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Recognizing Rosacea

By: Christian Jurist, MD
Posted: August 29, 2011, from the September 2011 issue of Skin Inc. magazine.

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Also, pertaining to this disease and the role of microorganisms, greater numbers of D. folliculorum mites—part of the skin’s normal flora—are found in some rosacea clients who exhibit papulopustular eruptions. One theory proposes that changes in connective and vascular tissue provide a favorable environment for the mites to multiply. Potentially, the mites can cause an immunologic reaction that triggers an inflammatory response. This contributes to the aggravation of the symptoms.

Furthermore, it has been suggested that H. pylori,an ulcer-related agent, synthesizes gastrin in the stomach, which has been linked to promoting flushing. The participation of microorganisms in the development of this disorder continues to remain unclear at this time, as study results are inconclusive and inconsistent. Further research is necessary.

Evolution of the disease

The evolution of rosacea affecting the skin usually progresses from a mild stage, including redness and increased skin sensitivity, to a later stage, including papulopustular eruptions, commonly known as acne rosacea. As the condition evolves, it may present complications such as rhinophyma, a nose enlargement mostly affecting men, and rosacea fulminans, featuring pyoderma faciale abscesses and nodules. Fortunately, fulminans is a rare complication. Advanced and chronic schemes of the disease may additionally present sebaceous hyperplasias, fibrosis and lymphedema, or swelling. Ocular rosacea may be accompanied by inflammation inside the eyes, lids and surrounding area. In some cases, recurrent conjunctivitis and periorbital lymphedema are reasons why people consult their physicians.

The causative reasons for acne and acne rosacea are different. Acne originates primarily within the hair follicles and does not involve microcirculation; a very inflamed acne, though, can resemble rosacea, which results in the confusion. Acne rosacea, identified by inflamed and raised lesions over an erythematous area, develops as papules and pustules that may foster parasitic microorganisms. Unlike common acne breakouts, the problem is not from bacteria, retention hyperkeratosis (dead cell retention) and excess sebum, but from a combination of parasitic activity and tissue inflammation. Clients may or may not report oiliness of the skin; sometimes they may actually experience drying and peeling. For skin care professionals, the most interesting and easily recognizable features of acne rosacea versus acne are the absence of comedones and minimal scarring in the former, plus a logical correlation with the history of the condition, which can be identified during consultation.

Last but not least, there is also neck rosacea, which appears as a dilation of capillaries with diffused v-shaped reddish-brown discoloration on the sides of the neck, and a gooseflesh appearance of the skin. This occurs due to repeated exposure to sunlight or sunburn on rosacea-prone skin, causing partial atrophy of the epidermis and dermis, but sparing the tissue surrounding the hair follicles, therefore creating a bumpy look and feel.

Treating rosacea