David Pascoe vision EDU Rosacea Frequ

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From: David Pascoe <pascoedj+usenet@spamcop.net>
Newsgroups: alt.skincare.acne,alt.support.skin-diseases,alt.skincare,sci.med,sci.answers,alt.answers,news.answers,sci.med.vision
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Subject: Rosacea Frequently Asked Questions v1.16
Date: Mon, 31 May 2004 20:52:23 +0800
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Archive-name: medicine/rosacea
Last-modified: 2004/05/31
Version: 1.16
URL: http://rosacea.ii.net/faq.html
Maintainer: David Pascoe <pascoedj@spamcop.net>

CVS Version: $Id: faq.txt,v 1.16 2004/05/31 12:47:40 user Exp $

Disclaimer: the following information is a guide only. Self diagnosis is a
Questions is a simple guide to rosacea, and a pointer to more information.
This text should not be used in the place of professional advice from

Rosacea (said rose-ay-shah) is a potentially progressive neurovascular

The most common symptoms include facial redness and inflammation across
the flushing zone - usually the nose, cheeks, chin and forehead ; visibly
nflammatory papules and pustules.

Rosacea can develop gradually as mild episodes of facial blushing or
flushing which, over time, may lead to a permanently red face.

Ocular rosacea can affect both the eye surface and eyelid. Symptoms can
nclude redness, dry eyes, foreign body sensations, sensitivity of
the eye surface, burning sensations and eyelid symptoms such as chalazia,

A panel of experts have agreed on a standard classification system for
Rosacea. This system is a brief text that is not intended to be
exhaustive, but is a place to start.

Their classification system was published in the Journal of American
Academy of Dermatology (United States), Apr 2002, 46(4) p584-7)

"Rosacea is a chronic cutaneous disorder, primarily of the central face.
various combinations of such cutaneous signs as flush, erythema,
telangiectasias, edema, papules, pustules, ocular lesions, and rhinophyma.
erythema, papules, pustules, and telangiectasias. A variety of secondary
features are listed that may be absent or present as a single finding or
n any combination."


The panel of Rosacea experts agreed on the following broad, non exclusive
text (i.e. there are other factors and types that come into play).

"The system divides rosacea into four subtypes: erythematotelangiectatic,
erythematotelangiectatic disease and phymatous rosacea as following or
occurring together with either erythematotelangiectatic or papulopustular
consistent with common concepts about rosacea natural history, they are

"In its current iteration, the classification system excludes rosacea
fulminans, steroid-induced acneiform eruptions, and perioral dermatitis


As rosacea is a neurovascular disorder it affects the flushing zone.

acne vulgaris.

Some rosacea sufferers have a significant acne component in their symptoms
of rosacea tend to be less follicular in origin.

Rosacea will probably have an underlying redness that is related to
flushing and thus looks different to acne vulgaris. Acne sufferers
normally do not have the accompanying redness.

Rosacea usually begins with flushing, leading to persistent redness.

As both conditions are inflammatory, the treatment for rosacea and acne
vulgaris can be somewhat similar, but some of the acne vulgaris regimes
are too harsh for rosacea affected skin and can severely aggravate the

Rosacea sufferers are cautioned against using common acne treatments such
as alpha hydroxy acids (glycolic and lactic acids), topical retinoids
(such as tretinoin, Retin-A Micro, Avita, Differin), benzoyl peroxide,
topical azelaic acid, triclosan, acne peels, chemical peels. Additionally
the caution extends to topical exfoliants, toners, astringents and alcohol
containing products.


Seborrheic Dermatitis and Rosacea are closely related, they both involve
nflammation of the oil glands. Rosacea also involves a vascular component
causing flushing and broken blood vessels. 

Seborrheic Dermatitis may involve the presence of somewhat greasy flaking
nvolving the T zone, crusts, scales, itching and occasionally burning,
and may also be found on the scalp, ears and torso.  It does not usually
nvolve red bumps as in Rosacea.

The T zone is the area shaped like a `T' composed of your forehead, nose
and around your mouth.

Just to confuse things further, the two conditions are often seen


From "Beating Rosacea, Vascular, Ocular and Acne Forms", by Geoffrey Nase

"Rosacea is primarily a disorder of the facial blood vessels. Experts from
across the world agree that vascular abnormalities are central to all

To paraphrase: Rosacea blood vessels undergo changes in function and
become hyper-responsive to internal and external stimuli. These changes
are ultimately responsible for the progression of all rosacea symptoms.

As with many conditions, there appears to be a genetic propensity to


"Rosacea normally progresses in the same generalised fashion, frequent
and structural damage."

Rosacea experts talk about rosacea symptoms appearing in 4 stages. Over
time rosacea can progress from one stage to the next.

From Dr. J Wilkin:

"Most textbooks and literature citations characterize rosacea as a disease
that gradually evolves from early to later subtypes. However, there is not
conclusive evidence to substantiate that course and we want to know if it


Dr. Nase talks about 4 stages, called Pre-Rosacea, Mild Rosacea, Moderate
Rosacea and Severe Rosacea.

more stimuli, open wider and stay open for longer periods of time compared
to normal persons. No visible damage can normally be seen.

Mild Rosacea: begins when the facial redness induced by flushing persists
for an abnormal length of time - usually 1/2 an hour or more after a
trigger. Those who have frequent pre-rosacea flushing are highly

Some of the common triggers for a facial flush are heat, cold, emotions,
exercise, topical irritants and allergic reactions.

Moderate Rosacea: as facial flushing becomes more frequent and intense,
vascular damage occurs. This can result in long lasting redness, swelling
and inflammatory papules and pustules. Telangiectasia (damaged micro blood
vessels, often visible on the surface of the skin) may be noticed in the
areas where flushing is worst. 

Severe Rosacea: characterised by intense bouts of facial flushing, severe
nflammation, facial pain, swelling and burning sensations.  Sufferers may
nflammatory papules, pustules and nodules may be present. Some experience
a bulbous enlargement of the nose, known as rhinophyma.

This is just a guide, you may of course experience symptoms outside these


The best answer is "working with the support of your registered health
and reduce the number of papules and pustules associated with rosacea.

Current run-of-the-mill treatment might include oral antibiotics and
topical metronidazole. One study showed that the use of topical
metronidazole alone can help some sufferers to reduce rosacea flare-ups
once the rosacea is brought under control.

For those sufferers that do not benefit from the metronidazole based
treatments, there are many other options.  Quite a few treatments options
are often discussed on the rosacea-support email group. Some of their

Experts agree that a gentle cleansing regime is very important. Avoiding
chemicals that aggravate the rosacea, but will clean and moisturise the

As the sun is a strong trigger for many rosacea sufferers, a good
non-irritating sunscreen used daily is very important. For those who react
badly to chemical sunscreens, a physical sunscreen may be more suitable.
ngredients (rather than the ability of some chemicals to absorb the sun's
energy). The most common physical sunscreens are based on zinc oxide or
titatinium dioxide.

The vitamin A derivative isotretinoin (known as Accutane or Roaccutane),
to treat resistant rosacea. At low doses, accutane has also been shown to
be used under strict supervision of your doctor.

Low does accutance may be more suitable than the regular dose, as there
are less side effects and lesser chance of aggravating redness.

The mixed light pulse laser - Photoderm is showing promise as a treatment
for the vascular component of rosacea. It works by targeting facial
microvessels that are damaged.

One treatment that has been shown to help some is Rosacea-LTD III. It is
the third generation of topical mineral salt based treatment. The minerals
nformation is available at http://www.rosacea-ltd.com

For those wanting to treat the flushing side of their rosacea, 2 drugs are
that you could look at with your doctor.

From a subjective view of the rosacea-support list members it would appear
that one person's treatment does not necessarily suit another, so your
mileage may vary with any recommended treatment. Experiment a little and
find what helps you. Depending on the stage of your rosacea, some
treatments may be aggravating, while for others the same treatment may not
cause problems. Every rosacea patient is unique and needs individual

Whatever path you choose, the support of a doctor or dermatologist that is
are happy with your health professional. 

Dr. Nase's book will serve as a valuable resource - it contains detailed
and proven current rosacea treatment information.


Steroids have long been prescribed for rosacea because of their perceived
quick relief. Milder (1% hydrocortisone) over the counter preparations are
also popular as they are thought to be safer than the prescription

Sufferers should be aware of the following warnings:

"Topical steroids can worsen all rosacea symptoms by dilating facial blood
vessels, thinning the protective skin barrier, and thinning the dermis by
breaking down the collagen and elastin support structures".  

"Medical experts stress that rosacea sufferers should not use topical

These quotes are from Dr. Nase's book. They are backed up by several pages
of studies and comments. Topical steroids can induce rosacea and worsen


your symptoms to a manageable level. There are plenty of treatment options
out there, you may just need to experiment with a few.

cured, check out Geoffrey Nase's before and after photographs at


There are some pages that are worth visiting. You can find a list of
Directory at 
There you will find sections on companies offering treatment products,


Yes, see http://rosacea.ii.net/ml.html or

Many interesting and useful discussions have taken place on the mailing
list since it was created in October 1998. There are 2 Doctors on the list
can see the list highlights categorised by treatment, symptoms and more at

There is a Rosacea forum for those who use AOL as their internet company.
The address is aol://5863:126/mB:144806

Another place to try is http://www.esfbchannel.com/forum/ , the
Blushing/Flushing and Sweating forum. This forum deals more with issues of


Not exclusively for Rosacea. Perhaps the best 2 to try are
alt.skincare.acne and alt.support.skin-diseases. You can read and post to
these forums using the Google Groups facility at http://groups.google.com

You could also try your local feed of these newsgroups if your browser is
configured: news:alt.support.skin-diseases news:alt.skincare.acne


There are very few books about Rosacea. In the last year of so there has
been a couple of `self help' books written about rosacea. You can find a

A recently published book by Dr. Geoffrey Nase is destined (we believe) to
become a seminal text on Rosacea. You can read a detailed discussion of
the contents of the book at http://www.drnase.com The book is titled
"Beating Rosacea, Vascular, Ocular and Acne Forms". It is only available
from his web site.


Yes, you may find a more up to date listing if you check

You can find the official html'ised archived version of this FAQ at

Also, you can get this FAQ via email. The address of the faq server is

First, get the directory listing with the `index' command, and then fetch
the latest version of the FAQ with the `send' command. You should include
the commands in the _body_ of the message, the subject will be ignored.
All messages to the mail server should be on one line only, if your email
find retrieving the FAQ difficult.

For example, to get version 1.12 of the FAQ you would send the following
texts in the body of 2 emails (first one to get directory and second, once
you know the filename you want).

ndex usenet-by-group/alt.support.skin-diseases



You may want to check out The National Rosacea Society and the

The National Rosacea Society is a non profit organisation set up to
as conduct surveys about rosacea sufferers. Also they make published
nformation available to sufferers via regular mail. The National Rosacea
Society are an introductory organisation that are a good first point of
contact for information. The depth and breadth of information that they
make available is something that we hope that they will be able to devote

There is an email support group that you can subscribe to. This email
about 10-40 messages per day. Digest versions are available. To find out
more information about the list, visit http://rosacea.ii.net/ml.html or go

An alternative list archive on the web is also located at 
more traditional feel to it, you may prefer to read from this archive.

Rosacea Reading Glossary

As you read more about Rosacea, you might come across lots of terms that
are new to you. Below is a short list of some of the terms you might come

accutane: a powerful vitman A derivate that was originally prescribed for
known as roaccutane. 
for more info http://www.rocheusa.com/products/accutane/

blepharitis: inflamation and crusting of the eyelid.

cutaneous: pertaining to the skin.

mites that lives in the skin. Some have suggested that this is the cause
of rosacea, but most experts discount this theory. According to Dr Nase,
"This theory has now been disproved. Rosacea experts all agree that this
mite plays no real role in the development or progression of rosacea
(except for the odd pustule).", pg. 110 in Beating Rosacea.

chalazion: a lump on the eyelid that is caused by a clogged duct of one or
more of the meibomian glands on the eyelid.

conjunctivitis: inflammation of the conjunctiva (the thin transparent
lining in the front of the eyeballs and eyelids).

or quality of tears.

edema: presence of abnormally large amounts of fluid in the intercellular
tissue spaces of the body, especially wrt subcutaneous tissues.

epifacial: another term referring to a full face treatment using

epilight: a treatment very similar to photoderm, originally intended for
nformation see http://www.skinandhealth.com

erythema: inflammatory redness of the skin.

erythematotelangiectatic: having symptoms of both erythema and

ESB: Endoscopic Sympathetic Block, clamps used to block the transmission
of the neural impulses in the sympathetic chain. Is considered a

ETS: Endoscopic Transthoracic Sympathectomy (or endoscopic transthoracic
nerves that supply the hands, neck and face. Main indications for ETS are
blushing and hyperhidrosis. One place for more information:

fotofacial: a treatment regime using photoderm pioneered by Dr. Patrick
Bitter Jnr., for more information, see http://www.fotofacial.com

Helicobacter pylori: bacteria that live in the cell lining of the stomach.
According to Dr. Nase, "Most rosacea specialists now conclude that H.

ncrease in size of its constituent cells.

family of machines made by ESC. For more information, see

sotretinoin: the a vitamin-A derivative that is the active ingredient in
accutane (also known as roaccutane).

keratitis: infection or inflammation of the cornea of the eye.

ketoconozole: the active antifungal ingredient in nizoral, helpful for

lupus: an auto-immune disease that causes inflammation in various parts of
the body such as the skin, joints and kidneys. Skin flushing is an
mportant symptom of lupus.

metrogel: a 0.75% metranidazole treatment. For more information

metronidazole: a topical treatment for rosacea. Has been found by some to
effective against rosacea. Has a yet to be understood anti-inflammatory
action.  Is the active ingredient in metrogel, metrocream, metrolotion,

meibomitis: inflammation of the oil producing meibomian glands of the

Multilight: a member of the Intense Pulsed Light family, along with the
Can also be used for hair removal.

noritate: a 1% metronidazole treatment. for more info

ocular: of the eye.

are usually small red bumps or even pus bumps and mild peeling.

flushing associated with rosacea. a new treatment for rosacea that
s producing some exciting results. For more information see

Bitter Snr., for more information, see http://www.photofacial.com

treatments. photorejuvenation treatments are aimed at stimulating
collagen formulation.

Quantam SR: a member of the Intense Pulsed Light family, along with the

known as accutane. for more info 

more info http://www.medsafe.govt.nz/consumers/cmi/r/rozexgel.htm

tchy flaking skin.

telangiectasias: damaged micro blood vessels, often visible on the surface
of the skin.

tetracycline: an antibiotic often prescribed for rosacea. 

V-beam: the fifth generation (hence roman 5=V) of the pulse dye laser. for
more information, see http://www.vbeamlaser.com

vascular: of the blood vessels.

vasculight: a IPL+laser machine that can be used to give mixed wavelength
and fixed wavelength treatments. Can target large and deep blood vessels.
For more information see http://www.skinandhealth.com

versapulse: a type of laser, for more information, see

" vim:tw=74:et

David Pascoe, pascoedj+usenet@spamcop.net, Western Australia