Title: Rosacea Facts, Fiction, and Fantasy
1RosaceaFacts, Fiction, and Fantasy
- Michael Q. Martin
- Circadia, by Dr Pugliese
- Reading, Pa
Saxifraga Rosacea
2What 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.
3Who 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.
4Rosacea 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.
5Variations 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.
6Characteristics 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)
7Clinical 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.
8Histopathology of Rosacea
9Histology of Rosacea
Hyperplasia of epidermis
Lymphocytic infiltration
10Histology of Rosacea
Hyperplasia of epidermis
Granulomatous reaction
11Classification 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)
12Classification of Rosacea (cont.)
- Subtype 3 Enlargement of the Nose (Phymatous
Rosacea) - Subtype 4 Eye Irritation (Ocular Rosacea)
- (National Rosacea Society)
13Subtype 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.
14Subtype 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.
15Clinical Picture
The Many Faces of Rosacea
Erythema
Mild Papules
16The Many Faces of Rosacea
Moderate papules
Moderate Pustules
17Telangiectasia in natural light.
Augmentation of red areas.
18Subtype 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.
19Subtype 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.
20The Many Faces of Rosacea
Severe Erythema
Pustules and Papules
21Subtype 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.
22Stage 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.
23The Many Faces of Rosacea
Inflammatory rosacea With early rhinophyma
Early scarring
24The Many Faces of Rosacea
Marked hypertrophic scarring
25Very severe rhinophyma
Note involvement in areas of sebaceous gland
activity.
26Subtype 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.
27So what causes Rosacea?
- Even though the pathology of Rosacea is not
fully understood, many theories and connecting
factors are shedding light on the subject.
28The 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)
29What 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.
30Environmental 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.
31What on Earth is that?
Living within a hair follicle
Crawling on skin surface
Front view with eight legs
32Demodex 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.
34Inflammatory Reaction
- Could be bacteria
- Could be auto-immune
- Could be an antigen (foreign body)
- Inflammation caused by environmental factors (sun
exposure)
35Treating 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.
37A 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.
38Treating 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.