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  1. Rosacea or Rosy Cheeks? Skin Doctor Clears the Air on Healthy Skin


     

    When I was in my late teens I naively thought that in a few short years I'd enjoy spot-free skin. Here I am on the threshold of 50 and I still find myself scrubbing and squeezing away facial flaws on an almost daily basis. What's with that?

    Noted dermatologist Dr. Herbert Goodheart has the skinny on clear skin at almost any age. We've got Dr. Goodheart and today he's here with a look at a skin condition that mirrors acne but won't be cleared with common zit creams or pimple preparations.

    It's a condition known as rosacea. Check it out and see if that's what been affecting you and your outlook on life. Then heed Dr. Goodheart's advice and get a clear start on a happier life!

    Rosacea 101
    by Herbert P. Goodheart, M.D.,
    Author of Acne For Dummies

    It's easy to understand why rosacea was called "acne rosacea" for so many years -- rosacea and acne look so much alike. They both often have red pimples and, of course, both appear on the face. A major difference is that rosacea usually turns up in people from age 30 to 50. Unfortunately, rosacea is typically a longer lasting condition than teenage acne because it can go on and on through one's adult life.

    What causes rosacea?

    Although the precise cause of rosacea remains a mystery, researchers believe that heredity plays a major role. It has been suggested that abnormalities of blood vessels, certain bacteria, or skin mites often found in patients with rosacea may be what's behind it; however, evidence that these factors play a central role in the development of this disorder is lacking.

    Despite the lingering myth, ones drinking habits have nothing to do with causing rosacea; however, it is accepted that the blushing and flushing of rosacea can flare when some people drink alcohol. They may get a short-term redness, especially from red wine. It's doubtful, however, that drinking alcoholic beverages brings about a long-term worsening of this condition.

    Who is likely to develop rosacea?

    Anyone can develop rosacea; however, people from certain ethnic backgrounds are most likely to get it. If you have fair skin and have ancestors hailing from Great Britain (including Ireland, Scotland, and Wales), Germany, and Scandinavia, or certain areas of Eastern Europe, you have the greatest tendency to develop rosacea. The condition is rare in Hispanic, African, and African-American populations along with other dark-skinned people. Women are affected with rosacea more often than men.

    What does rosacea look like?

    Rosacea is characterized by persistent redness (erythema) on the cheeks, nose, chin or forehead. These areas comprise the central one-third of the face. Besides the redness, there are often visible blood vessels called telangiectasias. Many people refer to telangiectasias as "broken blood vessels", but there's nothing broken about them. They're actually enlarged blood vessels that look like thin red lines on the face, especially on the cheeks. Furthermore there are the acne-like bumps (papules and pustules) on the face.

    What are its symptoms?

    Very often, people who have rosacea describe how they're inclined to flush and blush easily. Temporary redness normally occurs whenever a blood vessel dilates (widens); it then contains a greater volume of blood, which produces the redness. When a person develops persistent redness, the condition usually doesn't go away on its own. For adults in the prime years of their careers, the appearance and psychological effects of rosacea can pose problems.

    Additional rosacea-related signs and symptoms involving the eyes and nose may occur such as:

    Ocular rosacea

    The eyes may:

    • Feel irritated and gritty as if there is something in their eyes
    • Tend to look bloodshot
    • Become overly sensitive to light

    If you have these symptoms, you should consult your doctor or an ophthalmologist to establish the correct diagnosis and to get appropriate therapy.

    Rhinophyma

    Rhinophyma is quite uncommon. It consists of knobby bumps that tend, over time, to get larger and swollen. It occurs when oil glands enlarge and a bulbous, red nose develops. This condition usually occurs in men over 40. Rhinophyma is rarely seen in women. It can be successfully treated with surgery and special lasers. Rhinophyma gave one famous rosacea patient, W. C. Fields, his bulbous nose.

    How does rosacea differ from acne?

    Unless acne is also present, particularly adult-onset acne, rosacea is different from acne in the following ways:

    • It usually makes its debut well after the acne-prone years
    • Lacks the blackheads and whiteheads seen in acne
    • The pimples of rosacea are generally small don't fluctuate with a woman's menstrual cycle as they do with acne
    • Fortunately, rosacea tends to heal without forming the types of scars that can result from severe acne
    • Telangiectasias, the tiny, visible blood vessels, often are present on the skin

    What are possible triggers?

    Factors that can cause flare-ups include: prolonged sun exposure, emotional stress, topical steroid medications and various skin care products. There is no convincing evidence as to whether the following factors have any long-term harmful effects on rosacea, but, they are known to increase the redness of the face temporarily: red wine, spicy food, temperature changes, vigorous exercise, or certain oral medications.

    How is rosacea treated?


    To reduce pimples and redness an oral antibiotic, such as a tetracycline derivative, may be prescribed for moderate to severe cases. This often rapidly gets rosacea under control and improvement is usually noticeable in a matter of a week or two. However, most cases can be treated and controlled with very effective topical medications alone. Often, the antibiotic is initially given in addition to topical therapy and topical therapy is continued as the antibiotic is gradually discontinued.

    Other Important Advice:

    • Use of sunscreens
    • Green-tinted cosmetics to hide facial redness
    • Avoidance of possible triggers

    Determining whether it's rosacea or just rosy cheeks

    Varying degrees of facial redness and blushing and flushing occur in many people, but that doesn't mean they have rosacea. In fact, rosacea is a condition that is regularly over- diagnosed by healthcare providers. What's more, many people diagnose themselves as having rosacea. Some of these self-diagnosers reach their conclusion after seeing "ask-your-doctor" television advertisements that introduce them to the condition.

    Some people are flusher/ blushers who don't have rosacea at all. In fact, if you carefully evaluate the location of redness on some of their faces, you discover that the redness seems to occur in different places than where it's commonly seen in rosacea. Moreover, a red face can be due to a variety of other skin disorders. For example, the so-called hot flashes of menopause, medication reactions, and allergy to cosmetics, all can be confused with rosacea.

    In many instances, rosacea can be hard to distinguish from weathered, sun-damaged skin that's seen in many fair-skinned farmers, gardeners, sailors, or other folks that worked or spent long periods of their lives outdoors. Such long-term sun exposure can lead to persistent red faces and tiny broken blood vessels that sometimes look quite a bit like rosacea. Lots of folks simply have rosy cheeks; they become flushed in hot rooms or when they drink alcohol or eat spicy foods.

    If you were to go to Ireland or Australia and observe the faces of many fair-skinned people there, you'd think there was an epidemic of rosacea because so many of them have rosy cheeks. And sometimes, what has been called "rosacea" on your face -- is simply rosy cheeks! You're just stuck with a healthy looking facial glow. Traditionally, folks like you didn't receive a medical diagnosis but were described as having a "peaches and cream" complexion.


    Herbert P. Goodheart, M.D., of New York, NY, author of Acne For Dummies, is a practicing dermatologist who also teaches at the Mount Sinai College of Medicine. He is the author of a highly regarded dermatology textbook titled Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, which is in its third edition.

    For more information please visit http://herbertgoodheart.com/

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