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What is Rosacea
Definition, Stages & Classification
What is Rosacea? In a Definition by a famous dermatologist:
Rosacea is defined as chronic (long term) skin disorder that most
often affects the nose, forehead, cheekbones,
and chin (Dr. Berasques).
Groups of tiny microvessels (arterioles, capillaries, and venules) close to the surface of the skin become dilated, resulting in blotchy red areas with small papules (a small, red, solid, elevated inflammatory skin lesion without pus, that is minor when the size is of a small measles lesion, moderate when about the size of a pencil eraser, and severe when the papule is the size of a small currency coin or the tip of the little finger) and pustules (pus-filled inflammatory bumps). The redness can come and go, but eventually it may become permanent. Furthermore, the skin tissue can swell and thicken and may be tender and sensitive to the touch.
Note:
Pustules are NOT pimples. Pimples have a bacterial component to their
pathogenesis and are also mainly localized in and around the hair follicles.
The inflammation of rosacea can look a great deal like acne, but blackheads and whiteheads are almost never present. Acne is a fairly common disorder -- about one in every twenty Americans is afflicted with it (Drs. Faria and Edward).
Rosacea is more than just a red face. In fact it is a complex system of action and reaction. Rosacea partially results from an overly acidic body and skin. The pH (potential of hydrogen) as you remember from your high school general science or chemistry class, ranges from 0 to 14 with 7 being neutral. As you rethink your past history, you will notice that "all" the rosacea triggers come from "acidic items" regardless of whether they are foods, drinks, stress, or merely out of breath. We all know that if we hold our breath for 30 seconds or 60 seconds, we will notice that our face turns pink or red. We know, but hardly think that the cause is a build up of carbon dioxide which is an "acidic" gas and we have a shortage of oxygen. Very similarly, when we exercise for a short period, we have a build up of "lactic acid," which is a body waste, which is obviously acidic. Likewise, those with acne need to be very concerned about the build up of acids in our blood stream due to the foods and beverages that we consume. We know of our triggers such as alcohol, coffee, various medications, etc. which all have a pH below 7.0 or are termed acidic. Our objective therefore should be to balance, buffer, or neutralize the acids with alkaline foods or water. To learn more about the effects of an acidic imbalance on rosacea, visit: About Rosacea page
The Primary Component of Rosacea Flushing or Facial Redness:
Rosacea usually begins with frequent flushing of the face, particularly the nose and cheeks. This
facial flushing is caused by the swelling of the blood vessels under the
skin. This "red mask" can serve as a flag for attention. Telangiectasis
is easy to recognize, characterized by the visible presence of capillaries,
bright red in color.
Diffuse redness frequently precedes the appearance of telangiectasis and is a constant flushed appearance. True diffuse redness is quite different from a localized erythema as seen in cases of sunburn, inflammation, or over stimulation. With both telangiectasis and diffuse redness, the redness is not transitory and generally, there is not an increase in skin temperature, but particularly there are no alterations in the tissue structure or biochemistry as seen in rosacea. The circulatory network of the skin is extensive and the capillaries are the smallest, most delicate vessels.
During normal blood circulation the capillaries undergo constant changes. In between beats the pressure is relieved and the vessels constrict back to their normal size. This return to normal size is accomplished by the natural elasticity in the structure of the capillary. If telangiectasis is present, the capillaries' elasticity is deteriorated so they remain slightly dilated.
The constant influx of blood perpetuates this slight
dilation. The skin gradually becomes congested and eventually the capillaries
become visible through the skin's surface. When it comes to telangiectasis,
sometimes a person's lifestyle and habits can be the skin's worst enemy.
In a fair, delicate skin predisposed to telangiectasis, a steady diet
of hot, spicy food, chronic alcohol consumption, and eating meals too quickly
will promote telangiectasis. And many retinoids used for acne, as well as
many harsh soaps, continue to aggravate the skin.
Rosacea flushing can be triggered by many factors, such as sunlight, physical or mental stress, fatigue, consumption of fatty (or acidic) foods, drinking alcohol or caffeinated beverages, and extremes in temperature. It is important to note that each patient reacts to rosacea triggers in different ways; what triggers one person's rosacea may not trigger another person's rosacea. The most important link between all of these factors is that they are acidic on the pH scale. Our body naturally wants to be pH neutral or alkaline. When we are exposed to our rosacea triggers, the natural balance is thrown off and the immune system reacts causing rosacea redness. The good news is that you can buffer, or offset, the acidic triggers by consuming more alkaline foods and drinking water.
Cigarette Smoking:
Cigarette smoking, which depletes the skin of vitamin C, essential for the formation
of collagen, accelerates the cross linkage of collagen and the hardening
of elastin and furthermore, creates a trillion free radicals, which destroy
the capillary structure.
Smoking, which additionally robs the skin of oxygen, is a potent initiator of telangiectasis. Also, the smoker may have a variety of medical problems such as high blood pressure, and mineral deficiencies, which can cause the appearance of telangiectasis.
Stages - Plewig and Kligman Classification of Rosacea
Stage I: The erythema may persist for hours and days, hence the old term erthema 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 areas 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 extensive inflammatory infiltration, connective tissue hypertrophy, massive fibrosis and elastosis, diffuse sebaceous gland hyperplasia, and extreme enlargement of individual sebaceous glands forming dozens of yellowish unbilicated 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)
Ocular Rosacea: Rosacea can also cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps, eye lashes sometimes fall out, compounded by bloodshot eyes. (Dr. Thiboutot). The ophthalmic signs are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ophthalmic rosacea covers all these signs. The ophthalmic complications are independent of the severity of facial rosacea. Rosacea keratitis has an unfavorable prognosis, and in extreme cases can lead to corneal opacity with blindness. The most frequent sign, which may never progress, is chronically inflamed margins of the eyelids with scales and crusts, quite similar to seborrheic dermatitis, with which it is often confused. Pain and photophobia may be present. It is instructive to ask rosacea patients how their eyes react to bright sunlight. (Drs. Gerd Plewig & Albert M. Kligman).Ocular rosacea is a serious condition that needs to be quickly under control, as the patient could potentially lose vision from this condition in the more severe cases. Any patient with rosacea who has ocular irritation, light sensitivity along with a decrease in visual acuity, or obvious inflammation of the lids or conjunctiva should be referred to an ophthalmologist. One of the concerns in ocular rosacea is the possibility of secondary infection, since a dry environment is a good breeding ground for bacteria like staphylococci.
When treating the symptoms of rosacea, one may observe a rosacea-like eruption around the mouth area. Known as perioral dermatitis, perioral refers to the facial area around the mouth while dermatitis pertains to inflammation, redness or irritation of the skin. This rosacea-like inflammation generally consists of small red bumps or even pus bumps and mild peeling as the skin is extremely aggravated. This condition may be wrongfully thought of as acne while others believe it to be a manifestation of their rosacea. Perioral dermatitis is often aggravated by fluoridated or tartar-control toothpaste, chapstick, the ingredients in lipstick, and mouthwash. It is also believed that topical steroids, residue from asthma inhalers containing steroids, cinnamon, cosmetics, and even moisturizers contribute to perioral dermatitis. Hormones, sunlight, and stress can cause perioral dermatitis to be more severe. Perioral dermatitis is a common skin problem that mostly affects young women, however, occasionally men and children are affected by it. Perioral dermatitis symptoms characteristically involve the mouth area, but do not affect the lips themselves. There may also be some flaking of the skin at the site of occurrence. Many times if the flaking is isolated to the lip area it may be mistaken for chapped lips. Perioral dermatitis may be considered a variant of rosacea or as a distinct and separate skin condition. Although rosacea papules may appear in the perioral area, perioral dermatitis without rosacea symptoms cannot be classified as a variant of rosacea. Perioral dermatitis is characterized by symptoms of microvesicles, scaling, and peeling.
Rosacea, once believed to be a condition almost exclusive to caucasions, is now increasingly occurring in asians and middle-easterners. Some believe this is due to the influence of western culture and habits - lifestyles if you will - becoming more common in eastern cultures. While cultural changes are inevitable, change is not always progressive unless we have chosen the proper course in our rosacea treatment. Often adjustments are needed in our lifestyles for progressive change as they are often the 'cause' of rosacea. Many rosacea patients have continued with the same pattern of lifestyles producing more catecholomines that produces the "alarm" to the skin. Therefore the rosacea patient continues to face the same problems without much change.
Rosacea Ltd was designed specifically to improve the appearance of damaged, sensitive facial redness (erythema) and dilated facial vessels (telangectasia), as well as rosacea-related papules (raised red lesion without pus), and acne pimples (with pus and inflammation due to bacteria). The very sensitive skin of patients with the combination of rosacea, seborrheic dermatitis, and acne are very happy with Rosacea Ltd III. These rosacea patient's past rosacea treatments would irritate one condition while trying to improve another of these three skin conditions that often co-exist together that makes for a most complex rosacea treatment plan.
During the past 11 years, 98% of rosacea patients throughout the world have confirmed that they are extremely impressed with Rosacea Ltd III and our Bass & Boney Pharmaceuticals, Inc. 120 day 100% refund. Rosacea Ltd III received it's name by being the third generation of Rosacea Ltd which was developed in April of 2000. As you will notice the appearance and shape of Rosacea Ltd III allows for a simple easy application to the eye lid for those with ocular rosacea.
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SYMPTOMS OF ROSACEA
The symptoms of rosacea can vary substantially from one patient to another, and may include various combinations of rosacea signs and symptoms.
These rosacea symptoms include:
1) Facial rosacea redness or flushing. Facial redness or diffuse redness is one of the most common symptoms of rosacea and frequently appears before other signs and symptoms develop. The flushing factor tends to be cause of comment and embarrassment for the rosacea sufferer. Facial redness or erythema is defined as a lengthy flush of embarrassment or emotion in a social situation that may last for a few minutes to many hours. As the flushing symptom progresses it becomes a more constant redness or blotchy flushed appearance. The redness is generally located on the cheek area but can spread down to the chin, neck, or even upper chest. In some cases the forehead may also be involved.
2) Telangiectasis also known as damaged or dilated facial blood vessels or spider veins visible on the surface of the skin. This effect is due to small blood vessels of the face becoming enlarged and emerging closer to the top of the skin to become more visible. Telangiectasia usually appears on the cheek and nose area and is more noticeable as the rosacea flush subsides. These blood vessels take on the appearance of fine red lines coursing through the surface of the facial skin.
3) Rosacea Papules are small, red, solid, elevated inflammatory skin lesions without pus. Rosacea papules are considered minor when the size is of a small measles lesion, moderate when about the size of a pencil eraser, and severe when the papule is the size of a small currency coin or the tip of the little finger. The top of the papule can be flat, pointed, or rounded. Papules are common lesions in acne. Vascular flushing causes these rosacea bumps. Over time, flushing results in leakage of inflammatory cells out of the blood vessels and into the skin. These inflammatory cells then migrate toward the surface of the skin, resulting in inflammatory papules.
4) Rosacea Pustules which is a dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria. Facial pustules are small, red, inflamed, pus-filled, blister-like lesions on the skin surface. Vascular flushing in areas around sebaceous glands causes rosacea pustules. Over time, flushing results in leakage of inflammatory cells out of the blood vessels and into the skin. These inflammatory cells then migrate towards the sebaceous gland or pore, resulting in inflammatory pustules. The redness can come and go, but eventually it may become permanent. Furthermore, the skin tissue can swell and thicken and may be tender and sensitive to the touch. Note: Pustules are NOT pimples. Pimples have a bacterial component to their pathogenesis and are also mainly localized in and around the hair follicles.
5) Rosacea facial swelling. Facial swelling occurs when fluid and proteins leak out of facial blood vessels at abnormal rates. Frequent facial flushing leads to increased movement of water and proteins across abnormal blood vessel walls. Over time, this "spillage" overwhelms the lymphatic system (drainage vessels), and leads to fluid build up in the facial skin.
6) Burning sensations on the skin. Many rosacea patients define rosacea as a hot burning sensation on the skin similar to what sunburn might feel like. In the early stages of rosacea this burning sensation may come and go. In the later stages of rosacea, the effect can become more constant. The burning sensation of rosacea may last anywhere from hours to days at a time.
7) Ocular rosacea, often described as a red, irritated, gritty feeling in the eyes, the ocular rosacea eyes may also have a swollen, watery appearance. Studies suggest that eye (ocular) symptoms may occur in over half of rosacea patients, and 12 to 20% of ocular rosacea patients reported they developed their eye symptoms before developing any facial rosacea symptoms.
8) Rhinophyma is a form of rosacea that is characterized by chronic redness, inflammation, and increased tissue growth of the nose. Rhinophyma can take on many different forms. In most forms, the nose is chronically red and inflamed. There is also evidence of swelling, and the skin often appears thickened with large pores, resembling the peel of an orange. In some forms, sebaceous gland hypertrophy and hyperplasia (increased growth and number of sebaceous glands) can cause the nose to grow considerably, resulting in a bulbous appearance.
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