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What Is Rosacea?

ผื่นแพ้จากการสัมผัส
   Contact dermatitis

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 What Is Rosacea?

Rosacea (pronounced "roh-ZAY-sha") is a chronic, relapsing and potentially life-disruptive disorder of the facial skin that affects an estimated 14 million Americans. Many have observed that it typically begins any time after age 30 as a redness on the cheeks, nose, chin or forehead that may come and go. In some cases, rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness becomes ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue. This is the condition, called rhinophyma (pronounced "rhi-no-FY-muh"), that gave the late comedian W.C. Fields his trademark bulbous nose. In many rosacea patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

Although rosacea can affect all segments of the population, individuals with fair skin who tend to flush or blush easily are believed to be at greatest risk. The disease is more frequently diagnosed in women, but more severe symptoms tend to be seen in men -- perhaps because they often delay seeking medical help until the disorder reaches advanced stages.

While there is no cure for rosacea, medical therapy is available to control or reverse its signs and symptoms. Individuals who suspect they may have rosacea are urged to see a dermatologist for diagnosis and appropriate treatment.

Rosacea is a common skin disease that causes redness and swelling on the face. Often referred to as "adult acne," rosacea may begin as a tendency to flush or blush easily, and progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin, and nose. It also may involve the ears, chest and back. As the disease progresses, small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads.

When it first develops, rosacea may come and go on its own. When the skin doesn't return to its normal color and when other symptoms, such as pimples and enlarged blood vessels, become visible, it's best to seek advice from a dermatologist. The condition rarely reverses itself and may last for years. It can become worse without treatment.


What Should I Look For?

Redness
Facial redness from rosacea may appear similar to a blush or sunburn, and may be caused by flushing -- when a large amount of blood flows through vessels quickly and the vessels expand under the skin to handle the flow. The redness tends to become ruddier and more persistent over time. Burning and stinging are common in many with rosacea, and swelling may also occur. In some patients the facial skin may appear to be very dry.

Visible Blood Vessels
Visible blood vessels called telangiectasia (pronounced "tell-an-jek-TAY-zha") may appear on the surface of the skin in some patients. The small blood vessels on the face may grow permanently larger from flushing and eventually show through the skin. These enlarged blood vessels look like thin red lines on the face, usually on the cheeks or nose. These lines may be hidden by facial redness, but become more noticeable when the redness is cleared up.

Bumps and Pimples
Rosacea sufferers often develop small, red, solid bumps known as papules, and/or pus-filled pimples known as pustules. These bumps and pimples may be inflamed and look similar to teenage acne. However, rosacea does not normally involve follicular plugging (blackheads, comedones) as seen in acne. Rosacea may also cause raised red patches known as plaque.

Eye Irritation
In about half of rosacea patients, the eyes may be irritated and appear watery or bloodshot. In many cases, the eyes may feel as if a foreign object is present or feel "gritty." The eyelids may also become red and swollen, and styes are common. Symptoms are typically mild, but severe cases can result in vision loss without medical help.

Enlarged Nose
In severe cases, the nose may become swollen from excess tissue, and small knobby bumps may appear. Known as rhinophyma, this condition affects more men than women. In rare cases, skin thickening or excess tissue may develop in facial areas other than the nose. Please see the Faces of Rosacea page for photographs showing the signs and symptoms of rosacea.


How Is Rosacea Treated?
The signs and symptoms of rosacea vary substantially from one patient to another, and treatment must therefore be tailored by a physician for each individual case.

Various oral and topical medications may be prescribed to treat the bumps, pimples and redness often associated with the disorder. Dermatologists usually prescribe initial treatment with oral antibiotics and topical therapy to bring the condition under immediate control, followed by long-term use of the topical therapy alone to maintain remission.

When appropriate, treatments with lasers, intense pulsed light sources or other medical and surgical devices may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Ocular rosacea may be treated with oral antibiotics and other therapy.

In addition to medical treatment, rosacea sufferers can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors that trigger rosacea flare-ups or aggravate their individual conditions. The National Rosacea Society offers a free Patient Diary Checklist to assist patients in identifying factors that may affect their individual cases, as well as a booklet called "Coping with Rosacea" that provides tips on lifestyle management.

Treatment Options

Many people with rosacea are unfamiliar with it and do not recognize it in its early stages.

Identifying the disease is the first step to controlling it. Self-diagnosis and treatment are notrecommended, as some over-the-counter skin applications may make the problem worse.

Dermatologists often recommend a combination of treatments tailored to the individual patient. Together, these treatments can stop the progress of rosacea and sometimes reverse it.

Gels and creams may be prescribed by a dermatologist. A slight improvement can be seen in the first three to four weeks of use. Greater improvement is usually noticed in two months.

Oral antibiotics tend to produce faster results than topical medications.

Cortisone creams may reduce the redness of rosacea. However, they should be not used for longer than two weeks and strong preparations should be avoided. It is best to use these creams only under the direction of your dermatologist.

The persistent redness may be treated with a small electric needle or by laser surgery to close off the dilated blood vessels. Cosmetics may offer an alternative to the more specific treatment. Green tinted makeup may mask the redness.

It's important to eliminate factors that cause additional skin irritation. Daily facial products such as soap, moisturizers, and sunscreens should be free of alcohol or other irritating ingredients. Moisturizers used along with topical medications should be applied very gently after the medication has dried. When going outdoors, especially on warm sunny days, sunscreens with an SPF of 15 or higher are necessary.

Other Treatments

Rhinophyma is usually treated with surgery. The excess tissue that has developed can be carefully removed with a scalpel, laser or through electrosurgery. Dermabrasion, a surgical method that smoothes the top layer of the skin, will then help improve the look of the scar tissue.

The key to successful management of rosacea is early diagnosis and treatment. It is also important to follow all of your dermatologist's instructions. Rosacea can be treated and controlled if medical advice is sought in the early stages. When left untreated, rosacea will get worse and may be more difficult to treat.

 

 

 

 

 

 Frequently Asked Questions about Rosacea

Click on the questions below to read an answer.

General

  1. What causes rosacea?
  2. Is rosacea contagious?
  3. Is rosacea hereditary?
  4. Can rosacea be diagnosed before a flare-up?
  5. Is there any sort of test for rosacea?
  6. Will my rosacea get worse with age?
  7. How long does rosacea last?

Signs and Symptoms
  1. Does rosacea cause facial swelling, burning or itching?
  2. Are symptoms generally symmetrical or asymmetrical?
  3. I suffer from acne and rosacea -- is this common?
  4. Is dry, flaky skin typical with rosacea?
  5. Is oily skin common for rosacea sufferers?
  6. Is there a connection between rosacea and seborrheic dermatitis?
  7. Is there a connection between rosacea and eczema?
  8. Is there a connection between rosacea and lupus?
  9. Are rosacea sufferers more likely to get skin cancer?
  10. The redness is gone, but I've got more spider veins -- what's going on?

Trigger Factors
  1. What are the most common lifestyle and environmental factors that cause flare-ups?
  2. How effective is avoiding lifestyle and environmental factors?
  3. How long after a rosacea trigger will a flare-up occur?
  4. Is there a relationship between rosacea and allergies?

Treatment
  1. Can rosacea be cured?
  2. How is rosacea treated?
  3. Why are antibiotics prescribed for rosacea? Is it a bacterial infection?
  4. What medications are used for rosacea besides antibiotics?
  5. Are there any dangers to long-term use of topical therapy?
  6. Will topical medication lose effectiveness over time?
  7. Should I still use my medication between flare-ups?
  8. How should I care for my skin?
  9. How does laser therapy work?
  10. Is there research being conducted on rosacea?

General
  1. Q.  What causes rosacea?

    A.  The exact cause of rosacea is unknown, although several theories exist. One theory of rosacea's origin is that the disease may be a component of a more generalized disorder of the blood vessels, which could explain why rosacea sufferers have a tendency to flush. Another theory is that changes in normal skin bacteria or infection of the stomach by Helicobacter pylori may play a role. Other theories suggest that the condition is caused by microscopic skin mites (Demodex ), fungus, a malfunction of the connective tissue under the skin or even psychological factors. None of these possibilities has been proven.

  2. Q.  Is rosacea contagious?

    A.  No. Rosacea is not considered an infectious disease, and there is no evidence that it can be spread by contact with the skin or through inhaling airborne bacteria. The effectiveness of antibiotics against rosacea symptoms is widely believed to be due to their anti-inflammatory effect, rather than their ability to destroy bacteria.

  3. Q.  Is rosacea hereditary?

    A.  Although no scientific research has been performed on rosacea and heredity, there is evidence that suggests rosacea may be inherited. Nearly 40 percent of rosacea patients surveyed by the National Rosacea Society said they could name a relative who had similar symptoms.

    In addition, there are strong signs that ethnicity is a factor in one's potential to develop rosacea. In a separate survey by the Society, 33 percent of respondents reported having at least one parent of Irish heritage, and 27 percent had a parent of English descent. Other ethnic groups with elevated rates of rosacea, compared with the U.S. population as a whole, included individuals of Scandinavian, Scottish, Welsh or eastern European descent.

  4. Q.  Can rosacea be diagnosed before you have a major flare-up?

    A.  It is sometimes possible to identify "prerosacea" in teenagers and persons in their early 20s. These individuals generally come to the dermatologist for acne treatment and exhibit flushing and blushing episodes that last longer than normal. The prolonged redness usually appears over the cheeks, chin, nose or forehead. These patients also may find topical acne medications or certain skin-care products irritating.

    Once identified, these rosacea-prone individuals can be counseled to avoid aggravating lifestyle and environmental factors known to cause repeated flushing reactions that may lead to full-blown rosacea. If you recognize the symptoms of prerosacea in a younger family member or others, they might be advised to consult a dermatologist.

  5. Q.  Is there any kind of test that will tell you if you have rosacea?

    A.  There are no histological, serological or other diagnostic tests for rosacea. A diagnosis of rosacea must come from your physician after a thorough examination of your signs and symptoms and a medical history. During your exam you should explain any problems you are having with your face, such as redness; flushing; the appearance of bumps or pimples; swelling; burning, itching or stinging; or other information.

  6. Q.  Will my rosacea get worse with age?

    A.  There is no way to predict for certain how an individual's rosacea will progress, although physicians have observed that the signs and symptoms tend to become increasingly severe without treatment. Moreover, in a National Rosacea Society survey, about half of rosacea sufferers said without treatment their condition had advanced from early to middle stage within a year. Fortunately, compliance with medical therapy and lifestyle modifications to avoid rosacea triggers has been shown to effectively control its signs and symptoms on a long-term basis.

  7. Q.  How long does rosacea last?

    A.  Rosacea is a chronic disorder, rather than a short-term condition, and is often characterized by relapses and remissions. A retrospective study of 48 previously diagnosed rosacea patients found that 52 percent still had active rosacea, with an average ongoing duration of 13 years. The remaining 48 percent had cleared, and the average duration of their rosacea had been nine years. While at present there is no cure for rosacea, its symptoms can usually be controlled with medical therapy and lifestyle modifications. Moreover, studies have shown that rosacea patients who continue therapy for the long term are less likely to experience a recurrence of symptoms.
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Signs and Symptoms
  1. Q.  Does rosacea cause facial swelling, burning or itching?

    A.  Facial burning, stinging and itching are commonly reported by many rosacea patients. Certain rosacea sufferers may also experience some swelling (edema) in the face that may become noticeable as early as the initial stage of the disease. The same flushing that brings on rosacea's redness can be associated with a build-up of fluid in the tissues of the face. It often occurs above the nasolabial folds -- the creases from the nose to each side of the mouth -- and can cause a "baggy cheek" appearance. It is also believed that in some patients this swelling process may contribute to the development of excess tissue on the nose (rhinophyma), causing it to become bulbous and bumpy.

    If you experience any of these symptoms, discuss them with your physician.

  2. Q.  Are rosacea symptoms generally symmetrical or asymmetrical?

    A.  Rosacea can present itself in different ways for different individuals. Rosacea patients may exhibit varying levels of severity of symptoms over different areas of the face. Patients have often reported that the disorder actually began with a red spot or patch on one cheek or another part of the face, and then spread to other areas. On the other hand, many rosacea patients exhibit similar symptoms on both sides of their faces.

  3. Q.  I suffer from regular acne in addition to rosacea. Is this common?

    A.  Rosacea and regular acne, called acne vulgaris, usually appear separately, but some patients are affected by both. While both conditions in adults are often informally referred to as "adult acne," they are two separate diseases, each requiring different therapy. Acne vulgaris is associated with plugging of the ducts of the oil glands, resulting in blackheads and pimples on the face and sometimes also the back, shoulders or chest. Rosacea seems to be linked to the vascular network of the central facial skin and causes redness, bumps, pimples and other symptoms that rarely go beyond the face. Special care is necessary in treating patients with both conditions because some standard medications for acne vulgaris can make rosacea worse.

  4. Q.  Is dry, flaky skin typical with rosacea?

    A.  It has been estimated that approximately half of all rosacea sufferers may appear to experience dry skin. With treatment, this dryness often eases along with disappearance of papules and pustules. To combat dry, flaky skin, use a moisturizer daily after cleansing and applying medication. You also may wish to check with your dermatologist to see which medication is best for your skin type, since some have a drying effect and others are more moisturizing.

  5. Q.  Is oily skin common for rosacea sufferers?

    A.  There is no standard skin type for rosacea patients. Many sufferers experience dry, flaky skin, while others may have normal or oily skin, or both. The key is to identify your skin type and use medication and skin-care products that are suitable for you.
  6. Q.  Is there any connection between rosacea and seborrheic dermatitis?

    A.  It is not unusual for seborrheic dermatitis to appear concurrently with rosacea. Seborrhea manifests as reddish-yellow greasy scaling in the central third of the face. Scalp, eyebrows and beard may have fine flakes of white scale, dandruff or patches of thicker, greasy yellow scale. Eruptions may also appear beyond the face.

  7. Q.  Is there any connection between ordinary eczema and rosacea?

    A.  No, nothing in the medical literature links rosacea and atopic eczema. The two diseases may share some symptoms, but also have many differences. Rosacea is more common in fair-skinned individuals and nearly always affects the face only, causing such signs and symptoms as redness, visible blood vessels, bumps and pimples and sometimes swelling of the nose from excess tissue. Atopic eczema is more common in individuals with dry skin and can appear in various areas of the body, producing red scaling and crusted or weeping pustules that itch fiercely.

  8. Q.  Is there a connection between lupus and rosacea?

    A.  No. Discoid lupus is a chronic, scarring skin disease. Another form, systemic lupus, is characterized by a variety of signs, including some in the vascular system. Because lupus can cause a reddish skin rash that spreads across the bridge of the nose and face, often in a butterfly pattern, it can appear similar to rosacea. However, while both rashes can be smooth in texture, the presence of bumps and pimples, which rarely occur in a lupus flare, may help differentiate the diseases. In addition, lupus is almost always accompanied by other symptoms not associated with rosacea, such as fever, arthritis and signs of renal, lung or heart involvement. A dermatologist can usually quickly tell the difference between a butterfly rash of lupus and rosacea.

    Moreover, unlike lupus, as many as 50 percent of rosacea patients may also have ocular signs. Visually, an eye affected by rosacea often appears watery or bloodshot. Sufferers may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.

  9. Q.  Are rosacea sufferers more likely to get skin cancer later in life?

    A.  No medical evidence has linked rosacea directly with skin cancer. Rosacea sufferers may be more likely to develop skin cancer later in life because of their frequent light complexions and propensity to injury from ultra-violet radiation from the sun. It is important that you consult your dermatologist if you have any signs of possible skin cancer, such as a mole that is enlarged or asymmetric or that has an irregular border or varying color. Although unrelated to rosacea, skin cancer is a potentially fatal disease whose incidence has been on the rise.

  10. Q.  I've been using medication for some time now and it has cleared my pimples and reduced my redness, but it also seems to have made me develop more spider veins. What's going on?

    A.  Visible blood vessels (telangiectasia) sometimes develop with rosacea and were likely always there, but were hidden or less noticeable because of your redness. Once medication has diminished the redness, it is not uncommon for spider veins to become more noticeable. These can be camouflaged with makeup, or removed with a vascular laser, intense pulsed light source or other medical device.
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Trigger Factors
  1. Q.  What are the most common lifestyle and environmental factors that aggravate rosacea or trigger flare-ups?

    A.  According to a National Rosacea Society survey, some of the most common rosacea tripwires include sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, heavy exercise, hot baths, heated beverages and certain skin-care products.

  2. Q.  How effective is avoiding lifestyle and environmental factors?

    A.  In a survey of 1,221 rosacea sufferers by the National Rosacea Society, 96 percent of those who believed they had identified personal trigger factors said avoiding those factors had reduced their flare-ups.

  3. Q.  How long after a rosacea trigger will a rosacea flare-up occur?

    A.  Although there are no data available on how quickly a rosacea trigger may lead to a flare-up, the time is likely to vary depending on the individual and the nature of the tripwire. Try monitoring your individual case to see how quickly your rosacea has responded. And remember, while a wide range of factors has been identified as potential triggers, not every tripwire affects every individual everytime.

  4. Q.  Is there any relationship between rosacea and allergies?

    A.  Allergies may cause an altered reaction of the body that includes flushing, which frequently triggers rosacea symptoms. As with more common rosacea tripwires, identifying and avoiding allergens -- the substances you are reacting to -- may also help control your rosacea.
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Treatment
  1. Q.  Can rosacea be cured?

    A.  While rosacea cannot be cured, medical treatments are available that can control or eliminate its various signs and symptoms.

  2. Q.  How is rosacea treated?

    A.  The signs and symptoms of rosacea vary substantially from one patient to another, and treatment must therefore be tailored by a physician for each individual case. In general, various oral and topical antibiotics, as well as other medications, are commonly prescribed to treat the bumps, pimples and redness often associated with the disorder. When appropriate, laser treatment or other surgical procedures may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Ocular rosacea is commonly treated with oral antibiotics and ophthalmic therapy.

    Rosacea patients are also advised to identify and avoid lifestyle and environmental factors that may aggravate their individual conditions.

  3. Q.  Why are antibiotics prescribed for rosacea? Is it a bacterial infection?

    A.  It is unknown exactly why antibiotics work against rosacea, but it is widely believed that it is due to their anti-inflammatory properties, rather than their bacteria-fighting capabilities. Normal skin surface bacteria are affected by antibiotics and their role is being investigated.

  4. Q.  What medications are used for rosacea besides antibiotics?

    A.  Physicians may use a variety of medications to help control rosacea in individual patients. Products containing a sulfur drug or azelaic acid may be prescribed as an alternative or adjunct to antibiotic therapy, and a cardiovascular medication is sometimes used to control severe flushing. Other medications may also be considered, especially in cases that do not respond to initial therapy.

  5. Q.  Are there any dangers to long-term use of topical therapy?

    A.  Because of the higher risk of adverse reactions associated with long-term use of oral antibiotics, topical therapy is usually preferred long-term. Topical treatments usually minimize side effects because the amount of medication absorbed into the bloodstream is either absent or minuscule. If you have concerns about long-term use of your topical treatment, discuss them with your dermatologist.

  6. Q.  If I take long-term medication consistently, will it lose its effectiveness?

    A.  Topical therapy usually controls rosacea on a long-term basis, without loss of effectiveness.

  7. Q.  Should I still use my medication between flare-ups?

    A.  Rosacea is characterized by flare-ups and remissions, and a study found that long-term medical therapy significantly increased the rate of remission in rosacea patients. In a six-month multicenter clinical study, 42 percent of those not using medication had relapsed, compared to 23 percent of those who continued to apply a topical antibiotic. In general, treatment between flare-ups can prevent them.

  8. Q.  How should I care for my skin?

    A.  A rosacea facial care routine recommended by many dermatologists starts with a gentle and refreshing cleansing of the face each morning. Sufferers should use a mild soap or cleanser that is not grainy or abrasive, and spread it with their fingertips. A soft pad or washcloth can also be used, but avoid rough washcloths, loofahs, brushes or sponges.

    Next, rinse the face with lukewarm water several times and blot it dry with a thick cotton towel. Never pull, tug, scratch or treat the face harshly. Sufferers should let their face air dry for several minutes before applying a topical medication. Let the medication soak in for an additional five or 10 minutes before using any makeup or other skin care products.

  9. Q.  How does laser therapy work?

    A.  To remove visible blood vessels or reduce extensive redness, vascular lasers emit wavelengths of light that target tiny blood vessels just under the skin. Heat from the laser's energy builds in the vessels, causing them to disintegrate. Generally, at least three treatments are required, depending on the severity of redness or visible blood vessels.

    Vascular lasers may also be used to help retard the buildup of excess tissue, and in severe cases a CO2 laser may be used to remove unwanted tissue and reshape the nose. New laser technology has been developed to minimize bruising, and recently developed devices called intense pulsed light sources mimic lasers but generate multiple wavelengths to treat a broader spectrum of tissue. As with any surgical technique, the safety and effectiveness of laser therapy may depend on the skill of the physician.

  10. Q.  Is there research being conducted on rosacea?

    A.  The National Rosacea Society has instituted a research grants program to encourage and support scientific investigation into the potential causes and other key aspects of rosacea that may lead to improvement in its treatment, as well as its potential prevention or cure. Information on this program can be found under Research Grants.
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