Accessing Rosacea Information

Rosacea is a hereditary, chronic skin disorder which most often affects the face. Groups of tiny blood vessels under the skin of the face dilate, causing flushing (general facial redness), spidery veins, and/or blotchy red areas with small papules (inflammatory bumps).
Ocular rosacea can cause inflammation, redness, and irritation of the eyes.
Rosacea can be aggravated by sunlight, stress, allergies, alcohol, spicy foods and extreme temperatures.
Topical steroids (e.g., DesOwen, Westcort) at first calm rosacea symptoms but over time may destroy the skin and cause severe disfigurement: "a flaming red, scaling, papule-covered face".
Pregnant women must be extremely cautious about any use of medication.
Stress aggravates rosacea and acne.
Cigarette smoking aggravates rosacea and acne.
Alcohol dehydrates the body and provokes rosacea-related facial flushing (redness).
Lifestyle changes and healthy habits can greatly reduce the redness, papules, and other symptoms of rosacea. Recommended lifestyle changes:
Reduce stress.
Drink at least 8 eight-ounce glasses of water (2 liters) per day. Ten to twelve glasses (3 liters) per day is recommended. Water should be icy cold. The hypothalamus, the body's "thermostat", cannot properly regulate temperature (and prevent facial flushing) unless kept cool and supplied with adequate water. Water also hydrates the skin, preventing clogged pores.
Avoid stimulants such as coffee, tea, tobacco products and excessive sugar.
Avoid alcohol.
Avoid vigorous scrubbing, exfoliants, and other abrasives.
Use the right soap. Most soaps are too harsh for rosacea-afflicted skin.
Recognize and avoid foods and beverages which provoke a rosacea-related allergic reaction.
Avoid large meals; eat three small meals instead.
Exercise.
Avoid astringents and astringent soaps.
Change wash-cloths and body towels after each use.
Avoid the sun as much as possible. Sun exposure aggravates rosacea.
Rosacea-Ltd is simple and easy to use.
Rosacea-Ltd is more effective than antibiotics because bacteria cannot develop a resistance to its ingredients.
Unlike most rosacea products, Rosacea-Ltd has no known side effects.
You can be confident that you run no risk in buying Rosacea-Ltd.
Rosacea-Ltd effectively improves the appearance of skin affected by rosacea-related papules, pustules, facial redness and dilated facial vessels.
Scientific articles on rosacea, rosacea treatment, and rosacea-related lifestyle changes.Also The International Rosacea Foundation has very scientific rosacea treatment information that is very clear and helpful at The International Rosacea Foundation.Org.
Some rosacea sufferers also have lupus. The symptoms of lupus are listed

Treating Ocular Rosacea

Tetracycline derivatives are the mainstay of therapy for ocular rosacea. Our standard regimen is to start with 100 milligrams of doxycycline orally twice a day for one month, after which it is used once daily for at least two more months.Therapeutic response. Patients are advised that there will be a delayed therapeutic response of several weeks. At three months, the medication is adjusted according to the therapeutic response: For marked improvement, the medication can be tapered to 100 mg every other day for the next three months. For mild to moderate improvement, 100 mg is continued on a daily basis. After six months, patients may go on “doxycycline vacations” for two to three months. Eventually symptoms will recur in most cases, and periodic reinstitution of low maintenance doses is necessary.Systemic vs. topical. For patients who can’t tolerate systemic tetracycline therapy, topical metronidazole gel (NetroGel) 0.75 percent twice daily or 1 percent daily, applied to the eyelids, has been shown to be safe and effective.Side effects. The major side effect that compromises the ability to use doxycycline is gastrointestinal disturbance. This is probably dose-related; it is ameliorated by taking the medication with food and is better tolerated with time. Photosensitivity may be a problem in some patients. All patients are advised to avoid excessive sun exposure and to use appropriate skin screening agents until their response to doxycycline is known.Contraindications. Doxycycline is contraindicated in pregnant women, nursing mothers and children under the age of 8.

Three-Step Approach
Tetracycline derivatives are most effective when used in conjunction with the following three-step approach:

1. Normalize tear film disturbance.
Warm compresses. These help further minimize meibomian gland obstruction and improve lipid flow into the tear film.
Punctal occlusion. Temporary or permanent occlusion is useful if aqueous tear production is deficient.
Artificial tear substitutes. These are useful until ocular surface wetting, punctate epitheliopathy and variable vision during prolonged visual tasks have improved.
2. Control bacterial overgrowth.
Lid hygiene. This is part of a long-term maintenance program to minimize meibomian gland obstruction, improve lipid flow into the tear film and control bacterial overgrowth.
Topical antibiotics. These are useful in the first month of treatment to reduce bacterial flora. Generally, they should be used when acute mucopurulent blepharoconjunctivitis, marginal corneal infiltrates or peripheral ulcerative keratitis are present.
3. Control inflammatory and hypersensitivity reactions.
Topical corticosteroids. These are useful in the first month of treatment to reduce ocular surface inflammation. Generally, they should be used if marginal corneal infiltrates, peripheral ulcerative keratitis without progressive thinning and/or vascularization are present.
Topical progestational steroids. Compounded medroxyprogesterone 1 percent may be used if peripheral ulcerative keratitis with progressive thinning is present.
In addition, topical progestational steroids are useful in conjunction with corticosteroids for treating progressive vascularization.

Dr. Kaldawy is assistant professor of ophthalmology at Boston University; Drs. Sutphin and Wagoner are both professors of clinical ophthalmology at the University of Iowa, Iowa City.

Rosacea And Antibioitcs

Many rosacea sufferers have been frustrated for many years with unsuccessful or marginal results from many rosacea skin care products. Antibiotics, retnoids, Accutane, and steroids have been a mainstay of rosacea treatment for years. Rosacea sufferers have noticed that these prescribed treatments and various rosacea laser treatments have not worked well as a rosacea skin care product; also these past treatments for rosacea may have caused additional damage to the sensitive rosacea skin. Oral and topical antibiotic rosacea treatments for adult acne rosacea can work for up to several months before the bacteria become immune to the antibiotic, causing the antibiotic to lose its effectiveness. Oral antibiotic treatment actually cause more rosacea red symptoms. For information on the latest FDA findings, see Bacterial Resistance to Antibiotics.

Rosacea And The Nitric Oxide Connection

Dr. Ethan A. Lerner, associate professor of Dermatology, Harvard Medical School.In research funded by the National Rosacea Society, Dr. Lerner examined the potential contribution of nitric oxide to the redness and inflammation of rosacea.

Nitric oxide is a gas produced naturally in nearly all of the body's cells and is used by the nervous, immune and cardiovascular systems. Because nitric oxide is known to make blood vessels dilate, it was hypothesized that it may play a role in rosacea.
The study aimed to test for the presence of nitric oxide synthase (NOS), a nitric oxide-producing enzyme, and the gene that creates NOS in the skin of rosacea patients through in situ hybridization and immunoperoxidase.
The in situ hybridization test was inconclusive; the researchers had difficulty obtaining clean results from the probes, and high background levels made it difficult to isolate NOS readings.
In the immunoperoxidase test, stains of biopsies taken from the skin of rosacea patients showed a normal amount of NOS. This could be interpreted as indicating that nitric oxide is not a significant factor in rosacea. However, Dr. Lerner believes that different types and severities of rosacea should be tested before the molecule can be completely ruled out.
The researchers also determined how much of a known nitric oxide inhibitor is absorbed through the skin, so that the effects of suppressing nitric oxide might be tested.
In other research, Dr. Lerner is developing a mouse model of what happens in human skin when too much nitric oxide is present. He is attempting to produce transgenic mice in which the gene for NOS is expressed in the skin under the control of a promoter, so that application of a topical compound will cause production of nitric oxide. Among the potential outcomes to be observed is whether too much nitric oxide produces any signs of rosacea.

Rosacea or A Similar Skin Condition?

Rosacea is aggravated by many factors, including sunlight, physical and mental stress, sinus and allergy conditions, hot liquids, spicy foods, extremes in temperature, alcohol (either topically applied or orally consumed) and stress (Drs. McKoewn, Wilkin, Wilkin, Wilkin). But it is important to note that what aggravates one person's rosacea may have no effect on another person's condition (Dr. Wilkin)
The following other conditions can have symptoms similar to rosacea:
Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent, but can also affect adults in their 20s, 30s and 40s. While there is no permanent cure for acne, it is controllable.
Psoriasis causes the skin to become inflamed, while producing red, thickened areas with silvery scales. This persistent skin disease occurs most often on the scalp, elbows, knees, and lower back. In some cases, psoriasis is so mild that people don't know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body.
Eczema is used to describe all kinds of red, blistering, oozing, scaly, brownish, thickened, and itching skin conditions.
The word atopic describes a group of allergic or associated diseases that often affect several members of a family. These families may have allergies such as hay fever and asthma, but also have skin eruptions called Atopic Dermatitis. The disease can occur at any age, but is most common in infants to young adults.
Eczema/Atopic Dermatitis in infants occurs mainly on the face and scalp, although spots can appear elsewhere. In teens and young adults, the eruptions typically occur on the elbow bends and backs of the knees, ankles and wrists and on the face, neck and upper chest.

Tips To Combat Rosacea

Substances like alcohol and caffeine are factors causing roughly 16 million Americans to live with facial redness, also known as Rosacea.
Rosacea is a condition where the flushing of small blood vessels on the face causes your cheeks, nose or chin to redden and can even result in small bumps or acne on the skin.
Dermatologists offer treatment options, but you can also look to your local drugstore for "redness relief" formulas. Experts say a product that has green neutralizers will help conceal redness and even out complexion.
Doctors say to avoid future flare-ups, you should keep a diary of red episodes with notes on food, medicines and products so you can help pinpoint triggers.

The Plewig/Kligman Classication Of Rosacea

Plewig and Kligman Classification of Rosacea
Stage I: The erythema may persist for hours and days, hence the old term erythema congestivum. Erythema lasting only a few minutes is not early rosacea. Telangiectases becomes progressively prominent, forming sprays on the nose, nasolabial folds, checks, and glabella. Most of these patients complain of sensitive skin that stings, burns, and itches after application of a variety of cosmetics, especially certain fragrances and sunscreens. Trauma from abrasives and peeling agents readily induces long-lasting erythema, thus the facial skin is unusually vulnerable to chemical and physical stimuli..
Stage II: Inflammatory papules and pustules crop up and persist for weeks. Some papules show a small pustule at the apex, justifying the term papulopustular. The lesions are always follicular in origin, mainly in sebaceous follicles but also in the smaller and more numerous vellus follicles. Comedones do not occur. The deeper inflammatory lesions may heal with scarring, but scars are inconspicuous and tend to be shallow. Facial pores become larger and prominent. If there has been much solar exposure over decades, the stigmata of photodamaged skin becomes superimposed, namely yellowed, leathered skin (elastosis), wrinkles and solar comedones. The papulopustular attacks becomes more and more frequent. Finally, rosacea may extend over the entire face and even spread to the scalp, especially if the patient is balding. Itchy follicular pustules of the scalp are typical. Eventually, the sides of the neck as well as the retroauricular and presternal area may be affected.
Stage III: A small proportion of patients goes on to develop more serious expressions of the disease, namely large inflammatory nodules, furunculoid infiltrations, and tissue hyperplasia. These derangements occur particularly on the cheeks and nose, less often on the chin, forehead, or ears. The facial contours gradually become coarse, thickened, and irregular. Curiously, patients may not notice these disfigurements. The deranged appearance becomes evident when photographs from previous years are reviewed. Finally, the patient shows diffusely inflamed, thickened, edematous skin with large pores, resembling the peel of an orange. These coarse features are due to extensively inflammatory infiltration, connective tissue hypertrophy, massive fibrosis and elastosis, diffuse sebaceous gland hyperplasia, and extreme enlargement of individual sebaceous glands forming dozens of yellowish umbilicated papules on the cheeks, forehead, temples, and nose. Thickened folds and ridges may create a grotesque appearance mimicking leonine facies of leprosy or leukemia. The ultimate deformity is the phymas, of which rhinophyma is the prototype. (Drs. Plewig & Kligman)