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What is Rosacea

The Rosacea is a chronic skin condition that is manifested by redness on the cheeks, nose and forehead and chin. As the disease progresses, these rednesses become permanent, small dilated vessels (telangiectasia or rosacea ) appear on the cheeks and the wings of the nose, as well as small red pimples (papules).

Rosacea usually begins around the age of 30 and affects mostly people with fair skin and eyes and a tendency to blush easily.

It is a condition that gets worse over the years, especially if it is not treated well. In many people, the symptoms evolve cyclically, with worsening periods alternating with periods of remission.

Long termed rosacea , rosacea should not be confused with acne that occurs during adolescence. Blackheads and white pimples are almost absent and the evolution of the disease differs. In addition, the factors behind these two conditions are very different.

Prevalence of Rosacea

The rosacea can affect anyone aged 20 to 70, but adults from 30 years to 50 years, with the clear complexion and whose skin has a tendency to blush easily are more often affected. From 3% to 10% of the population would be affected by rosacea, to varying degrees. In Canada, more than 2 million people suffer from rosacea.

Women are more prone to rosacea than men, the latter being more inclined to develop rhinophyma , which is characterized by a red, swollen, bumpy nose. This is a very advanced stage of the disease.

Very rarely, rosacea can appear in children, in the form of redness affecting mainly the cheeks. At this age, ophthalmologic symptoms (red eyes, swollen eyelids) often precede skin problems.

Causes of Rosacea

The causes are unknown, but according to research, rosacea could be attributed to:

  • a disturbance of the immune system concerning the skin;
  • “Hyperreactivity” of the blood vessels of the face, which dilate excessively. This is what creates the redness and the sensation of heat;
  • microorganisms (bacteria or mites of the Demodex folliculorum type );
  • An abnormal reaction of the skin to the sun.

Contrary to popular belief, alcoholism is not the cause of rosacea, although even moderate drinking can make it worse.

Certain diseases affecting the skin, such as lupus or scleroderma, may be accompanied by skin lesions similar to those of rosacea (telangiectasia, redness). It is therefore essential to consult a doctor to confirm the diagnosis.

Finally, the continual application on the face of cortisone cream can cause skin lesions that are visually identical to those of rosacea. In this case, it is rosacea induced by corticosteroid therapy and must be discontinued.

Evolution of rosacea

Rosacea evolves differently from person to person. Four subtypes were established, which were previously considered as the different phases of the disease. However, the disease never progresses to the highest stage in many people and most patients have a combination of subtypes. It is therefore impossible to predict the course of the disease.

Subtype 1: Erythematotelangiectatic rosacea

  • Redness on the face and neck , after a meal, after the consumption of alcohol or hot drinks or during a change in temperature. These bouts of redness, called flushing or flushing , last for a few minutes, then disappear. It is often the first symptom of rosacea.
  • Redness (erythema) is permanently present in the central area of ​​the face, especially on the cheeks, nose and middle of the forehead.
  • The small vessels under the epidermis become visible and create fine red lines, especially on the cheeks and the wings of the nose. This is called telangiectasia or rosacea . The redness of the skin may mask them, but the red lines usually reappear when the redness fades.
  • The skin may become dry , rough, with burning and tingling sensations.

Subtype 2: papulopustular rosacea

  • Small red and solid pimples or papules (pustules) besiege the face, adding to erythema .
  • Telangiectasia may be present.
  • Redness persists on the central area of ​​the face.

Subtype 3: phymatous rosacea

  • This is the subtype with the most marked symptoms . The sebaceous glands of the nose increase in volume, the pores dilate and the skin thickens, forming fleshy protuberances or blisters ( nodules ). The nose is the part of the face that undergoes the most deformations. This hypertrophy, called rhinophyma , affects men more (95% of cases) than women and occurs after 50 years. Rhinophyma requires surgical correction.

Subtype 4: Ocular rosacea

  • This subtype is characterized by eye irritation , which becomes red and dry, with excessive tearing and sensitivity to light. The ocular rosacea affects more than half of people with rosacea. The other symptoms are conjunctivitis and inflammation of the eyelids (blepharitis). The irritation remains minimal in most cases. If the situation worsens, it is necessary to intervene quickly under pain of causing a sharp decrease in vision.
  • Ocular rosacea is sometimes the precursor of the first cutaneous symptoms.

Symptoms of Rosacea

  • Redness on the face (erythema);
  • Dry and sensitive skin, with burning sensation;
  • A tendency to blush easily on the cheeks, but sometimes on the nose, forehead and chin. Of flushing , or redness of access, are triggered by emotions and temperature changes. They often occur after meals;
  • Small blood vessels visible on the nose and cheeks ( telangiectasia or rosacea);
  • Small red and solid pimples (papules) or pus (pustules) on the nose, cheeks, forehead and chin;
  • Dry, red and irritated eyes;
  • A red nose, swollen and covered with nodules, in the advanced stage of the disease.

People at risk

  • People with pale complexions, usually of Irish, Scottish or North European descent (Scandinavian countries);
  • People whose parents have suffered from rosacea, because some hereditary factors increase the risk of being affected;
  • Women, who are twice as affected as men.

Risk factors for rosacea

The exact origin of rosacea remains unknown, but it is known that various factors may aggravate it or contribute to outbreaks of rosacea. This is particularly the case when:

  • prolonged exposure to the sun or in tanning lamps. UVA rays cause dilation of the blood vessels which, after a while, can become permanent. The heat also has a harmful effect: by dilating the vessels, it accentuates the effect of the rays;
  • a sudden change in temperature ;
  • Exposure to extreme weather conditions (cold, rain, heat, etc.);
  • the consumption of hot drinks, spicy foods or alcohol;
  • of hormonal fluctuations (during pregnancy and menopause);
  • strong emotions (anger, embarrassment, stress);
  • Taking corticosteroids (cortisone). Whether used in the form of tablets or ointment, corticosteroids cause dilation of the blood vessels and thinning of the skin, gradually aggravating rosacea.

Prevention of rosacea

N we prevent rosacea?
As the causes of rosacea remain unknown, it is impossible to prevent its appearance.
Measures to prevent and reduce the severity of symptoms
As a first step, we must look for what aggravates the symptoms and then learn how to better manage or avoid these triggers. Keeping a symptom diary can be very helpful.

The measures below often reduce the intensity of symptoms:

  • Avoid as much as possible exposure to the sun. If it is done, always apply a good sunscreen SPF 30 or more, against the UVA and UVB rays, and this, summer and winter;
  • avoid drinking and foods that contribute to the dilation of blood vessels: coffee, alcohol, hot drinks, spicy foods and other products that cause redness;
  • Avoid exposure to extreme temperatures and high winds. Protect your face from cold and wind during the winter. Avoid also rapid temperature changes;
  • learn to relax to better manage stress and strong emotions;
  • avoid saunas and prolonged hot baths;
  • Except medical advice, avoid applying creams containing corticosteroids on the face.

Facials

  • Use lukewarm water at body temperature and a mild, unscented soap;
  • Many skin care products contain ingredients that can aggravate rosacea (acids, alcohol, etc.). Check with your pharmacist, doctor or dermatologist to find out which ones are suitable for rosacea;
  • Regularly apply a moisturizer on the face, so as to reduce the burning sensation and the dryness of the skin. Ask your pharmacist, your doctor or your dermatologist to obtain a cream suitable for skin with rosacea. 0.1% kinetin-based lotions (N6-furfuryladenine) appear to be effective in moisturizing skin and reducing symptoms;
  • Avoid overly oily cosmetics and foundations, which can aggravate inflammation.

Medical treatments for rosacea

The Rosacea is a chronic disease . Various treatments generally improve the appearance of the skin, or at least slow down the evolution of symptoms. However, several weeks are often necessary before observing a result and no treatment makes it possible to obtain a total and lasting remission. Thus, the treatments do not act on telangiectasias (dilated vessels) and the redness on the cheeks and the nose never disappears completely. However, it is essential to consult a dermatologist as soon as the first symptoms appear, since the treatments are more effective when used at the early stage of the disease.

Treatment varies according to the stage of the disease and the intensity of the symptoms. It can be very effective, but you should know that in most cases, rosacea worsens after stopping treatment. Usually, almost continuous processing is necessary to maintain a satisfactory result.

Remarks

  • Rosacea associated with pregnancy does not require any treatment since it usually disappears of itself a few months after delivery.
  • Telangiectasia can occur following facial surgery. It is not a true rosacea and symptoms usually fade over time. It is therefore advisable to wait six months before starting treatment.
  • Rosacea affecting babies and young children is rarely problematic. Normally, it fades as the skin of the child gets thicker.

Pharmaceuticals

Antibiotics. The most commonly prescribed treatment for rosacea is an antibiotic cream to be applied to the skin, based on metronidazole (Metrogel,Rosasol in Canada, Rozex, Rozacrème… in France). Clindamycin creams can also be used. When rosacea is extensive or associated with inflammation of the eyes, the doctor may order an oral antibiotic ( tetracycline or sometimes minocycline in Canada) for three months. Although rosacea is not directly linked to bacteria, antibiotics help reduce inflammation of the skin.

Acide azélaïque. Appliqué sur la peau sous forme de crème ou de gel, l’acide azélaïque (Finacea) contribue à réduire le nombre de pustules et à atténuer les rougeurs. Cependant, ce produit est assez irritant pour la peau, il faut donc utiliser une crème hydratante adaptée en complément.

Oral isotretinoin Accutane in Canada is sometimes used in low doses to treat severe forms of rosacea (in case of phymatous rosacea or papules, pustules or nodules that are resistant to other treatments). As it causes serious side effects, it is prescribed under close medical supervision. Thus, it increases the risk of congenital malformations if used during pregnancy. Women of childbearing age who receive this treatment should be provided with effective contraception and regular pregnancy tests to ensure that they are not pregnant. It is advisable to check with your doctor.

 

Important. Corticosteroids, in cream as in tablets, are contraindicated in case of rosacea. Although they temporarily reduce inflammation, they eventually cause symptoms to worsen.

Surgery

To reduce redness and reduce the appearance of telangiectasia (small red lines following dilation of the vessels) or rhinophyma, various surgical treatments exist.

Electrocoagulation. This is an effective technique on telangiectasia (rosacea) that may require several sessions and has various disadvantages, including: slight bleeding, redness and the formation of small scabs in the following days, a risk of scarring or permanent depigmentation of the skin. This treatment cannot be considered during the summer (risk of formation of brown spots).

Laser surgery. More effective and less painful than electrocoagulation, the laser generally leaves fewer scars. However, it may cause some bruising or temporary redness. It takes from one to three sessions per zone to be treated.

Dermabrasion. This procedure consists in “using” the superficial layer of the skin using a small brush with rapid rotation.

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