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Rosacea for the Esthetician: A Comprehensive Guide, Part I

By: Cynthia Bailey, MD
Posted: July 1, 2013, from the July 2013 issue of Skin Inc. magazine.

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2. Demodex mites have been implicated in some studies. However, the role of demodex mites remains controversial. A recent study suggests that a protein on a bacteria on the mites might be important, but it’s a to-be-continued story because:

  • Pores with demodex mites are more likely to be inflamed; however, 100% of elderly people have demodex in their pores and not all have rosacea;
  • The presence of demodex mites is most closely associated with inflammatory papulopustular rosacea; and
  • Killing the demodex mites with medicine does not necessarily cure rosacea.

3. Intestinal bacteria, such as Helicobacter pylori, have been implicated as well, but there is evidence both for and against this hypothesis. It may turn out that it’s more important for some people than others.

Identifying rosacea

Classic rosacea is easy to identify, but subtle rosacea can be tricky. The three most common conditions that may mimic rosacea include:

  1. Non-rosacea forms of acne;
  2. Skin rashes of allergic and irritant dermatitis; and
  3. Facial dandruff (seborrheic dermatitis).

Tips to tell acne from rosacea.

  • Look for blackheads, not just engorged and clogged pores—blackheads are more common in acne.
  • How old is your client? Acne is more common in adolescents and young adults.
  • Female hormonal acne happens in adulthood, but it usually manifests as big, painful cysts along the jaw, which is not a common site for rosacea.

Tips to tell rosacea from the red and scaly rashes of dermatitis and dandruff.

  • Is the condition caused by a potential product allergy or irritation? Check and see if the irritation is located only where a product is being applied.
  • There is often an itching with allergic reactions. Poison oak or ivy is a classic example of allergic dermatitis. Many ingredients in skin care products can be allergens, too.
  • There is often a dry, chapped appearance with stinging in irritant reactions. Classic examples are alpha hydroxy acid (AHA) or acne products that are too strong for a client.
  • Dandruff usually involves the eyebrows, hairline, ears and along the sides of the nose more than the convex surfaces of the face. (See Facial Distribution of Seborrheic Dermatitis.)
  • Dandruff often occurs with rosacea, and the good news is that the treatments overlap.

Part II

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