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KNOWING ROSACEA Rosacea is a disorder of the blood vessels. It is a common skin disorder. Approximately 48 percent of the world population suffers from Rosacea. However, Rosacea is one of the most misunderstood states of the skin. FAMOUS PERSONS SUFFERING FROM ROSACEA If you are having Rosacea, you are then in the august company of eminent persons. A few of the noted personalities suffering from Rosacea are JP Morgan, WC Fields, Cameron Diaz, Bill Clinton, Prince Harry of England, besides the late princess of Wales and mother of Prince Harry – Diana. ROSACEA SYMPTOMS The common symptom of rosacea is transformation of the skin color into red. The body portions most affected by rosacea are the cheeks, nose and forehead. At times, such redness and flushing of skin can also spread to the ears, scalp, chest or the neck. As Rosacea progresses, the reddish tinge can turn into a permanent condition. There can also be a marked visibility of the small blood vessels particularly at the skin surface, stinging or burning skin sensation, eyes turning gritty and reddish, and pus-filled or simple bumps that appear red. Among these severe symptoms are bulbous noses. The maiden rosacea symptoms are nagging redness which is often wrongly attributed to cleansing, exercising or temperature changes. SIMILAR SKIN DISORDERS Many confuse rosacea with seborrheic dermatitis or/and acne vulgaris. Mentionably, rosacea can co-exist with acne vulgaris and seborrheic dermatitis. THE ROSACEA VULNERABLE SECTION It has been generally noticed that the people with fair skin are the most vulnerable section with reference to rosacea. Therefore, rosacea does have a hereditary strain. Those having a descent from the Celtic or the fair-skinned European stocks are genetically inclined to suffer from rosacea. Notably, both the sexes can fall prey to rosacea. People of all ages can be affected by rosacea. It has also been noticed that people in the age group of 30-50 are easily affected by rosacea. Nonetheless, women in their middle ages are the most vulnerable section of the populace. The reason is, of course, menopause-abetted hot flushes. However, rosacea symptoms are more severe with reference to men. CAUSES OF ROSACEA There is no unanimity among the medical researchers as to the exact rosacea pathogenesis. Nonetheless, there is a concurrence in views insofar as to the cause of rosacea. Rosacea occurs when stimuli repeatedly dilate the blood vessels, and as a result of which the blood vessels get damaged. The damaged blood vessels dilate rather easily. Besides they either remain permanently dilated or stay dilated for a considerably long time. The consequence is redness of the affected portion and its flushing. ROSACEA PAPULES OR INFLAMMATORY PUSTULES The papule or inflammatory pustule can be I the form of a boil, or a pimple, or an eruption for that matter. In rosacea (papulopustular), the mediators (inflammatory ones) as well as immune cells ooze out from the skin bed that is basically micro-vascular by nature. This, in turn, leads to the inflammatory pustule or papule. OTHER CAUSES OF ROSACEA Various conditions can also lead to rosacea. One thing is for sure: strenuous movements cause blushing and flushing. A few of the situations where such flushing or blushing can be formed are as follows: Stress, cold weather, acute sunburn, and extreme heat exposure especially from the sun. Rosacea can also be caused by sudden changes in temperatures while traveling, or in heated rooms especially in winter. FOODS CAN ALSO CAUSE ROSACEA Certain food items that contain very high quantity of histamine have been identified as responsible for the eruption of rosacea symptoms in many people. Similarly, spicy food besides alcoholic substances can definitely trigger off rosacea. MEDICATIONS TOO CAN LEAD TO ROSACEA Several topical irritants and medications may at times cause rosacea. Take for example several drugs people take to hide wrinkles or to deal with acnes. Among these chemicals those particularly responsible for causing rosacea are tretinoin, benzoyl peroxide, isotretinoin, microdermabrasion, and certain chemical peels. Obviously, one should immediately stop the use of any such irritants the moment any rosacea symptoms appear. INDUCED (STEROID) ROSACEA The term ‘steroid induced rosacea’ points to such rosacea symptoms that are caused by steroids, particularly nasal and topical. Notably, these types of steroids are generally prescribed for patients suffering from seborrheic dermatitis. First aid: In such circumstances, immediately consult the physician. Moreover, one should begin the medication discontinuing process over a period of time. Decrease the dosages slowly. Else there may be a flare up of the rosacea symptoms. MITES & BACTERIA CAN CAUSE ROSACEA AS WELL A considerable number of rosacea people have been found to possess the species of mites known as demodex. This is more so the case with those people who have rosacea from steroids. Mentionably, the presence of a large number of these demodex mites can only cause rosacea. But, they cannot by themselves cause the rosacea condition. The demodex mites will have tom act in conjunction with other factors to be able to trigger off the rosacea states. Bacteria, especially the intestinal bacteria, can cause rosacea. These intestinal bacteria reside in our digestive highways. This is a neurological dysfunction. Such rosacea conditions can erupt after the intestinal bacteria activate the plasma kakllikrein-kinin system. THE KAKLLIKREIN-KININ SYSTEM The kakllikrein-kinin system or the kinin-kallikrein system or just the kinin system is a not well delineated structure of blood proteins. The blood proteins have a major role to play in causing pain, coagulation, control of blood pressure and inflammation. Mentionably, the major mediators of the kinin system are bradykinin and kallidin. Both of them act on different cell types. Both are vasodilators DIFFERENT FORMS OF ROSACEA Researchers have identified four forms of rosacea. Each of these subtypes can have its typical symptoms. More importantly, one person can have more then one of the subtypes at the same time. THE ROSACEA SUBTYPES The four rosacea subtypes are Ocular rosacea, Phymatous rosacea, Papulopustular rosacea and Erythematotelangiectatic rosacea. OCULAR ROSACEA Ocular rosacea mainly affects the eyes. The Ocular rosacea symptoms are burning and itching besides sensations as if there are foreign bodies within the eyes. When anyone is affected by ocular rosacea, the eyes and the eyelids turn dry and red. Irritation of the eyes and the eyelids is also very common. PHYMATOUS ROSACEA Phymatous rosacea affects the nose, ears, cheeks, forehead, chin and the eyes. Phymatous rosacea is also linked with the nose enlargement dysfunction called rhinophyma. Another disorder closely connected with phymatous rosacea is the visibility of small blood vessels near the skin surface. Other symptoms of phymatous rosacea are appearance of irregular surfaces on the skin and which may be also accompanied by nodularities. The skin can get thick as well. PAPULOPUSTULAR ROSACEA Many confuse Papulopustular rosacea with acne. However, Papulopustular rosacea remain reddish while acne do not. The common Papulopustular rosacea symptoms are papules (red bumps) filled with pus. Such bumps are called pustules. Papulopustular rosacea papules with or without pustules generally dissolve within five days. People having Papulopustular rosacea usually have permanent redness of their skin. This state is described medically as erythema. Another symptom of Papulopustular rosacea is they tend to flush or blush quite easily. Moreover, the patient can also have burning or itching sensations. ERYTHEMATOTELANGIECTATIC ROSACEA Erythematotelangiectatic rosacea causes the small blood vessels to appear rather prominently near the surface of the skin. This typical state is known as telangiectasias. TREATING ROASAEA There are various treatments for rosacea people. The strategies vary depending on the acuteness and the rosacea subtype that a particular person may be suffering from. Hence, there can be different treatments for different persons suffering from the rosacea symptoms. Hence, the dermatologists opt for the sub-type-directed method to diagnose, analyze and treat rosacea. LASER TREATMENT Laser treatment in dermatology is variously known as Broad spectrum (Intense Pulsed Light), or Single wavelength (Vascular laser). Laser treatment is one of the most popular treatment methods of rosacea. In laser treatment, light is made to infiltrate the epidermis. The light hits the skin’s dermis layer. It targets the dermis capillaries. The oxy-haemoglobin gets heated up after it absorbs the light. The process heats up the capillary walls till 70 degree centigrade. This heat destroys the capillary walls. The damaged walls are then absorbed by the body via its defence mechanism. CO2 LASER TREATMENT Focused thin beams of CO2 laser are manipulated to defocus or cut (as scalpels) the tissues. Then these tissues are vaporized. CO2 lasers are used to get rid of the excessive tissues formed by phymatous rosacea. In this method, our skin directly absorbs the CO2 lasers wavelength. SIMPLE STEPS TO TACKLE ROSACEA (i) Gentle skin cleansing regime Always deal with the skin gently and lovingly. Go for only those cleansers that are non-irritating. (ii) Shielding skin from sun Never venture out in the sun-bated beach sans protection shields. Regularly use sunscreens. Choose such a sunscreen that consists of a physical blocker agent. Such active blockers are titanium dioxide or zinc oxide. (iii) Trigger avoidance It is important to maintain a diary of the foods and the climatic or other factors that generally lead to rosacea. In fact, The National Rosacea Society promotes this habit. This approach also goes a long way in identification and reduction of the triggers. Moreover, trigger avoidance is ideal to control the onset frequency of rosacea. But, all alone it cannot check rosacea. Nonetheless, the mild rosacea attacks can be effectively checked if a patient avoids the factors that triggered off the rosacea symptoms. One can get flushing after consuming red wine or food items having high quantities of histamine. Then, go for antihistamines. Some common antihistamines are loratadine or cetirizine. (iv) Eyelid hygiene Eyelid hygiene is especially recommended for persons complaining of eyelid infections. Practice eyelid hygiene frequently. Here are some easy eyelid hygiene steps. Gently scrub the eyelids daily; You can use baby shampoo in a diluted form; Or, you can also opt for any across-the-counter eyelid cleaner. Apply the cleaner in warm compresses. But, mind you, never should it be hot. Carry on the practice several times in a day. MEDICATIONS (ii) Topical & Oral Antibiotics To get instant relief from the rash, redness, inflammation, pustules and papules, you can go for topical and oral antibiotics. An effective topical antibiotic is metronidazole. Similarly, ideal oral antibiotics are the tetracycline antibiotics. Some examples of tetracycline antibiotics are minocycline, doxycycline, and tetracycline. The oral antibiotics are rather effective in treating ocular rosacea symptoms. Isotretinoin is generally given to patients who complain of persistent pustules or papules. However, there are several side effects of isotretinoin. Therefore, isotretinoin is prescribed only in acute situations. It is also given to treat acute acne. Nevertheless, for patients suffering from phymatous and papulopustular rosacea, low dosages of isotretinoin have been delivering the goods. BETA BLOCKERS OR α-2 AGONIST The commonly used α-2 agonist is clonidine. It is helpful to deal with blushing and flushing. But it has side effects. One can feel drowsy or/and one’s blood pressure may also plummet. So, to neutralize this effect, one can use monoxidine as an alternative. Monoxidine has lesser side effects. But many do not find it as effective as clonidine. Propanolol is an ideal beta blocker. It is akin to α-2 agonists. And, it has been found to be effective in dealing with recurrent social blushing rather than the general rosacea flushing. 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