 602 rosacea patients, 88 percent said that their rosacea flares up when they are under emotional stress. Only 8 percent reported that stress was not a factor.

However, survey results show that stress reduction techniques definitely help. About 62 percent of respondents said they had incorporated stress avoidance and reduction techniques into their lifestyles, with 92 percent of these sufferers reporting that control- ling stress had reduced their rosacea flare-ups.

Some healthy ways of reducing stress include exercising moderately, cutting down on caffeine and getting adequate sleep and nutrition. Rosacea sufferers also may benefit from periodically practicing relaxation techniques.

To begin one popular relaxation routine, find a quiet place to stretch out and lie on your back, with arms at your sides and palms facing upward. Legs should be relaxed with toes pointing slightly outward.

Then, beginning from the top of the head, focus on each muscle separately and relax each one. Feel the muscles of the forehead and relax them. Find the facial muscles, and relax those. Work down to the neck and shoulders and relax them. Relax the arms, hands and fingers. Feel the muscles in the back and abdomen. Finally, continue down the legs and relax the thighs, calves, feet and toes. Once the body is fully relaxed, spend a few minutes letting your mind wander.

When asked what cause of emotional stress was hardest on their rosacea, 35 percent named their jobs, and 31 percent cited family. Relationships and social pressures were the next most common causes of emotional stress, noted by 20 and 19 percent of respondents, respectively, followed by money and health, with 16 percent and 14 percent selecting these as major causes. Almost half of respondents indicated more than one factor as a reason for stress.

A. It is possible that indoor temperature could affect rosacea in certain cases, since anything that causes a sufferer to flush may have the potential to lead to a flare-up. Hot weather has been documented on surveys as a rosacea trigger for 53 percent of sufferers, and being "too warm" indoors can also induce flushing. If you find yourself in a warm environment where you cannot turn the temperature down, try sipping on a cool drink or chewing on ice chips, which will help lower your facial temperature to help avoid flushing.

Q. Is it common for skin affected by rosacea to be dry and flaky? What can I do to reduce flakiness?

A. Yes, it has been estimated that approximately half of all rosacea sufferers experience dry skin. More- over, rosacea usually appears after age 30, when facial skin naturally tends to be drier. To combat dry, flaky skin, use a moisturizer daily after cleansing and topical medication. You also may wish to check with your dermatologist to see which topical medication is best for your skin type, since some have a drying effect and others are more moisturizing.

Why do some foods prompt rosacea? Anything consumed that brings on flushing - most commonly spicy foods or thermally hot beverages - can be a culprit in inducing a flare-up. And a vast array of other foods, while less common as tripwires, has also been found to affect various individuals.

Foods containing histamine or those that release histamines in the body such as tomatoes, spinach, eggplant, cheese, chocolate, chicken livers, citrus fruits, bananas, raisins, figs, avocados, yogurt and sour cream, or foods containing niacin can cause flushing. Foods high in niacin include liver and yeast.

"Hot" spices such as white andblackpeppcr,paprika,red pepper and cayenne are common rosacea tripwires. Look for substitutes.
Marinated meat) vanilla, soy sauce) vinegar, red plums) and the pods of broad-leaf beans) such as limas) navy or pea) have been found to affect some rosacea sufferers. Taking an antihistamine about two hours before a meal that includes a food high in histamine or an aspirin before eating a niacin-containing food may be helpful.
It is the heat in beverages, rather than other substances such as caffeine, that may directly bring on a flare-up. So reducing the temperature may be all that's necessary.

Though the list of food tripwires is long, few if any individuals are affected by each one. The National Rosacea Society offers a patient diary checklist, free of charge, to help you determine which foods affect you.

Source: Rosacea Review, Winter 1997
National Rosacea Society
800 South Northwest Highway, Suite 200
Barrington IL, 60010