Acne Rosacea is a common, but poorly understood, disorder that involves primarily the face. It affects approximately 14 million Americans. This condition is seen much more frequently in women, but can also affect men in a more severe form, characterized by nasal enlargement. This problem affects people primarily of European descent with a familial tendency. It appears in adult life often in the later thirties to early forties and is often characterized initially by facial flushing with persistent redness. Later, inflamed papules and pustules can appear usually on the cheek and nose.
With more prolonged involvement there is often swelling and induration of the face which can be later followed by nasal enlargement, particularly in men. In some individuals eye irritation can occur as a form of ocular rosacea.
Causes of Rosacea
The causes of rosacea have been poorly understood. However, recently a number of new developments are helping us understand the pathophysiology of this condition. This disorder has been characterized by an alteration of the immune system on the surface of the skin which results from an abnormality of a protein referred to as a canthelicidin peptide. Over-expression of this protein results in an inflammatory response that appears to lead to the characteristic features of rosacea; redness, papules, and dilated blood vessels.
The most well known trigger of this condition is sunlight. The damage caused by UVB light results in over-expression of the canthelicidin peptide. When the barrier function of the skin is disrupted by wind or extremes in temperature or by vigorous bathing, there is an exacerbation of the factors that lead to this problem. Chronic inflammation in this condition eventually leads to repeated vascular damage resulting in dilatation and eventually persistence of enlarged blood vessels, often referred to as facial telangiectasia.
Therapy and Treatments for Rosacea
The treatment of rosacea involves a three pronged approach. First and foremost special care must be paid to the alter skin barrier function which can be repaired by close attention to gentle cleansing with non-soap cleansers and the use of moisturizers which reestablish barrier function of the skin.* Concurrent use of sunscreens especially during the sunny months of the year helps to eliminate the UV light trigger and preserve barrier function of the skin.*
There are topical and oral treatments for this condition; azeleic acid and metronizodol are important topical agents that have a antimicrobial and possibly anti-inflammatory mode of action.* Often they are sufficient to control the milder forms of this disorder.* The tetracycline family of drugs also plays an important role. There is a low dose form of this drug known and approved as Oracea which acts primarily as an anti-inflammatory drug.* The side effects are minimal due to the low systemic doses required for activity. Higher dose tetracycline, Doxycline and minocycline can be more useful in difficult cases.* Attention must also be given to physical factors which can trigger rosacea. Minimizing over heating and trauma combined with pharmacologic treatments often results in significant improvement and control of this problem.*
Our center has special expertise in treating telangiectatic vessels, a noticeable feature of this condition.* We have pioneered research in the use of IPL, 532 KTP laser, Pulse Dye Laser, and combined 595, 1064 synergy for the treatment of this problem.* In one to two treatments, we generally can see 75% or better improvement.*
We are proud of our special expertise in the treatment of vascular lesions and have made it an important part of our academic studies.* We also have published many papers on this topic from chapters and text book on vascular lesions to the treatment of facial telangiectatic vessels.
We invite you to read some of these publications.
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