Although Rosacea was described as a clinical entity a number of decades ago, the etiology has remained a mystery until recently. It is characterized by redness over the face that continues to get progressively worse over time and eventually increases the appearance of blood vessels of the face with many breaking and leaking. One of the characteristics is that in one of the stages of rosacea, there is a significant breakout of stopped-up oil glands that has the same appearance as acne . This is the reason that the moniker applied to this condition is acne rosacea, which is incorrect.
What causes Rosacea?
It occurs both in males and females and is generally worsened by stress, alcohol, exercise, spicy foods and anything that will increase blood flow to the face. If allowed to continue untreated over decades, some will develop rhinophyma or an enlarged nose, characteristic of W. C. Fields. This is the reason the association has occurred between alcoholism and rosacea. However, there are many alcoholics who do not have rosacea and many with rosacea who are not alcoholics.
In addition to the problems with the skin of the face, there is also associated a conjunctivitis or inflammation of the eye making it feel as though there is gravel in the eyes.
Classically, treatment has been aimed at clearing the acne-like bumps and killing an organism that lives in the oil glands, hence the prescribing of tetracycline and a topical called Metrogel. The conjunctivitis was also treated with tetracycline.
Recent research, performed mostly in Ireland, has disputed most of these old ideas and delineates the fact that rosacea is actually a disorder of blood vessels and that accounts for all the manifestations of the disease, including the oil gland problem as the oil gland difficulty arises from the increased fuel to the glands (I.e. blood).
Clinical trials have shown that topical treatment of a drug that has been used for the treatment of glaucoma decreases the blood vessel problem and therefore clears the rosacea. This medication is now available by prescription under the name of Mirvaso.
The conjunctivitis should be treated with prednisolone 1% ophthalmic solution and should be administered properly. The eye, just as the skin, has memory, so that if treatment is started and discontinued too rapidly, the problem will simply return. The eye drops should be used 3 times a day for 2 weeks, twice a day for 2 weeks and then once a day for a month before discontinuing it.
It is also prudent for the patient to avoid anything that causes more blood to flow to the face. One of the strange characteristics about the skin of rosacea is that it is very dry—not oily—and requires significant moisturizing with good moisturizers. Topical steroids, which are often used to treat redness of the skin, may actually irritate rosacea skin.
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