Family Health Magazine - FAMILY MEDICINE
Is Your Face Red?
It could be rosacea
One day, you notice that your face seems much redder. A few tender ‘pimples’ are forming in unusual places. You find small, prominent blood vessels on your cheeks or nose. Surely, you think, it is just a bit of windburn. Maybe your hormones are acting up, or your skin is reacting to a new face cream or aftershave. Still, if it does not disappear in a few days or weeks, and seems to be getting worse, you may have rosacea.
This common condition has frustrated many, including medical and skin specialists, the cosmetic industry, and those who face it in the mirror. Causes, prevention, and treatment have all been hard to find, in both conventional and alternative medicine. The variety of theories about rosacea shows a lack of true understanding of the condition.
Suggestions to prevent flare-ups
- Wear sunscreen with a sun protection factor (SPF) of 15 or higher to protect your face from the sun.
- Protect your face in winter with a scarf or ski mask.
- Avoid irritating your facial skin by rubbing or touching it too much.
- Stay away from facial products that contain alcohol or other skin irritants.
- When using moisturizer along with a topical medication, apply moisturizer only once the medication has dried.
- Use products that are labelled "non-comedogenic", which won’t clog oil and sweat gland openings (pores) as much.
- Avoid becoming overheated.
- If you wear makeup, consider using green or yellow-tinted pre-foundation creams and powders as they are designed to counter skin redness.
- Avoid alcohol.
The good news is that answers are emerging and help is now available. Still, you must recognize that there is a problem and seek help before damage is done. If skin has permanently changed, the medical esthetic industry can offer some new tools to reduce the effects. The first place to seek help is your family doctor.
What is rosacea?
Rosacea often starts between the ages of 30 and 50. It may affect more women than men. Still, men tend to have more severe symptoms, perhaps because they delay seeking medical help until symptoms are severe.
Rosacea is characterized by redness, enlarged oil glands (which may look like acne without the infection), and the appearance of small blood vessels. It is most common on the central face area – the cheeks, nose, forehead and chin. Rosacea is usually divided into five categories. These are:
- redness and flushing alone
- redness and flushing with ‘papules’ (small, pimple-like bumps)
- redness with skin thickening and surface nodules (in severe cases, called ‘potato nose’)
- any of the above with eye irritation
- enlargement of separate oil glands.
Most report that rosacea gets worse if they become ‘flushed’ by hot drinks or food, hot weather, or strong emotion. Certain foods and alcohol can cause flare-ups. As rosacea is considered an inflammatory condition, other conditions that create slight inflammation may be triggers. For instance, food sensitivities or stress may help bring it on.
The condition seems more common in those who blush easily. Such people may have blood vessels that are closer to the skin or vessels that react easily.
Rosacea may look similar to regular acne. It can also be confused with various types of dermatitis (skin inflammation), especially seborrheic dermatitis. Other skin problems with similar symptoms include lupus erythematous, which also appears as facial redness, or use of too much cortisone cream on the skin. As treatment for each condition is different, it is important for your doctor to carefully diagnose rosacea.
Treatment and care
Rosacea is a chronic condition. The goal of treatment is to control rather than cure. Many treatments are now available for rosacea and its complications. Hope exists that it may be controlled with careful attention to lifestyle and diet.
As with most skin conditions, the first step is learning about good basic skin care. Use a mild cleanser regularly, but not excessively. This means at least once daily, but twice daily is better. Avoid harsh or irritating chemicals. Protect skin year round with a good sunscreen, broad spectrum UVA plus UVB type with a SPF15 or higher. Sunscreens with titanium dioxide or zinc oxide are least irritating.
Once rosacea has been diagnosed, specific treatments exist. The redness and papules (and often pustules or pimples) may respond to over-the-counter acne medication such as benzoyl peroxide. A doctor can prescribe topical antibiotics to be applied to the skin, such as metronidazole, erythromycin and clindamycin. In more severe cases, topical vitamin A acids or oral antibiotics may be helpful. For very severe cases, oral isotretinoin (Accutane™) may be necessary. Once the condition has gone into remission, most skin specialists recommend a maintenance dose of topical metronidazole to prevent flare-ups.
New observations suggest that diet is very important in managing rosacea. In general, avoid hot and spicy foods, alcoholic beverages, and hot drinks. Many rosacea sufferers find that specific foods, such as tomatoes, peanuts, chocolate or even green peppers, cause a flare-up.
Discovering the offending substance may seem impossible, considering the number of foods and spices we may eat in a typical day or week. For some, a food elimination diet may be necessary. Here, specific foods or ingredients are removed from the diet in order to discover what may be causing the problem. A dietitian can help in planning a food elimination diet.
Many report success by eating 'according to blood type'. While no good scientific literature has been found to support this idea, so many patients have noticed improvement that it may be an idea worth exploring if you are truly frustrated.
In spite of treatment, many with rosacea are left to deal with lasting redness and visible small vessels, while others may have scarring. These problems may respond very well to pulsed dye vascular laser therapy and intense pulsed light therapy. Such therapies are available in larger centers where cosmetic medical therapy is done. Be sure to have a very frank discussion with a cosmetic therapist beforehand to fully understand the risks, costs, and expected outcome.
Rosacea, while a common condition, has long frustrated both sufferers and therapists. However, there is now new hope for prevention, control, and treatment of this condition. Start by asking your family doctor.
Protect Your Skin
People with rosacea can modify their lifestyle in a variety of ways to reduce the effects of rosacea. The following suggestions are taken from www.rosecea.org.
Bathing and Cleansing
Rosacea sufferers must often take care in how they cleanse and bathe. The following tips on personal-care routines can help soothe and calm your facial redness:
- Avoid hot water, hot tubs and saunas. These flush your skin, aggravating the condition.
- Begin each day with a thorough, gentle facial cleansing. Use a gentle cleanser that is not grainy or abrasive and spread it with your fingertips. Rinse your face with lukewarm water to remove all dirt and soap, and use a thick cotton towel to gently blot the face dry.
- Never pull, tug, scratch or treat your face harshly. Avoid rough washcloths, loofahs, brushes or sponges.
- Let your face thoroughly air dry before applying any medication or skin-care products. Allow medication to dry completely for five to 10 minutes before applying any moisturizer or makeup.
- Men should use an electric shaver rather than a blade. If you prefer a blade, never use a dull one that requires extra scraping for a clean shave. Avoid shaving lotions that burn or sting.
- Repeat the cleansing process at night. Gently wash your face each night to remove any makeup or dirt accumulated throughout the day. Air dry and apply your topical medication.
A variety of skin-care products can help treat rosacea. Moisturizers reduce flakiness, while makeup can camouflage symptoms and improve appearance. You may have to experiment until you find the products that work best for your individual skin. Here are some general guidelines that will help you select products carefully:
- Steer clear of ingredients that sting, burn or cause facial redness. Some ingredients to avoid include alcohol, witch hazel, menthol, peppermint, eucalyptus oil or clove oil.
- Select fragrance-free products. If you must choose a product that contains a fragrance, be sure that it appears at the end of the list of ingredients. The further down it appears, the less fragrance the product contains.
- Use makeup to hide blemishes and cover redness. Spot application of makeup may be used to cover blemishes and visible blood vessels. Green-tinted pre-foundations are available at most cosmetic counters to mask general redness. They can be followed by a skin-tone foundation. Avoid powders, which can make dry flaky skin look worse.
Sun exposure, hot weather, humidity, cold and wind have all been known to aggravate rosacea. Use the following defences:
- Always protect your face from the sun. Wear a sunscreen with an SPF (sun-protection factor) of 15 or higher year-round. If necessary, use a children’s formula developed for sensitive skin. Wear a broad-brimmed hat. Minimize midday (10 a.m. to 2 p.m.) exposure to the sun during summer months.
- Stay in a cool, air-conditioned environment on hot, humid days. If this is impossible, sip cold drinks and try not to overexert yourself.
If necessary, chew on ice chips to lower facial temperature or spray the face with cool water.
- Cover your cheeks and nose with a scarf to combat the cold. In winter, consider donning a ski mask before participating in outdoor sports or activities, as well as covering up on windy days. If wind or weather aggravates your rosacea, limiting your time outdoors in cold weather may also help.
- Use a moisturizer daily during cold weather. This protects against the naturally drying effects of cold and wind.
Stress ranks high on the list of tripwires for many rosacea sufferers. However, in a survey of rosacea patients affected by stress, most said stress management techniques successfully reduced their flare-ups. When feeling overwhelmed, try some of the following stress reducers:
- Take care of your whole self. Eat well, exercise moderately and get the right amount of sleep. Cutting down on caffeine may also help.
- When under stress, try deep-breathing exercises. Inhale and count to 10, then exhale and count to 10. Repeat several times.
- Use visualization techniques. Sit in a quiet place, close your eyes and visualize a beautiful vacation spot or favourite pleasurable activity or painting. Hold the image for several minutes to feel its peace and beauty.
- Stretch out and relax all your muscles. For a whole-body stress reliever, relax muscles starting at the top of the head and working down to your toes.
Foods and Beverages
Steaming hot soup or coffee, spicy nachos, a glass of wine – no matter how appetizing they sound, these foods and beverages can cause problems. Hot liquids may flush skin. Spicy foods like oriental mustard sauce or salsa can raise a sweat, and alcoholic beverages often trigger flare-ups. These tips will help you select rosacea-friendly meals:
- • Monitor how your rosacea reacts to alcoholic beverages. Alcoholic beverages often cause flare-ups. If alcohol aggravates your condition, reduce your intake or avoid it entirely.
- Avoid ’hot’ spices such as white and black pepper, paprika, red pepper and cayenne, which are common rosacea tripwires. Try these flavour substitutes:
- Chili powder – 2 tsp cumin, 1 tsp oregano.
- Poultry seasoning – 1⁄2 tsp sage, 1⁄2 tsp coriander, 1⁄4 tsp thyme,1⁄8 tsp allspice, 1⁄8 tsp marjoram.
- Curry powder – 4 tsp coriander, 2 tsp turmeric, 1 tsp cinnamon,1 tsp cumin, 1⁄2 tsp basil or oregano, 1⁄2 tsp cardamom.
- Reduce the heat in beverages. Lowering the temperature may be all that is necessary to keep enjoying coffee, tea and hot chocolate. Or try reducing the number of cups you drink from three or four to one or two instead.
- Identify and avoid any foods that aggravate your individual condition.
- A wide variety of foods have been reported to trigger rosacea flare-ups. Check your skin’s reaction to cheese, sour cream, yogurt, citrus fruit, liver, chocolate, vanilla, soy sauce, yeast extract (though bread is OK), vinegar, eggplant, avocados, spinach, broad-leafed beans and pods, and foods high in histamine or niacin. Taking an antihistamine about two hours before a meal may counter the effects of histamine, while aspirin may reduce the effects of niacin-containing foods.
While exercise may be part of a healthy lifestyle, it could actually do harm if it makes your condition flare. Moderation is key. Consider these precautions:
- Avoid heavy exertion or high-intensity workouts that overheat and bring on flushing. Replace them with low-intensity exercise routines, which are often just as effective.
- Exercise for shorter, more frequent intervals. Try exercising for 15 minutes three times a day, rather than for 45 minutes all at once.
- If exercising outdoors during warm weather, choose early morning or early evening hours when it's cooler. No matter what time of day, protect your face from the sun and avoid hot weather exercise.
- If exercising indoors, make sure the room is well-ventilated. Run a fan, open the window for a breeze or turn on the air conditioning to avoid overheating.
- Try to stay as cool as possible when exercising. Drape a cool, damp towel around your neck, drink cold fluids or chew on ice chips. You can also keep a bottle filled with cool water to spray your face.
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6 [FM_FHa07]