Dallas Plastic Surgery Blog

Do you have redness of the face that causes other people to mistakenly think you are an alcoholic? You may be suffering from rosacea and there are treatment options available. Rosacea is a chronic facial skin disorder which causes redness of the skin, small visble blood vessels (telangieactasias), swelling of the skin, redness of the eyes, and can cause acne like lesions. It is usually first seen in people age 30 to 60, more common in women, but more severe in men. It is a progressive condition but can go through periods of remission. In severe cases, the end result of rosacea can be abnormal growth of the glands in the nose resulting in a disfiguring condition known as rhinophyma.

The cause of rosacea is not well known. There are several theories including infestation with a skin mite called Demodex follicularum and infestation with helicobacter pylori, the same bacteria associated with stomach ulcers. Other theories point to a malfunction in the body's temperature control system. There appears to be a genetic predisposition as 40% of people with rosacea have a family member with the disease. While the cause has not been clearly identified several factors have been identified which contribute to the condition including: sun exposure, stress, hot and cold weather, alcohol, spicy woods, exercise, wind, hot baths, hot drinks, certain drugs, skin care products, and topical or oral steroid treatment.

Diagnosis of rosacea is based on finding of the characteristic signs of rosacea. There are no other laboratory or imaging studies necessary to make the diagnosis though other conditions may need to be excluded.

There are several options for treatment for rosacea. The first step in treatment involves lifestyle modification. Use of sunscreens and avoidance of triggering events is an excellent start to decrease episodes of rosacea. Cosmetics can be used to cover some of the sequelae of rosacea.

Antibiotics, both topical and oral, can be useful for certain cases of rosacea. In cases of worrisome lesions on the face which are unresponsive to antibiotics, isotretinoin can be used but the benefits must be weighed against the risks of use and discussion with a knowledgeable physician is absolutely necessary. In cases of flushing being the worrisome symptom, blood pressure medication such as clonidine or beta-blockers may be effective in resolving the symptom.

For patients who desire treatment of the facial redness or telangiectasias, laser treatment may be beneficial. Pulsed dye lasers or intense pulse light treatment can be very helpful in reducing redness and removing telangiectasias. There are usually minimal side effects and treatments can often be undertaken as a 'lunch time office' procedure. The drawback to these procedures though is that it can take several treatments to produce the desired results.

For patients with rhynophima, or nodules on the nose from rosacea, more invasive surgery may be necessary to bring the nose back to its normal shape. Surgical results are often excellent but can require a several week intense care period.

For more information about rosacea, visit the national rosacea society at http://www.rosacea.org.