DERMATOLOGY

Dr. Larry Bishop

Disfiguring. Aggravating.  Embarrassing. Frustrating. In a nutshell, that's rosacea.  It's a disease that, although affecting 14 million Americans, is virtually unknown, and is one of the most under-diagnosed skin diseases in America.

Ask most of its victims and they'll say "Yeah, I blush really easily." Or, "I'm starting to get these tiny broken blood vessels on my face" or "It's not fair! I'm getting wrinkles and acne at the same time!"  What they don't know is that they have one of the most common, most disfiguring skin diseases and that there are lots of things we, as doctors, can do to help.

Rosacea is a common inflammatory skin disease primarily of the face, characterized by facial flushing and redness, dilated blood vessels of the face, as well as acne-like changes on the cheeks, chin, nose and forehead. It can even affect the eyes.  In really severe cases, it can lead to swelling of the nose and cheeks, leading to a condition known as rhinophyma. W.C. Fields, the famous comedian, was famous for his swollen, red nose.

This disease affects one out of seven women and one out of 20 men.  It most commonly begins in the 30s through the 50s, but can have its onset as early as the teens.  Commonly referred to as "adult acne," rosacea can be a socially isolating and painful disease.

There are certain predisposing factors. Northern Europeans tend to get it more  commonly, especially those of German and English lineage. It is also more common in perimenopausal women.

Things that tend to make rosacea worse, causing increased redness, burning and breakouts are hot, spicy foods, alcohol, heat, and exercise. Additionally, in northern climates we find that cold and wind can precipitate attacks. In certain women, rosacea flares are tied to migraine attacks, with the rosacea preceding the headaches, clearly acting as a cause of the migraines.

Ocular rosacea, which is unusual, is the type of rosacea that affects the eyes.  It primarily manifests itself by causing watery, bloodshot, irritated eyes, and often is associated with frequent styes.

Luckily, there are things we can do to help prevent flares of rosacea.  Primary among the defenses are sun avoidance, avoidance of triggers (spicy foods, alcohol, etc.) and skin and eye care, aiming toward lowering inflammation.  Additionally, there are medical therapies that can make a significant difference.

AMONG THE MOST famous rosacea sufferers is former President Bill Clinton. Others reported to have suffered from the disorder include W.C. Fields, Princess Diana, financier J.P. Morgan and the Dutch painter Rembrandt.

Treating Rosacea
The largest impact on rosacea are either laser or intense pulsed light therapies.  These treatments shrink down dilated blood vessels, which in turn shut down many of the inflammatory changes that characterize the disease.  They are the only treatments that actively reverse the disease, while other medical treatments seem to only hold the rosacea in check.

The medical therapies available are gels and creams based on either metronidazole or azelaic acid.  Both are effective, but metronidazole gets the nod as the more effective of the two.  Additionally, oral medications based on doxycycline or one of the other tetracycline derivatives are effective, particularly for the type of rosacea that simulates acne, with pustules and red bumps.

One of the newest products for rosacea is an oral medication that is low-dose doxycycline called Oracea, and it seems to work pretty well.  It has very few side effects and avoids the biggest side effect of traditional doses of antibiotics such as yeast infections.  Taken once a day, this medication works by decreasing the inflammatory white blood cells that attack the skin.

Living with Rosacea

• First, avoid the inciting agents. Wear a good sunscreen that doesn't irritate your skin every time you go outdoors. Avoid any foods or drinks that make you flush or blush or make your face feel warm. And try to exercise in the cooler hours of the day, so that the excess heat doesn't increase blood flow to your face.
• Second, establish good habits. Use your medicine regularly, so that the disease will not progress and your flares will not be so severe. Metronidazole, which comes in multiple skin medications, is our topical treatment of choice. Also, take oral medication if your rosacea is severe or if you have ocular rosacea.
• Third, learn the art of camouflage. Many of the cosmetic lines in the department stores have a line of green-tinted foundations that neutralize the red (remember in third grade how green plus red equaled brown? In this case, pink plus light green equals tan!) Just remember that it is worth the investment to buy products that are of high quality and won't block your pores.
• Finally, attack the problem at its root. The most common effective treatment for rosacea is intense pulsed light (IPL). The dilated blood vessels actually shrink from the IPL treatments, which when combined with a special solution called Levulan, can shrink enlarged pores and oil glands as well.

Rosacea is a tough disease to live with, but with persistence, determination, appropriate medication and a good game plan, it's entirely manageable.  But, you still might try to avoid the jalapenos the next time you order nachos at Cantina Dos Amigos.

Dr. Bishop attended Wright State University medical school and then served nine years in the Air Force as a flight surgeon. An affiliate of MIMA, he specializes in cosmetic and surgical dermatology, including Mohs Micrographic Surgery, and non-surgical rejuvenation of the face. You may call Dr. Bishop at 321-751-9097, or CLICK HERE FOR MORE INFORMATION.

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