What Allison Taylor hates most about rosacea, the skin problem that turns faces red and makes people look like they’ve had a few too many, is the chronic embarrassment.
“I wear a lot of makeup because I’m so self-conscious,” says Taylor, 35, who manages a medical practice in Boston. “I always look sunburned. People ask me if I don’t feel well.”
For others, like a 44-year old Cape Cod psychologist who asked that her name not be used, it’s the complications of rosacea, like eye irritation, that are unattractive and make wearing contact lenses impossible. “It’s not like I won’t go out of my house,” she says. But it’s a “major pain in the neck.”
Rosacea is an unglamorous problem. It won’t kill you. It won’t even really make you sick. But emotionally, it can make life miserable for the 13 million Americans who have it. Some hate to go to work; others, like Taylor, dread parties because some foods and alcohol make you “get redder and redder.”
Rosacea is a chronic condition that first strikes in one’s 30s and 40s, though many people suffer for years before they’re properly diagnosed. Famous faces with rosacea have included Rembrandt, W.C. Fields, and Princess Diana. President Clinton also suffers from the ailment.
Initially, rosacea is just excessive flushing and blushing caused by dilation of blood vessels on the cheeks, nose, chin or forehead, says Dr. Arthur Sober, associate chief of dermatology at Massachusetts General Hospital.
Nobody is sure why this happens, but it may be an abnormal response to temperature changes. In fact, researchers have shown it’s the heat in hot coffee or tea, not the caffeine, that triggers flushes. Other triggers include stress – notably anger and embarrassment – sun, wind, hot showers, coughing, spices, chocolate, tomatoes, and even exercise.
When a healthy person exercises hard, he may get red, “but this usually calms down in about 15 minutes,” says Dr. Mark V. Dahl, chairman of dermatology at the University of Minnesota Medical School. When someone with rosacea exercises, his face may stay red for an hour or two.
Chronic flushing leads to the appearance of broken blood vessels, or telangiectasia. “If you have a constantly increased blood flow to the skin, it creates new blood vessels. They may look broken but they’re not,” says Dr. Steven J. Ugent, a dermatologist at Boston Medical Center. But these vessels are treatable with lasers – “perhaps the most gratifying cosmetic procedure one can perform because it works so well and there’s so little risk,” says Dr. Robert Stern, a Beth Israel Deaconess Medical Center dermatologist.
In many people, though, rosacea doesn’t end with flushing and blushing but progresses to inflammation, in which the face breaks out with papules (little red bumps) and pustules (pus-filled pimples) that may look like acne.
Some think this may be caused by skin mites called Demodex folliculorum, though it’s unclear which comes first, the mites or the rosacea. The mites may trigger inflammation, but they may also flock to sites of rosacea and take up residence.
Others blame Helicobacter pylori, the bacteria that causes stomach ulcers. One recent study of more than 200 people, however, found that the prevalence of H. pylori is no higher in people with rosacea than in those without it, says Dr. Kenneth Arndt, chief of dermatology at Beth Israel Deaconess. And treatment of H. pylori doesn’t seem to get rid of rosacea.
What does work for inflammatory rosacea is the antibiotic metronidazole (Flagyl), applied as a cream or gel, with or without tetracycline, another antibiotic taken in pill form.
“Antibiotics work tremendously well,” says Dahl of Minnesota, though researchers still aren’t sure whether it’s because the drugs – often taken for months or longer, at low doses – actually kill microbes or simply quell inflammation.
In some cases, rosacea progresses to a third phase, called rhinophyma – or W.C. Fields nose – in which the nose becomes bulbous as oil glands become enlarged and the layer of skin called the dermis becomes thicker.
“This is women’s greatest fear,” says Dr. Joseph Bikowski, clinical associate professor of dermatology at the University of Pittsburgh. In reality, women “rarely, if ever” get rhinophyma, he adds, though men often do.
If the nose gets so big it interferes with vision, surgery is necessary to resculpt tissues. In cases where rhinophyma is caught early, a drug called Accutane may work, though it can’t be taken by women who are pregnant or who might become pregnant because it causes birth defects.
In some people, like the Cape Cod psychologist, rosacea can attack the eyes. She’s been taking low dose antibiotics for years, which helps, though she still can’t wear eye makeup.
But for most people with rosacea, it’s the embarrassment, not the medical problems, that hurts most, especially the assumption that rosy faces are a sign of alcoholism.
“People assume that people with rosacea are drinkers, when that is not the case,” says Ugent of Boston Medical Center. “You can have rosacea and never touch alcohol.”
“People tend to trivialize it because it’s a skin disease,” adds Dahl of Minnesota. But “for some people, it’s life-destroying.”
Triggers of rosacea
A number of foods, drinks, skin care products and other factors can cause flare-ups of rosacea, including these:
Foods:
- Certain cheeses, chocolate, soy sauce, vinegar, citrus fruits, spicy and thermally hot foods.
- Beverages: Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne. Any thermally hot drink.
- Emotional factors:
- Stress, anxiety, embarassment, anger.
- Skin Care Products and Medications:
- Cosmetics and hair sprays, especially those containing alcohol, acetone, witch hazel or fragrances.
- Topical steroid creams.
- Any product that causes redness or stinging.
- Vasodilators (used to lower blood pressure).
Thermal factors:
- Saunas, hot baths, excessively warm environments.
Weather:
- Sun, strong wind, cold, humidity.
Exercise:
- Any workout that raises body temperature and increases blood flow to the face, such as aerobic exercise.
Medical conditions and behavioral factors:
- Menopause, chronic cough, caffeine withdrawal, smoking.
For more information, contact the National Rosacea Society on the web at www.rosacea.org/ or by telephone, 1-888-NO-BLUSH.