Acne rosacea, acne rosecea, acne rosasa, acne roseaca – all these terms, including common misspellings are incorrect. The appropriate term is simply Rosacea, which is a chronic skin disease that affects the middle third of the face with persistent redness over the areas of the face and nose that normally blush: mainly the forehead, the chin and the lower half of the nose. The tiny blood vessels in these areas enlarge (dilate) and become more visible through the skin, appearing like tiny red lines (called telangiectasias). Pimples can occur that look like teenage acne, and sometime rosacea and acne appear together, but these are essentially different types of skin disease. See laser treatments of acne and laser resurfacing of acne scars.
Unlike acne, rosacea is not primarily a plague of teenagers. It occurs most often in adults (ages 30 to 50), especially those with fair skin, and affects both sexes but tends to be more common in women but worse in men. Unlike acne, there are no blackheads or whiteheads in rosacea.
When rosacea first develops, it may appear, then disappear, and then reappear. However, in time the skin fails to return to its normal color and the enlarged blood vessels and pimples arrive. Rosacea rarely reverses itself. It lasts for years and, untreated, it worsens.
Untreated rosacea can cause a condition called rhinophyma (ryno-fee-ma), literally growth of the nose, characterized by a bulbous, enlarged red nose and puffy cheeks (like the old comedian W.C. Fields). There may also be thick bumps on the lower half of the nose and the nearby cheek areas. Rhinophyma occurs mainly in men.
Another complication of advanced rosacea affects the eyes. About half of all people with rosacea feel burning and grittiness of the eyes (conjunctivitis). If this is not treated, the complications of what is called rosacea keratitis may impair vision.
Rosacea can be treated but not cured. Over-the-counter medications for acne can be a hazard; they can irritate the skin in rosacea. Topical antibiotics (such as metronidazole) and oral antibiotics (such as tetracycline) are often used. Short-term topical cortisone (steroid) preparations of the right strength may also be used to reduce local inflammation.
Avoiding smoking, spicy foods, hot beverages and alcoholic drinks that cause flushing helps minimize the blood vessel enlargement. Limiting exposure to sunlight and to extreme hot and cold temperatures also helps relieve rosacea.
Rubbing the face tends to irritate the reddened skin. Some cosmetics and hair sprays may aggravate redness and swelling. Facial products such as soap, moisturizers and sunscreens should be free of alcohol or other irritating ingredients. Moisturizers should be applied very gently after any topical medication has dried. When going outdoors, sunscreens with an SPF of 15 or higher are needed.
Cover-up make up is used for the telangiectasias. Telangiectasias can be treated with a laser to close off the dilated blood vessels.
Rhinophymas are treated by surgery. The excess tissue is removed with a scalpel, laser or electrosurgery.
Lasers have been proven to be the treatment of choice for mild cases of Rosacea. Laser beam heats and distroys dilated blood vessels, which are naturally removed from the skin by your immune and fluid systems. Multiple treatments are required to get a good control of rosacea. Regular (3-4 times a year) photorejuvenation sessions will help control the desease and prevent flare ups.
Cases of severe Rosacea, especially those that are border line with rhinophyma, require a complex treatment approach, which will include but be limited to lasers alone.
Rosacea is a chronic inflammatory eruption of the face that may significantly impair patients’ lives, leading to considerable emotional distress and behavioral withdrawal from normal social interactions. One of the most famous rosacea patients (and exceptionally well involved in the society) is President Bill Clinton, who has mild erythematotelangiectatic rosacea and all means and tools to control it.
Mild cases of rosacea are very common in people of all ages – see pictures.
It’s easy to see why rosacea and the facial erythema could have a tremendous impact on the quality of life. There is a growing body of research and conteolled studies, Nuno Menezes MD et al of the Servio de Dermatologia do Centro Hospitalar de VN de Gaia/Espinho in Portugal is one of the recent and better ones on the pulsed dye laser, which reinforces the idea that aesthetic laser usage for the treatment of erythematotelangiectatic rosacea is very efficient.
Laser treatments administered by dermatologists and aesthetic physicians selectively target hemoglobin, the predominant protein in red blood cells: oxyhemoglobin (the oxygen-loaded bright red form of hemoglobin) and deoxyhemoglobin (the oxygen-unloaded purple-blue form). Several laser wavelengths are proved to be very efficacious in the treatment of vascular lesions – because of the high level of absorption by hemoglobin.
Rosacea is a chronic disease that affects the skin and sometimes the eyes. Characteristics of the condition include redness, pimples, and, in advanced stages, thickened skin. Although rosacea usually affects the face, it can affect parts of the upper body. Despite how common the condition is, many people with rosacea go undiagnosed.
Approximately 14 million people in the United States have rosacea, and it is more common in women (particularly during menopause) than in men. Rosacea tends to occur more frequently in people with fair skin; however, it can occur in people of any skin color.
Although there is no rosacea cure, the condition can be treated and controlled. Without proper care, rosacea may progress to a more disfiguring condition, known as Rhinophyma.
The most common characteristic or symptom of rhinophyma is an enlarged, bulbous, and red nose. Rhinophyma is associated with the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. The condition is more common in men than women. See pictures of Rhinophyma
There is a common four-stage algorithm of treatment for these conditions. The first three stages of rosacea, and the fourth stage is rhinophyma. For the first stage of the pre-rosacea, the mainl treatment is focused on prevention. On the second stage, some topical and oral treatments are used. More agressive medication is typically used during the third stage. If nothing works and rosacea develops into rhinophyma, the only treatment is surgery. Topical treatment includes metronidazole gel and Retin-A; however, Retin-A may exacerbate the erythema. Oral treatments include tetracycline, metronidazole, and Accutane. Radiation and chemical scarification are no longer accepted methods. Originally all surgeries were skin grafted (decortication), as it was feared that the rhinophymatous tissue would recur. Now, however, surgical decortication with preservation of the sebaceous glands fundi is the preferred method of excision. Preservation of the glands will allow spontaneous re-epithelialization. These are the frequently used devices that we may see in rhinophymatous surgery. The oldest method of the rhinophymatous surgery is the excision (the cold technique). The risk of scarring and hypopigmentation are common. Electrosurgery for rhinophyma was introduced in 1950s. There is greater heat dispersion compared to CO2 laser and Cold Knife, which can lead to scarring and hypopigmentation. One can use a wire loop or a hockey stick attachment. Greenbaum, in an interesting study, took three patients and treated one-half of the nose with CO2 laser and then treated the other half of the nose with electrosurgery and concluded that both gave equivalent cosmetic results with equal time to re-epithelialization. However, he stated that the laser technique took him twice as long compared to the electrosurgery technique and he also reported that CO2 laser is 15 to 20 times more costly than the electrosurgery. Stucker states that you should reserve this technique only for diseases on the nasal tip. You can see why, since sometimes you may get some alar notching here. The CO2 laser was introduced in 1980s. Excision of the bulk of rhinophyma was used with the CO2 laser, and vaporization was used for the rest with the depth of 0.1mm. The Erbium:YAG laser use for rhinophyma became available and common in mid-1990s. Better cosmetic results with shorter healing time were obvious due to the smaller thermal damage zone compared to the CO2. Dermabrasion is another technique used in rhinophyma; however, it is usually used as an adjuvant to other methods. Dermabraders are simple tools that are very effective but may cause a very sever trauma and extended hypopigmentation. The recent advances in laser technologies offer less invasive and very efficacious approach to treating rosacea and preventing rhinophyma. Nd:YAG lasers are used to reduce and control rosacea and to get patients off Accutane, which has been linked to birth defects and other complications. If rosacea has developed into rhinophyma, the Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period. Combined carbon dioxide laser and bipolar electrocoagulation is another another option to treat rhinophyma. This combined method provides a bloodless operative field which allows the sculpting of the hypertrophic areas, leading to a good cosmetic outcome and a pain-free postoperative recovery. In conclusion, it is important to diagnose rosacea at an early stage and treat it effectively before it has a chance to develop into rhinophyma and disfigure the patient’s nose and face.
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