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Rosacea Facts, Fiction, and Fantasy

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Title: Rosacea Facts, Fiction, and Fantasy


1
RosaceaFacts, Fiction, and Fantasy
  • Michael Q. Martin
  • Circadia, by Dr Pugliese
  • Reading, Pa

Saxifraga Rosacea
2
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.

3
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.
4
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.

5
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.

6
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)

7
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.

8
Histopathology of Rosacea
9
Histology of Rosacea
Hyperplasia of epidermis
Lymphocytic infiltration
10
Histology of Rosacea
Hyperplasia of epidermis
Granulomatous reaction
11
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)

12
Classification of Rosacea (cont.)
  • Subtype 3 Enlargement of the Nose (Phymatous
    Rosacea)
  • Subtype 4 Eye Irritation (Ocular Rosacea)
  • (National Rosacea Society)

13
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.

14
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.

15
Clinical Picture
The Many Faces of Rosacea
Erythema
Mild Papules
16
The Many Faces of Rosacea
Moderate papules
Moderate Pustules
17
Telangiectasia in natural light.
Augmentation of red areas.
18
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.

19
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.

20
The Many Faces of Rosacea
Severe Erythema
Pustules and Papules
21
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.

22
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.

23
The Many Faces of Rosacea
Inflammatory rosacea With early rhinophyma
Early scarring
24
The Many Faces of Rosacea
Marked hypertrophic scarring
25
Very severe rhinophyma
Note involvement in areas of sebaceous gland
activity.
26
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.

27
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.

28
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)
29
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.

30
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.

31
What on Earth is that?
Living within a hair follicle
Crawling on skin surface
Front view with eight legs
32
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.

33
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.
34
Inflammatory Reaction
  • Could be bacteria
  • Could be auto-immune
  • Could be an antigen (foreign body)
  • Inflammation caused by environmental factors (sun
    exposure)

35
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.

36
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.
37
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.

38
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.
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