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AesthEx Academy

Facial Veins / Rosacea

ROSACEA AT A GLANCE   Detailed Description Follows Below 

  
The most common characteristic of rosacea is persistent facial redness, often resembling a blush or sunburn that doesn't go away. This redness typically appears on the central part of the face, including the cheeks, nose, forehead, and chin

WHAT IS ROSACEA?

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ROSACEA SYMPTOMS

  • Persistent facial redness (flushing)
  • ​Sensitive, irritable and dry skin up to burning and stinging
  • Inflammatory papules (small raised nodules) and purulent pustules (acne-like sores)​
  • Visible dilated spider-like blood vessels (telangiectasia)
  • Tuberous growths (e.g. bulbous nose)
  • Dry, light-sensitive and watery eyes
  • Redness of the eyelids and conjunctiva

ROSACEA TREATMENT 

There isn't a cure for rosacea, but treatments can help you manage the redness, bumps, and other symptoms
Drugs or topicals that treat rosacea include:
  • Azelaic acid, a gel or foam 
  • Brimonidine (Mirvaso), a gel 
  • Calcineurin inhibitors such as pimecrolimus and tacrolimus
  • Clindamycin (Cleocin, Clindagel, ClindaMax), an antibiotic
  • Ivermectin (Soolantra) 
  • Metronidazole (Flagyl) and doxycycline
  • Oxymetazoline (Rhofade), a cream
  • Sodium sulfacetamide and sulfur (Avar, Sulfacet, Clenia, Plexion), antibiotics
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Clinicians can also treat rosacea with a laser that uses intense light to get rid of blood vessels that have gotten larger. Lasers can also ease skin redness, while laser resurfacing can remove thickened skin. Other procedures include: 
  • Dermabrasion, which sands off the top layer of skin
  • Electrocautery, an electric current that zaps damaged blood vessels

ROSACEA SCIENCE

Studies suggest that rosacea is associated with abnormalities of blood vessels (the vascular system) and the immune system. 
Rosacea is also associated with abnormal inflammation, which impairs the skin's ability to act as a protective barrier for the body. A combination of blood vessel abnormalities, abnormal inflammation, and a disruption of the skin barrier underlie the signs and symptoms of rosacea.
Among the genes thought to play roles in rosacea are several genes in a family called the human leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders.

ROSACEA DEEP DIVE 

WHAT IS ROSACEA?

Rosacea is a chronic skin condition that primarily affects the face, causing a variety of symptoms that can vary in severity.There are four main types of rosacea, each with distinct features:
 
  1. Erythematotelangiectatic Rosacea: This type is marked by persistent redness and visible blood vessels (telangiectasia). The skin may also be prone to flushing and swelling.
  2. Papulopustular Rosacea: Often confused with acne, this type involves redness along with pus-filled pimples and bumps. These can appear on the central face and sometimes on the neck, chest, or scalp.
  3. Phymatous Rosacea: This type causes the skin to thicken and become bumpy, particularly around the nose. The nose may become enlarged and bulbous, a condition known as rhinophyma.
  4. Ocular Rosacea: This type affects the eyes, leading to symptoms such as redness, irritation, and swollen eyelids. It can cause the eyes to feel gritty and appear bloodshot¹.Rosacea symptoms can flare up for weeks to months and then diminish before flaring up again.
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COMMON ROSACEA TRIGGERS

  • Sunlight
  • Stress
  • Heat
  • Alcohol, especially red wine
  • Exercise
  • Spicy foods
  • Some skin and hair care products
  • Some makeup
  • Wind and cold
  • Some medicines

ROSACEA SYMPTOMS

Flushing
​Rosacea often begins with a tendency to flush easily. The person may notice redness or a darker color on their face, along with a warm feeling. With time, these may last longer. For those with darker skin tones, the only sign of flushing may be a warm feeling on their cheeks.
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Redness/violet color lasts longer
​As rosacea progresses, the person may notice that the redness or violet color remains for weeks, months, or longer. Depending on the skin tone, they may see red, violet, or brown across their nose and cheeks. Sometimes, the color appears on the chin, forehead, ears, neck, upper chest, or scalp.
 
Acne-like breakout
Many people who develop rosacea have breakouts. They are visible on all skin tones. The dermatologist may refer to them as “papules” and “pustules.” For those with a darker skin tone, the papules (bumps) and pustules (bumps filled with pus) may be the first sign of rosacea that is seen. 
 
Visible blood vessels
For those people that have a lighter skin tone, they may see blood vessels on their cheeks or nose that are not typically visible. These are difficult to see on darker skin tones.
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ROSACEA TREATMENT 

There is no cure for rosacea, but there are ways to make your skin look and feel better. Symptoms of rosacea differ among people, so doctors tailor treatments to each person.

A combination of self-care measures and medications is typical.

Most people respond well to therapy, but improvement is usually gradual and it can take 3 months or longer to see results. While treatment is usually long term, there may be times when symptoms improve and you can temporarily stop using medications.

The goals of treatment are to:

  • Control symptoms.

  • Prevent complications and worsening of the condition.

  • Improve quality of life.

 

Treatment may include:

 

Medications

​Topical agents, which are applied to the affected skin, are usually prescribed first, if symptoms are fairly mild. Oral medications are typically only used for moderate or severe cases.

Topical agents.

  • Creams, gels, and ointments that contain antibiotics, antiparasitics, or vasoconstrictors (substances that narrow blood vessels) are used to treat flushing and redness, as well as mild rashes.

  • People with eye irritation are treated with lubricating eye drops or ointments that contain antibiotics or immunosuppressant medications (that help to reduce inflammation in the skin).

Oral medications

  • Antibiotics. These are used for moderate to severe rashes and more serious eye symptoms. The antibiotics that are used are believed to work, at least in part, because they have anti-inflammatory properties as well as antibiotic effects.

    • Brimonidine (Mirvaso), a gel that tightens blood vessels in the skin
    • Calcineurin inhibitors such as pimecrolimus and tacrolimus
    • Clindamycin (Cleocin, Clindagel, ClindaMax), an antibiotic that kills bacteria on your skin
    • Erythromycin (Erygel), another antibiotic
    • Ivermectin (Soolantra), which reduces inflammation 
    • Metronidazole (Flagyl) and doxycycline, also antibiotics
    • Oxymetazoline (Rhofade), a cream
    • Sodium sulfacetamide and sulfur (Avar, Sulfacet, Clenia, Plexion), antibiotics
  • Retinoids. These compounds, which are related to vitamin A, may help some people with severe rosacea.

  • Occasionally, drugs approved for other conditions are used to reduce flushing. 

Light therapies

Clinicians can also treat rosacea with a laser that uses intense light to get rid of blood vessels that have gotten larger. Lasers can also ease skin redness, while laser resurfacing can remove thickened skin. Other procedures include:
  • Dermabrasion, which sands off the top layer of skin

  • Electrocautery, an electric current that zaps damaged blood vessels

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Surgery may be needed when thickened skin needs to be removed. The procedure may involve the use of a scalpel or special abrasion instruments.

ROSACEA CAUSES & SCIENCE

The causes of rosacea are complex and not well understood. Both genetic and environmental factors appear to influence the disorder, although many of these factors have not been identified.

 

Studies suggest that rosacea is associated with abnormalities of blood vessels (the vascular system) and the immune system. In people with this condition, blood vessels expand (dilate) too easily, which can cause redness and flushing of the skin. Rosacea is also associated with abnormal inflammation. Inflammation is a normal immune system response to injury and foreign invaders, such as bacteria. Abnormal inflammation impairs the skin's ability to act as a protective barrier for the body. Researchers believe that a combination of blood vessel abnormalities, abnormal inflammation, and a disruption of the skin barrier underlie the signs and symptoms of rosacea.

 

Among the genes thought to play roles in rosacea are several genes in a family called the human leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders. Each HLA gene has many different variations, allowing each person's immune system to react to a wide range of foreign proteins. Certain variations in HLA genes likely contribute to the abnormal inflammation that is characteristic of rosacea.

 

Another group of genes that appear to be involved in the development of rosacea are glutathione S-transferases (GSTs). The proteins produced from these genes help protect cells from oxidative stress. Oxidative stress occurs when unstable molecules called reactive oxygen species (ROS) accumulate to levels that can damage or kill cells. Variants in several GST genes have been associated with an increased risk of developing rosacea. Researchers suspect that these variants reduce the ability of GSTs to protect skin cells from oxidative stress, leading to cell damage and inflammation.

 

Environmental (nongenetic) factors can also increase the risk of developing rosacea and trigger its symptoms. Among the best-studied risk factors for rosacea is exposure to ultraviolet (UV) radiation from the sun. UV radiation causes oxidative stress that can damage skin cells. Studies suggest that having an overgrowth of certain microorganisms that live on facial skin, particularly mites called Demodex folliculorum, may also contribute to the development of rosacea. These mites stimulate an abnormal immune response and disrupt the normal skin barrier. Other factors that can trigger the signs and symptoms of rosacea or make them worse include heat exposure, spicy food, cigarette smoking, and alcohol, all of which cause blood vessels in the skin to dilate.

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​Learn more about the genes associated with Rosacea

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