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Seeing red: Causes and treatments for rosacea

Red, a strong, passionate color, is associated in our culture with love, vitality, energy, sensuality and power. Thus it is easy to understand why red is a popular color choice for celebrations, decorating and clothing. However, no one covets a red face.

A red face has negative social connotations – we assume that it is a sign of guilt, shame, embarrassment, emotional stress, inebriation, anger or illness.

In fact, a tendency to flush or blush easily can be an early symptom of rosacea, a dermatologic condition.

Festive events such as the holidays are an infamous time for unveiling rosacea. We imbibe and consume indulgently at parties. Alcohol, wine, warm temperatures, hot cider, spicy food, chocolate, cheese, tomatoes and eggplant are among the dietary factors that can cause rosacea to flare. Food by itself does not cause rosacea, but if one has a tendency to develop rosacea, certain foods can make it worse or precipitate a flare.

What is rosacea?

Rosacea is an inflammatory skin disease that affects primarily the face, but it can also target the eyes, ears and chest. The skin is hypersensitive and easily irritated. Common symptoms include stinging, burning, itching, persistent redness, swelling and bumpy skin. Sudden onset of blushing, flushing and redness for no apparent reason are typical complaints. Redness of the cheeks and nose from exercise or fluctuations in environmental temperature are more severe and last longer compared to individuals without rosacea under similar conditions. Rosacea sufferers report that everything they put on their face stings or irritates it.

Over time, if not treated, rosacea can cause permanent changes and scarring on the face. Oil glands can become permanently enlarged and chronic inflammation and swelling of the skin can result in a bumpy, uneven texture. Blood vessels on the face can become prominently dilated.

Rosacea can also affect the eyes. Symptoms include irritation, a persistent scratchy feeling, a sensation of something in the eye, dry eyes and chronically red eyes. Recurrent cysts in the eyelids called “chalazions” can be another sign. Consult an ophthalmologist if there are symptoms of potential ocular involvement.

Who gets it?

There is an increased prevalence of rosacea in individuals of northern and eastern European descent. Roughly 10 percent of middle-aged people are afflicted with rosacea. Typically, rosacea presents between 30-50 years of age. Rosacea is more common than diabetes. Fair-skinned individuals are more likely to develop rosacea than dark-skinned people. Ten percent of individuals who have rosacea also have a family member with rosacea.

How is it diagnosed?

Rosacea is diagnosed via evaluation by a dermatologist. There are no blood tests for rosacea. Under special circumstances, a biopsy may be needed to differentiate rosacea from other conditions that may present with facial redness.

What causes rosacea?

Although genetics play a role, the exact cause of rosacea is unknown. Current research demonstrates that there is an overproduction and abnormal processing in the skin of proteins cathelicidin and beta-defensin.

There is also increased activity of an enzyme known as kallikrein 5. Kallikrein 5 processes cathelicidin into a more active form, which then stimulates other skin cells to produce and release a multitude of inflammatory substances that attract the body’s white blood cells and stimulate excess formation of blood vessels, causing the characteristic redness in the face.

Can rosacea be treated?

There are many excellent treatments for rosacea, but there is no known cure. With appropriate medical therapy, rosacea in many instances can be well controlled to the extent that it is quiescent and the face appears normal.

Treatments range from topical medications to oral antibiotics and laser and intense pulsed light.

It is important to avoid foods that can aggravate rosacea. Adhering to a gentle skin-care program using products that contain no irritating chemicals is also key. Do not use over-the-counter products intended for treatment of adolescent acne. These products contain salicylic acid and/or benzoyl peroxide, which will increase stinging, burning and redness.

For more information, visit the National Rosacea Society’s website at www.nrs.com.

Dr. Patricia Wong is a dermatologist in private practice in Palo Alto. For more information, call 473-3173 or visit www.patriciawongmd.com.

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