Rosacea & Acne Rosacea - Frequently Asked Questions

1. What is Rosacea?
Rosacea (pronounced rose-ay-shah) is a potentially progressive neurovascular
disorder that generally affects the facial skin and eyes.

The most common symptoms include facial redness and inflammation across
the flushing zone - usually the nose, cheeks, chin and forehead ; visibly
dilated blood vessels, facial swelling and burning sensations, and
inflammatory papules and pustules.

Rosacea develops gradually as mild episodes of facial blushing or flushing
which, over time, may lead to a permanently red face.

Ocular Rosacea can affect both the eye surface and eyelid. Symptoms can
include redness, dry eyes, foreign body sensations, sensitivity of
the eye surface, burning sensations and eyelid symptoms such as chalazia,
styes, redness, crusting and loss of eyelashes.

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1.1 How is Rosacea different to Acne Vulgaris ?
As Rosacea is a neurovascular disorder it affects the flushing zone.

Is is common that Rosacea does not present with blackheads that are
seen with Acne Vulgaris. Also the age of onset, and the location of
redness is a clue. Rosacea is commonly an adult disease, and is generally
restricted to the nose, cheeks, chin and forehead. It can coexist with
acne vulgaris.

Some Rosacea sufferers have a significant acne component in their symptoms
so it can be easily confused with acne vulgaris. The papules and pustules
of Rosacea tend to be less follicular in origin.

Rosacea will probably have an underlying redness that is related to
flushing and thus looks different to acne vulgaris. Acne sufferers
normally do not have the accompanying redness.

Rosacea usually begins with flushing, leading to persistent redness.

As both conditions are inflammatory, the treatment for Rosacea and acne
vulgaris can be somewhat similar, but some of the acne vulgaris regimes
are too harsh for Rosacea affected skin and can severely aggravate the
condition.

Rosacea sufferers are cautioned against using common acne treatments such
as alpha hydroxy acids (glycolic and lactic acids), topical retinoids
(such as tretinoin, Retin-A Micro, Avita, Differin), benzoyl peroxide,
topical azelaic acid, triclosan, acne peels, chemical peels. Additionally
the caution extends to topical exfoliants, toners, astringents and alcohol
containing products.

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1.2 What is the difference between Rosacea and Seborrheic Dermatitis ?
Seborrheic Dermatitis and Rosacea are closely related, they both involve
inflammation of the oil glands. Rosacea also involves a vascular component
causing flushing and broken blood vessels.

Seborrheic Dermatitis may involve the prescence of somewhat greasy flaking
involving the T zone, crusts, scales, itching and occasionally burning,
and may also be found on the scalp, ears and torso. It does not usually
involve red bumps as in Rosacea.

The T zone is the area shaped like a `T' composed of your forehead, nose
and around your mouth.

Just to confuse things further, the two conditions are often seen
together.

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1.3 What causes Rosacea ?
From "Beating Rosacea, Vascular, Ocular and Acne Forms", by Geoffrey Nase
PhD, Nase Publications 2001.

"Rosacea is primarily a disorder of the facial blood vessels. Experts from
across the world agree that vascular abnormalities are central to all
stages and symptoms of Rosacea".

To paraphrase: Rosacea blood vessels undergo changes in function and
become hyper-responsive to internal and external stimuli. These changes
are ultimately responsible for the progression of all Rosacea symptoms.

As with many conditions, there appears to be a genetic propensity to
developing Rosacea.

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1.4 How does Rosacea progress ?
"Rosacea normally progresses in the same generalised fashion, frequent
dilation of facial blood vessels leads to vascular hyper-responsiveness
and structural damage."

Rosacea experts talk about Rosacea symptoms appearing in 4 stages. Over
time Rosacea can progress from one stage to the next.

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1.5 What are the stages of Rosacea ?
Dr. Nase talks about 4 stages, called Pre-Rosacea, Mild Rosacea, Moderate
Rosacea and Severe Rosacea.

Pre-Rosacea: the first cardinal sign of Rosacea: blood vessels dilate to
more stimuli, open wider and stay open for longer periods of time compared
to normal persons. No visible damage can normally be seen.

Mild Rosacea: begins when the facial redness induced by flushing persists
for an abnormal length of time - usually 1/2 an hour or more after a
trigger. Those who have frequent pre-Rosacea flushing are highly
susceptible to progressing to mild Rosacea.

Some of the common triggers for a facial flush are heat, cold, emotions,
exercise, topical irritants and allergic reactions.

Moderate Rosacea: as facial flushing becomes more frequent and intense,
vascular damage occurs. This can result in long lasting redness, swelling
and inflammatory papules and pustules. Telangiectasia (damaged micro blood
vessels, often visible on the surface of the skin) may be noticed in the
areas where flushing is worst.

Severe Rosacaea: characterised by intense bouts of facial flushing, severe
inflammation, facial pain, swelling and burning sensations. Sufferers may
develop intolerance to products they were able to use before. Also
inflammatory papules, pustules and nodules may be present. Some experience
a bulbous enlargement of the nose, known as rhinophyma.

This is just a guide, you may of course experience symptoms outside these
ranges.