An Alternate for Rosaceans

The Rosacea Research & Development Institute [RRDi] is the first 501 (c) (3) non profit corporation (pending approval) established June 7, 2004 in the State of Hawaii, USA for the purpose of researching rosacea established by rosaceans for rosaceans. The Charter of the Corporation states the purpose and clearly outlines the goals of the corporation.
The RRDi is a member driven organization and invites rosaceans to become involved. Volunteering is the force that drives the organization and is an integral spirit of the RRDi philosophy.

Should There be A Fifth Classification of Rosacea?

In the past year there has been considerable discussion among rosacea specialists concerning the addition of a fifth rosacea subtype. This subtype is classified as Neuropathic Rosacea. While this subtype is not officially recognized yet, it may only be a matter of time because it is just as common as ocular and phymatous rosacea, and it is the most debilitating form of rosacea.

Subtype 5: Neuropathic Rosacea: Neuropathic rosacea is characterized by bouts of centro facial burning and pain sensations following rosacea triggers. These bouts usually last longer than half an hour and in many moderate to severe cases can last for hours, days, weeks or become semi-permanent if the sensory nociceptors are permanently activated or damaged by dermal inflammation and various inflammatory substances. In severe cases of neuropathic rosacea, no trigger is needed to initiate the burning sensation; underlying facial inflammation may trigger the sesensitized sensory nociceptors.

Currently Accepted Classifications of Rosacea

Rosacea Subtype ClassificationThe Rosacea Society Medical Committee has recently developed a "Rosacea Classification System" to help diagnose rosacea subtypes. This system helps rosacea sufferers better understand their symptoms and find the proper treatments. Below is a summary of each subtype adapted from the Journal of the American Academy of Dermatology.2002; 46:584-587.

Subtype 1: Erythematotelangiectatic Rosacea:Erythematotelangiectatic rosacea is mainly characterized by flushing and persistent central facial redness. The appearance of telangiectasia is common in this subtype. Facial edema, stinging senations, and burning sensations may also occur. A history of flushing alone is common among patients presenting with erythematotelangiectatic rosacea.

Subtype 2: Papulopustular Rosacea: Papulopustular rosacea is characterized by persistent facial redness with transient papules or pustules. The papulopustular subtype resembles acne, except that white heads are absent. Burning and stinging sensations may be reported by patients with papulopustular rosacea. This subtype is often reported in combination with subtype 1.

Subtype 3: Phymatous Rosacea: Phymatous rosacea includes thickening of the nose skin, irregular surface nodularities, and sebaceous gland hyperplasisa. Rhinophyma is the most common phymatous irregularity.

Subtype 4: Ocular Rosacea: Ocular rosacea should be considered whena patient's eyes have one or more of the following symptoms such as watery or bloodshot appearance, foreign body sensation, burning or stinging, dryness, itching, light sensitivity, blurred vision, and telangiectasia of the conjunctiva.

Researching the Use of Zinc in Treating Rosacea

According to Dr Nase, and I will now quote from his book, that 'ZincOxide is a superb skin protectant approved by the FDA as a Category1 skin protectant'.Dr Nase goes on to say that 'Clinical and experimental studiesdemonstrate that zinc oxide can (1) Enhance the celluar processes ofthe epidermis (2) Protect damaged skin during the healing processand (3) Decrease inflammation in both the dermis and epidermis.Also from Dr Nase's book, he explains findings and direct quotes ina study conducted on Microfine Zinc Oxide. It says 'Zinc Oxide hasbeen used since 1888. Our search of available medical literature didnot yield a single adverse reaction report to zinc oxide. In fact,zinc oxide is the only sunscreen ingredient that appears on morethan one FDA monograph. In addition to being an approved sunscreeningredient, zinc oxide is both a Category 1 skin protectant and aCategory 1 diaper rash treatment. Thus zinc oxide enjoys asingularly remarkable history of extensive and safe use. It may bethe most used topical drug'.From what I can deduce, zinc oxide's protective barrier from theenvironment helps to shield the epidermis and decrease hyper-reactivity. It has significant healing properties when applied todamaged skin and I can only speculate that as it has these healingproperties, it may well make your skin less reactive in the future.Also Dr Nase mentions that 'most importantly, medical specialistsindicate that topical zinc oxide can help heal rosacea facial skinthat has been damaged and thinned by topical steroids'.

Maria Cardone

Medical Conditions Can Cause Rosacea Flares

Coming down with a cold or suffering through allergies this spring may be bad enough. Making matters worse, these conditions also cause rosacea flare-ups in many individuals, according to a recent survey on rosacea and other medical conditions by the National Rosacea Society.In the survey of 837 rosacea sufferers, 32 percent of the respondents reported that their rosacea flared up when they experienced allergic reactions. Twenty-four percent said colds aggravated their condition, and 20 percent cited fever as a problem. Of the women who responded, 21 percent said menopause had triggered flare-ups.Other medical conditions associated with flare-ups in various rosacea sufferers included cough (12 percent), flu (11 percent), stress (10 percent), migraine (8 percent) and caffeine withdrawal (4 percent).The survey confirmed what many physicians have already found -- some underlying health conditions and temporary ailments can stimulate a flushing response and trigger rosacea flare-ups. In general, anything that causes flushing of the face can lead to a flare-up, and 42 percent of the survey respondents cited this as a rosacea tripwire.Medical therapy for other health conditions also may bring about a flare-up in some individuals, the survey showed. Ten percent of the survey respondents said they experienced flare-ups in reaction to topical steroids. Smaller numbers reported rosacea flare-ups associated with ACE inhibitors (5 percent), cholesterol-lowering agents (4 percent) and vasodilators (3 percent).Nine percent of the respondents said their health care providers had changed their therapy to avoid medications that seemed to aggravate their rosacea. Fortunately, nearly 72 percent of the respondents said their rosacea improved after other medical conditions were under control.

Skin Care Tips

In addition to medical therapy, a gentle twice-daily facial cleansing routine can help keep your rosacea under control. Here are some tips that will leave your skin clean without aggravating your condition:
Use a very mild soap or non-soap cleanser. Any products that might irritate skin are not useful.

Massage cleanser with your fingertips. A soft pad or washcloth may also be gently used, but patients should avoid rough or abrasive materials, loofahs, brushes or sponges.

Rinse the face with lukewarm water. Avoid temperature extremes, especially hot water, which may cause flushing.

Dry the face gently. Blot with a soft and thick cotton towel. Never pull, tug, scrape or scratch.

Air dry before applying medication. Let your face dry until surface moisture is gone. Then apply any topical medication that has been prescribed. Let the face dry again before using any moisturizers, sunscreen, makeup or other skin-care products.

Don't view comments as negative. Most reactions to rosacea are simply caused by curiosity and ignorance of the disorder, rather than some negative intent. Turn these situations into positive educational opportunities by openly discussing your condition.

Knowledge leads to understanding. Taking the initiative to inform others about rosacea can put them at ease. At an opportune time, casually mention you have rosacea, a chronic facial condition that affects millions of Americans and is becoming more prevalent as the baby boom generation enters the most susceptible ages.

Describe the changing rosacea condition. Explain how rosacea causes redness, bumps and pimples that may come and go, and can become worse during a flare-up. Pass along that rosacea is not contagious and that you try to control the condition with medication and by avoiding personal rosacea triggers.

Dispel myths. Mistakenly, some people associate red faces and noses with heavy drinking, and the acne-like signs of rosacea with poor hygiene. Point out that both are untrue in the case of rosacea. Rosacea is unrelated to hygiene and, while alcohol can aggravate the disorder, the signs and symptoms can be just as severe in a teetotaler.

Avoid irritating skin-care products. Eliminate or find alternatives for any skin-care products that sting, burn, irritate or cause redness.

New System for Assessing Rosacea

The National Rosacea Society has introduced the first standard grading system for the study and clinical assessment of rosacea, developed by a consensus committee and review panel of 17 rosacea experts worldwide and recently published in the Journal of the American Academy of Dermatology.1
"The new standard grading system should be useful to both researchers and practicing dermatologists in addressing this often complex disorder," said Dr. Jonathan Wilkin, chairman of the consensus committee. In addition to the previously developed standard classification system, standard grading system is often essential to perform research, analyze results and compare data from different sources. This in turn provides a common reference for comprehensive patient evaluation, appropriate treatment and assessment of results in clinical practice."
The new system provides grading criteria and guidelines for the primary and secondary features of rosacea as defined in the standard classification system, and establishes a global assessment for rosacea patients by standard subtype that includes the physician's scoring of severity as well as the patient's own assessment. In most cases, some rather than all of these potential manifestations of the disorder appear in any given patient.
The primary signs and symptoms of rosacea are transient erythema (flushing), nontransient erythema (redness), papules (bumps) and pustules (pimples), and telangiectasia (visible blood vessels). For clinicians, the grading system recommends rating these signs as absent, mild, moderate or severe. Researchers are encouraged to provide more detailed measurements.
Clinicians may similarly rate the secondary signs and symptoms of rosacea -- ocular manifestations (eye irritation) and skin manifestations such as burning or stinging, plaques (raised red patches), dry appearance and phymatous changes (thickening of the skin) -- as absent, mild, moderate or severe, and are advised to note whether edema (swelling) and peripheral location of signs and symptoms are present or absent.
In addition, the system calls for a global assessment of the patient's condition according to the severity of signs and symptoms grouped into the four standard subtypes outlined in the standard classification system.

The Effect of Exercise on Rosacea

According to a new survey of 1,261 rosacea patients by the National Rosacea Society, more than 83 percent are affected at least somewhat by exercise. Fortunately, of those who have modified their exercise routine because of this condition, 89 percent said this had reduced their signs and symptoms. Perhaps because of its popularity, walking was the most commonly reported form of exercise that aggravated rosacea, affecting 36 percent of the respondents. Other common exercise triggers included jogging or running (33.5 percent), aerobics (30.5 percent), weights (16 percent), push-ups or sit-ups (15 percent), and bicycling or spinning (15 percent). Twenty-four percent of the respondents said they exercise daily, while 48 percent exercise one to three times a week and 16 percent only occasionally. People with rosacea who exercised only occasionally seemed to experience flare-ups more often than others, with 90 percent reporting that their conditions were affected at least somewhat. Interestingly, only 43 percent of those who exercised daily were affected. "While exercise is important to a healthy lifestyle, people with rosacea should anticipate flare-ups of signs and symptoms, especially with strenuous activity or outdoor heat exposure," said Dr. James Del Rosso, assistant clinical professor of dermatology at the University of Nevada School of Medicine, Las Vegas. Ways to help reduce the incidence of flare-ups include working out in the early morning or late evening when weather is cooler; working out more frequently but for shorter intervals; keeping cool indoors by running a fan or opening a window; and cooling off by keeping a damp towel on your neck and drinking cold fluids.

The Four Types of Rosacea

1. Prerosacea is the earliest noticeable stage of the disease. Signs of this stage include frequent episodes of flushing or redness of the face and/or neck that come and go. Things that can cause an episode are exposure to the sun, emotional stress, alcohol, spicy foods, exercise, cold wind, hot foods and beverages, and hot baths. Again, each person is different and what might affect one person might not bother the next.
2. Vascular rosacea is where blood vessels under the face swell and it is most common in women. Redness and flushing become persistent and eventually permanent as a result. The skin that is affected could be slightly warm or swollen.
3. Inflammatory rosacea often develops in people who’ve had a history with vascular rosacea. As the small blood vessels of the face get larger and show through the skin, little red lines, similar to a map, appear. Little pink bumps or pimples may also occur.
4. Rhinophyma is the most severe type of rosacea, which usually strikes men. An enlarged, bulbous nose is a characteristic of this type of the disease. Thick, knobby bumps can develop along with swelling in both the oil producing glands and the tissues surrounding the nose.