Rosacea – Glow Magazine Winter 2004/2005
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Feeling flushed and frustrated? Canada’s top skin experts offer their advice for relieving your rosy cheeks.

By Sydney Loney

No, I haven’t been on vacation. I haven’t been skiing or lying on a beach – and I have not been drinking. My face is just red. It’s red when I step out of the shower, have a hot cup of tea or some spicy Thai food. It’s red when I exercise, when I’m excited or stressed, when it’s hot, cold or windy. My face is just red. And so are the faces of the two million other Canadians who have rosacea.

I’ve always been a blusher, but at first it didn’t bother me. I never needed to resort to rouge and thought my persistently pink cheeks looked rather healthy, in an outdoorsy kind of way. But then the red began to spread. By age 22, my skin constantly looked irritated, and somewhat sunburnt. It was blotchy and bumpy and anything I put on it, from cleanser to sunscreen, only made matters worse. The first doctor I went to treated me for acne, the second, for eczema. Finally, when I was 24, a dermatologist diagnosed me with rosacea. I was told rosacea is a common, chronic and progressive skin disorder for which there is no cure.

“It seems to be fundamentally a vascular problem,” says Dr. Richard Thomas, a Vancouver-based dermatologist. “Essentially, if you never blush, you probably don’t have rosacea. Quite often people with the disorder can remember blushing since childhood.” While it’s an extremely frustrating condition, it can also be quite serious. About 58 percent of sufferers develop ocular rosacea and may have dry, itchy, watery eyes or swollen eyelids.

If left untreated, rosacea can cause permanent disfigurement to your face, impair your vision and, in rare cases, even lead to blindness. Fortunately, it is a condition that can be effectively treated and controlled. Rosacea can affect anyone between the ages of 20 and 70, although it tends to be more common in women and those with fair skin. “There are still a lot of unknowns with rosacea,” says Dr. Paul Cohen, a dermatologist in Toronto. “We don’t really know what causes it, other than it’s often genetic and tends to occur in certain skin types. The first thing you need to do is confirm the diagnosis – just because you flush easily doesn’t mean you have rosacea.” Other conditions, such as acne, lupus and dermatitis, have similar symptoms.

Generally, you should see a dermatologist if:

  • you find yourself flushing in response to common rosacea triggers, such as hot beverages or extreme temperatures, and your cheeks, nose or chin regularly appear red. · your face is easily irritated by skincare products and often feels itchy or hot.
  • you develop pimples in the form of small, red, solid bumps (the “acne” associated with rosacea seldom appears as blackheads or whiteheads).
  • your eyes feel gritty and often appear bloodshot.
  • you notice tiny blood vessels (telangiectasia) appearing on the surface of your skin.

As the condition progresses, your skin may become permanently red. Eventually you can develop rhinophyma (a problem more common in men) in which fleshy bumps form on the nose, giving it a bulbous appearance.

“Most people in the early stages of rosacea are simply at the level other people apply blush to get to,” says Dr. Anne Curtis, head of the Dermatology Laser Centre at Sunnybrook and Women’s College Health Sciences Centre in Toronto. “The problem is, as the years go by the pinkness deepens. The blood vessels that have been asked to open over and over again each time you flush start to stay open and enlar ge to the point where you can see them on your face.” Curtis says this is usually when people seek medical attention.

Talking Treatment: The sooner you seek help for rosacea, the better your chances of slowing its progression. “Historically, when dermatologists treated rosacea it was just ‘avoid the things that make it worse, ‘” says Dr. Lisa Kellett, a laser surgeon and cosmetic dermatologist in Toronto. “I always laugh at that because they’re things like wind, cold, heat and exercise – so what are you supposed to do all day?” While she says it’s important to identify your individual triggers, there are now better solutions than hiding out at home. Kellett says there are primarily three treatments for rosacea sufferers: topical, oral and laser. Tried individually or in combination, they can help relieve some symptoms and possibly prevent the disorder from getting worse.

Topical: When I was first diagnosed with rosacea, I was prescribed a topical antibiotic and told to apply it to my face twice daily, something I did religiously for about seven years. There are basically three to choose from: metronidazole, sodium sulfacetamide and azelaic acid, all of which do essentially the same thing. “Topical treatments are pretty effective if you have mild to moderate acne associated with your rosacea,” says Winnipeg-based dermatologist Dr. ‘Victoria Taraska. “That component we’re very good at treating and controlling. Where we’re not as effective is with the redness and flushing – that’s the most difficult part to manage.” I personally didn’t notice much change to my skin with the topical treatment and recently stopped using it, something Curtis doesn’t recommend. “Although some people don’t notice a striking improvement, we tend to encourage them to keep on it anyway,” she says. “We hope that we’re at least slowing the p rogression, even if we haven’t made a huge impact on reversing things.”

Oral: Oral antibiotics, such as tetracycline, are another treatment option, and one I have yet to try. They are usually effective at relieving more severe acne symptoms associated with rosacea. Some also have anti-inflammatory properties that may relieve redness. “If a patient has severe redness, I might put them on oral antibiotics for two to three months to see if their skin responds,” says Curtis. Sometimes you can maintain any improvement you experience from the oral an tibiotics with topical treatments, she adds. Oral antibiotics are also used to treat ocular rosacea.

Lasers & light: About four years ago, I was horrified by the appearance of small, bright red blood vessels on my cheeks and chin. Although friends and family said they didn’t notice them, I wanted them gone. That was when I went for my first laser treatment, which worked for a while. “With laser treatments, you’re turning back the clock, but never stopping it,” says Curtis. If you decide to try lasers, you may have to repeat the treatment every few years. I recently decided it was time for another round and was surprised at how much had changed since my last laser experience. “The nice thing about lasers now is they don’t have to bruise,” Kellett told me during our initial consultation. “You may be red afterwards and it may last for a couple of days, but I treat newscasters in the morning, then see them on the evening news.”

She explained there are a number of options for rosacea suffers, including Intense Pulse Light (IPL) and Pulsed Dye Lasers (PDL). “For someone like you I’d use the V-beam (a PDL) to combat the redness,” Kellett told me. An IPL uses a band of light and can target different colours, such as the red in blood vessels, or the brown in freckles. A PDL is a single wavelength that can be adjusted for different durations to get rid of background redness or to target individual blood vessels.

When I first had a PDL treatment a few years ago, I was left with small, raised purple bruises scattered across my face, which disappeared in a few days. This time, I went to work immediately afterwards with what looked like a mild sunburn. The treatment itself took only a couple of minutes. I simply strapped a pair of goggles over my eyes while Kellett explained the procedure. “The laser will spray you first with a cryogen spray that cools the surface of your skin. It still allows the beam to hit the blood vessels underneath and heat them up enough to close them off,” she said. “There is no bruising and damage as the superficial layer of the skin remains intact. It feels snappy, and it’s bright, but it’s not that bad.” To me, the procedure felt like a series of tiny pinpricks from a really cold needle. Because laser treatments are gentler than in the past, it can take anywhere from one to five sessions once a month for complete results.

Costs range from $300 to $700 a session, depending on what you’re having done. Risks are few, but in rare situations there can be scarring or pigment changes. “You just want to make sure you go to someone highly qualified who does it all the time,” says Kellett. She adds that there may be other benefits to laser treatment – you may notice your pores appear smaller afterwards or, in some cases, the appearance of fine lines may be reduced. “With repeated treatment you’re actually getting some stimulation of collagen in the deeper layers,” explains Curtis. “So you’re getting a side benefit of rejuvenation at the same time, although it’s very subtle.”

From day to day: Regardless of what stage your rosacea is at and whether or not you’re being treated for it, what you do to your skin on a daily basis can make a big difference in both its appearance and the rate at which the condition progresses. “Rosacea is a chronic problem that will wax and wane,” Cohen says. “It’s important to be educated about potential triggers and adopt habits that will help prevent your rosacea from flaring.” This may mean revising your skincare regimen. “Basically, it’s about avoiding a lot of things, such as strong exfoliants,” says Kellett. “Look for products that are made for sensitive skin – although even then it doesn’t mean you aren’t going to get red. A lot of my patients turn red just from washing their faces with water.” She recommends doing a patch test with products before spending money on them. Get a sample and apply it to your arm three times a day for three days. If nothing happens, repeat the test, but on your jawline. If you’re still okay, buy the product.

Fortunately, there are many ingredients that can be calming to rosacea-prone skin. “Keep things simple and use products with anti-redness and anti-inflammatory properties,” says Leanne McCliskie, education manager for the International Dermal Institute’s education centre for skin therapists in Toronto. Some of the ingredients she recommends include aloe vera, chamomile, lavender, red raspberry, Canadian willowherb and avena sativa (oats). “Antioxidants, such as vitamin C, are also good because they fight free radicals and can protect your skin from further damage,” she says. As for daily care, McCliskie says there are three important steps to follow: cleanse, moisturize and apply sunscreen. “Start with a gentle cleanser that is pH balanced so it won’t strip your skin of natural oils. Then apply a moisturizer to restore and protect your skin’s barrier function, followed by sunscreen – rosacea can be aggravated by the slightest sun exposure.”

Off to the Spa: For many women, fitting in a regular facial is an important part of their skincare routine. Although I’ve noticed a growing trend in “rosacea facials,” I’ve been reluctant to give them a try. Many years ago I had an unfortunate experience that left me looking as though I’d had a close encounter with a swarm of bees. My dermatologist at the time told me to forgo facials, and I hadn’t had one since. But McCliskie says rosacea sufferers shouldn’t be denied the benefits of facial treatments, which can help protect the health and integrity of skin. “People tend to think of them as a luxury, but they’re a necessity,” she says.

She recommends having a treatment about every six to eight weeks. “Skin cell turnover is about one a month, so that’s when it is important to have a deep cleanse.” Just ensure the person performing the treatment has the training required to recognize and respect your condition. McCliskie says there should be a detailed consultation prior to the treatment, as well as a follow-up afterwards. “It shouldn’t be just ‘Lie there and relax.’ It should be about passing knowledge on to the client.”

When I had a treatment with McCliskie, she did a through assessment of my skin beforehand and told me that a pressure point massage would be good as it wouldn’t over-manipulate my skin or increase blood flow like a regular massage. She also didn’t use hot steam, hot cloths or heavy creams and used a microfoliant, which is gentler than an exfoliant. Your face shouldn’t hurt or be red at the end of a treatment, McCliskie says. And, to my delight, it wasn’t.

Red relief: Now that I’ve resumed laser treatment and learned more about the other options available to me, I’m hoping that by next year’s holiday festivities I won’t be preparing for parties while worrying about what shade my skin might adopt for the evening. Maybe for the first time I won’t be so flushed that others end up asking me if I’m feeling all right, or if I’ve had too much to drink. In fact, maybe next year I’ll even have to apply a little rouge.

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