PERIORAL DERMATITIS

When treating the symptoms of rosacea, one may observe a rosacea-like eruption around the mouth area. Known as perioral dermatitis. This rosacea-like inflammation generally consists of small red bumps or even pus bumps and mild peeling as the skin is extremely aggravated. Perioral dermatitis is often aggravated by fluoridated or tartar-control toothpaste, chapstick, the ingredients in lipstick, and mouthwash. It is also believed that topical steroids, residue from asthma inhalers t containing steroids, cinnamon, cosmetics, and even moisturizers contribute to perioral dermatitis. Hormones, sunlight, and stress can cause perioral dermatitis to be more severe. Perioral dermatitis is a common skin problem that mostly affects young women, however, occasionally men and children are affected by it. Perioral dermatitis may be considered a variant of rosacea or a as distinct and separate skin condition.

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Rosacea And Rhinophyma

Rhinophyma has been observed from ancient times in Greece and Arabia but first named by Hebrea in 1845. The term rhinophyma stems from the Greek words: Rhis (Greek for nose) and phyyma (Greek for growth). A year later in 1846, rhinophyma was first associated with rosacea. Daniel Sennert performed the first known surgery for rhinophyma in 1629.

Rhinophyma is a form of rosacea that is characterized by chronic redness, inflammation, and increased tissue growth of the nose. In the early stages it may be seen as nasal bumps. Rhinophyma commonly occurs as a result of untreated rosacea. As more bumps appear, the nose takes on a more swollen, misshapen appearance. Rhinophyma can take on many different forms. In most forms, the nose is chronically red and inflamed. There is also evidence of swelling, and the skin often shows thickened skin with large pores, resembling the peel of an orange (peau d' orange). In some forms, sebaceous gland hypertrophy and hyperplasia (increased growth and number of sebaceous glands) can cause the nose to grow considerably, resulting in a bulbous appearance. It is a more severe form of acne rosacea. The cause is not really known.

Rhinophyma has been associated with many causes such as the over-consumption of alcohol. No consistent causative factor has been identified to date. Men are 12 times more likely to have this problem than women.

Symptoms of rhinophyma include an overgrowth of the sebaceous skin glands, vessel and tissue growth in the deeper layers of the skin, and a thickening of the outer layer of the skin. This can make for a very obvious and prominent nose.

Non-surgical treatment for rhinophyma is similar to rosacea care and includes attention to skin hygiene, avoidance of foods that seem to worsen the condition and the use of antibiotics when small infections are present.

Rhinophyma is actually a slow growing benign tumor due to hypertrophy of the sebaceous glands of the tip of nose often seen in cases of long-standing rosacea. Rhinophyma appears as a pink, lobulated mass over the nose with superficial vascular dilation; mostly affects men past middle age. Rosacea patient seeks advicenad treatment because of the unsightly appearance of the tumor, or obstruction in breathing and vision due to the large size of the tumor. Treatment consists of paring down the bulk of the tumor with sharp knife or carbondioxide laser and the area allowed to re-epithelialise. Sometimes, tumor is completely excised and the raw area skin-grafted.

The Early Stages of Rosacea

The earliest recognizable stage of rosacea is called pre-rosacea. That blush of embarrassment that may pop up at an inopportune moment. The classic symptoms of pre-rosacea are patchy diffuse redness or flushing and inflammation, particularly on the cheeks, nose, forehead, and around the mouth. Pre-rosacea symptoms typically appear between the ages of 30 and 50 and may affect more women than men. Because the symptoms emerge slowly, rosacea may initially be mistaken for sunburn, leading to a delay in treatment.

Although rosacea may first appear as early as the teen years, rosacea most frequently begins when sufferers enter their 30s, 40s or 50s as a flushing or transient redness on the cheeks or nose, and in some cases the chin or forehead. In this earliest stage, some sufferers may report stinging or burning sensations, including the feeling of dry or tight skin.

The signs and symptoms at this stage of rosacea include frequent episodes of flushing and redness of the face and neck that come and go. Many things can trigger a flushing episode, including exposure to the sun, emotional stress, alcohol, spicy foods, exercise, cold wind, hot foods and beverages, and hot baths. What causes flushing in one person may not cause a problem in another.

Flushing usually occurs when the body becomes fatigued and/or stressed which stimulates the sympathetic nervous system. The key to this is the autonomic nervous system (more specifically, the sympathetic postganglionic efferent nerves). Any activation of these nerves causes vasoconstriction of "body blood vessels" -- except in the "facial blush/flush areas" where it induces potent vasodilatation or flushing with the resulting "rosacea flush".

The early signs and symptoms of rosacea may also occur as a result of products used to treat other skin conditions such as acne. As adults, when we get acne we have a tendency to treat it the same way we did as teenagers – our old acne over the counter cream or lotion packed with high concentrations of benzoyl peroxide, salicylic acid and sometimes even topical vitamin A products.

As our skin ages we find that the skin doesn't respond the same way to these acne products as it did when we were younger. The result is red blotchy areas, more breakouts; the facial skin may react by becoming oilier or dryer with increased skin sensitivity. In trying to control this, we apply even more and stronger treatments to our skin, but instead of seeing an improvement; we actually see more damage and skin-related issues as the skin creates more oil to protect it from the damage and abuse of these harsh chemicals. Thus creating a vicious cycle of over-medicating the skin causing increased facial redness, clogged pores and skin irritation.

Rosacea And Topical Steroid Use

In the treatment of severe facial eczema, one may be prescribed a limited time dose of a topical steroid. Initially the anti-inflammatory and vasoconstrictive effects of the topical steroids result in what appears to be clearance of the primary dermatitis. Cortisones work by decreasing inflammation, swelling, burning and itching at the site of application. When applied in an ointment they can help the skin maintain moisture. In general steroid ointments are stronger than steroid creams because the medicine penetrates better when in an ointment form.

Topical steroids are generally used to treat the symptoms of eczema, a skin condition characterized by itchy, red, scaly skin. They are also used for other inflammatory skin conditions such as psoriasis and dermatitis. They don't cure the conditions but can ease the symptoms. They work by reducing inflammation of the skin and thus easing the symptoms of itching, redness and swelling that occur with many skin conditions.

When a rosacea patient is treated for a prolonged time with topical steroids the disorder may at first respond, but inevitably the signs of steroid atrophy emerge with thinning of the skin and marked increase in telangiectases. The complexion becomes dark red with a copper-like hue. Soon the surface becomes studded with round, follicular, deep papulopustules, firm nodules, and even secondary comedones. The appearance is shocking with a flaming red, scaling, and papule-covered face.

Topical steroids frequently cause thinning of the skin if used for long periods of time. They can also cause acne-like pustules, dermatitis, broken blood vessels under the skin, stretch marks, loss of skin color (which may clear-up on stopping treatment) and, when used on the face, a rosacea-like disorder (reddening of the skin), also known as steroid rosacea. Other side effects can include itching, easy bruising, and in some cases skin infection.

The persistent use of topical steroids leads to epidermal atrophy, degeneration of dermal structure, and collagen deterioration after several months. Ultimately the skin develops the appearance of rosacea, and it is rendered extremely vulnerable to bacterial, viral, and fungal infection. Patients persist in using steroid creams or ointments because they have typically learned the hard way about the severe rebound inflammation that occurs if they stop. In short, they find themselves caught between rosacea like steroid dermatitis and the erythematous pustular eruptions of steroid rebound.

Steroid rosacea is an avoidable rosacea condition, which in addition to disfigurement is accompanied by severe discomfort and pain. Withdrawal of the steroid treatment is inevitably accompanied by exacerbation of the rosacea like symptoms.

On initial assessment, it can be very difficult to distinguish between true rosacea and its steroid-induced mimic. The neck and scalp are often the giveaway, said Dr.Roger Allen of the University Hospital, Nottingham, England. Steroid-induced rosacea is often diffuse, extending from the face down along the neck. In balding men, the scalp is often affected. True rosacea tends to be less diffuse. Unfortunately there is no easy way to resolve steroid-induced rosacea, short of ceasing steroid use. This is, admittedly, a hard sell to patients who have already experienced the severe erythema, edema, and pustular eruptions associated with steroid rebound. Topical or systemic antibiotics may be needed if the patient has a bacterial infection. Cold chamomile tea compresses are a soothing adjunct for patients in the throes of steroid backlash. It is important to understand the rebound phenomenon in steroid induced rosacea. The rosacea sufferer is often baffled by their observation that the same medicine that was so effective in clearing their primary dermatoses or acne is now causing this distressing rosacea like condition, and that their skin gets markedly worse if they stop treatment. Prudence in steroid use is essential. Patients with seborrheic dermatitis, acne vulgaris, or other dermatoses simply should not be treated with topical corticosteroids.

Want to learn more about the effects of steroid induced rosacea? Visit these pages devoted to the rosacea connection and topical steroid use.

http://www.rosacea-ltd.com/malta.php3

http://www.rosacea-ltd.com/flushing.php3

www.rosacea-ltd.com/rossteroids.php3

http://www.internationalrosaceafoundation.org/steroids.php4

Understanding Rosacea Papules

Rosacea Papules are a small, red solid elevated inflammatory skin lesion without pus that is minor when the size is of a small measles lesion, moderate when about the size of a pencil eraser and severe when the papule is the size of a small currency coin or the tip of the little finger. The top of the papule may be flat, pointed, or rounded. Rosacea papules should not be mistaken for acne papules, which are common lesions in acne. Rosacea papules do not contain pus, while acne papules do contain pus.

Rosacea papules are small, red solid elevated inflammatory skin lesions without pus that are considered minor when the size of a small measles lesion, moderate when smaller than the size of a pencil eraser, and severe when the rosacea papule is the size of a small currency coin. Rosacea papules may open when scratched, becoming crusty and infected. A group of very small rosacea papules and microcomedones may be almost invisible but have a sandpaper feel to the touch.

Vascular flushing is a primary cause of rosacea papules. Over time, flushing results in leakage of inflammatory cells out of the blood vessels and into the skin. These inflammatory cells then migrate toward the surface of the skin, resulting in inflammatory papules. Bacteria or demodex mites do not cause facial papules.

Usually observed in stage two rosacea, inflammatory papules may crop up and persist for weeks. Rosacea papules show a small pustule at the apex, justifying the term papulopustular. The lesions are always follicular in origin, mainly in sebaceous follicles but also in the smaller and more numerous vellus follicles. Comedones do not occur. The deeper inflammatory lesions may heal with scarring, but scars are inconspicuous and tend to be shallow. Facial pores become larger and prominent. If there has been much solar exposure over decades, one may observe the appearance of photo-damaged skin in a yellowed, leathered skin (elastosis), wrinkles and solar comedones. The papulopustular attacks becomes more and more frequent. Finally, rosacea may extend over the entire face and even spread to the scalp, especially if the patient is balding. Itchy follicular papules of the scalp are typical. Eventually, the sides of the neck as well may be affected.

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