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The
skin disorder acne rosacea, or adult acne, has little in common with acne
vulgaris, which plagues many adolescents. You may go through your teen
years without even a blemish and still develop rosacea in your 30s, 40s
or 50s.
Here's
what it usually looks like: Acne rosacea normally begins as redness in
the areas where you blush-cheeks, nose, forehead, neck or chin-singly
or in combination. At first, this discoloration, which looks as if you've
been out in the sun when you haven't, comes and goes. It becomes permanent
when you develop a visible network of tiny blood vessels in these areas.
Your eyes may be bloodshot and irritated. Unlike acne of adolescence,
pimples aren't common in rosacea; when present, however, they almost always
are red. Whiteheads and blackheads are rare. About 10% of men whose rosacea
hasn't been treated develop bumps on the nose.
It
is important for people who are free of this disease to know something
about it so as not to judge unfairly those who suffer from it. With their
red faces and bumpy noses, people with acne rosacea often go through adult
life wrongly tagged as alcoholics - a perception that can hurt them both
socially and professionally.
To
appreciate what living with rosacea can be like, read a biography of the
financier J.P. Morgan. He was one of the richest and most powerful men
in the world a century ago, yet his rosacea robbed Morgan of much of the
satisfaction and pleasure he might otherwise have enjoyed.
The
cause of rosacea remains a mystery (unlike acne vulgaris, in which an
excess of male hormones results in an overproduction of oil and the blockage
of sebaceous_ glands in the skin). Rosacea is more prevalent in women
but usually more severe in men, possibly because women are more attentive
to their appearance than men and seek treatment sooner - before the disease
progresses. Genetics also may play a role: Though all races are susceptible,
the disease is more common in the fair-skinned and appears to run in families.
There's
one characteristic shared by all rosacea sufferers: They blush easily.
Some researchers believe that it's the repeated blushing that eventually
dilates the blood vessels and causes a permanent discoloration of the
face.
Rosacea begins as a redness in the face that comes and goes. If untreated,
it becomes more permanent, and tiny blood vessels become visible. In addition,
slight swelling, pimples and pustules develop. It can reach the point
where everything that touches the face stings, burns or irritates.
Rosacea can lead to watery, bloodshot eyes and inflammation of the eyelids.
Gently scrubbing the eyelid margins with diluted baby shampoo can help
relieve symptoms.
In advanced cases of rosacea, the nose may become bumpy, swollen and red
from excess tissue (rhinophyma).
There's
no cure, but the symptoms and your appearance can be improved. Also, in
contrast to the acne of adolescence, don't expect to grow out of it.
In
addition to avoiding the factors that trigger or worsen rosacea (see box),
the following therapies will help:
- Oral
antibiotics. Tetracycline-250mg every six hours for three to four weeks
and then gradually reduced-is the mainstay of treatment. (Your own doctor
may prefer a different dosage.) I prefer two related antibiotics, doxycycline
or minocycline, 50mg to 100mg every 12 hours. They're easier on the
gut than is tetracycline, and you don't have to take them on an empty
stomach. If you can't tolerate any of these drugs, erythromycin, ampicillin
or metronidazole also will work.
- Topical
antibiotics. A cream or gel containing metronidazole (MetroCream, MetroGel)
is effective following or accompanying oral antibiotics. (A stronger
version, Noritate cream, approved by the FDA in 1998, is the first prescription
once-a-day topical therapy for rosacea.)
- Clonidine
can be useful if you blush at the slightest provocation. This is a potent
blood pressure-lowering drug, so first check it out with your doctor.
- Fine
electric needles or lasers can obliterate the dilated blood vessels
if and when they become very prominent.
- Use
a moisturizer daily in cold weather to protect against the drying effects
of cold and wind. Cover your cheeks and nose with a scarf when outdoors.
(Some of my patients wear a ski mask, even if they have no felonious
designs on a bank.)
- Men:
Use an electric shaver rather than a blade, and don't apply aftershave
lotion that stings or burns.
- Avoid
over-the-counter-preparations for acne that contain alcohol, acetone,
witch hazel, menthol, peppermint, eucalyptus oil or clove oil.
- Be
sure that anything you put on your face is labeled "noncomedogenic,"
meaning that it won't clog your pores.
- Avoid
long-term use of topical steroids. They aggravate rosacea.
- If
you're a heart patient and must take vasodilator drugs (such as IsordiI
or Imdur) or long-acting nitroglycerine - all of which dilate blood
vessels on your face as well as in your heart - take the lowest possible
dose.
- Avoid
niacin, which many take to lower cholesterol. It usually causes a flush
that can aggravate rosacea.
Anything
that makes your face red will intensify rosacea. The most common triggers,
which you should avoid if possible, are:
- WIND
AND SUN (use sunscreen with an SPF of 15 or higher).
- HOT
OR COLD TEMPERATURES, including hot baths and hot liquids.
- SPICY
FOODS, especially pepper, paprika, cayenne, mustard or salsa.
- ALCOHOL.
- STRESS
OR EMBARRASSMENT.
- OVERHEATING
after a strenuous workout or in a steam room (humidity worsens rosacea).
- HOT
FLASHES CAUSED BY MENOPAUSE (they can be treated with hormone replacement).
Dr.
Isadore Rosenfield, Parade Magazine, August 26, 2001
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