Since Jina has stimulated a conversation about rosacea, we thought we would do a quick post on the subject. Maybe we will do a part two about management. But Dr George thinks he may be onto something new.
Not all redness is rosacea, and not all rosacea is the same.
Rosacea starts with redness, caused by excessive blood congesting within sensitive tissues of the face. Redness can be accompanies by itching, burning, and stinging. These are signs of inflammation. It starts out being intermittent, but then stays longer each episode, until some residual redness is present all the time. There are many “triggers” to redness (see below). As the condition progresses, inflammation increases, and papules (bumps) and pustules (bumps with pus) can appear, sometimes persisting for weeks. Facial pores become larger and prominent, and with solar exposure skin becomes yellowed, leathered (elastosis) and more prone to be wrinkled. Eventually the problem spreads from the face to also include neck, chest, and scalp regions. Visible spider veins (telangiectasia) can appear. Some go on to further stages including excessive inflammatory lesions, swollen nose, scars, and deformities.
Rosacea sufferers have more facial blood vessels than the average person and their blood vessels are abnormally constricted due to swelling and inflammation. There are various factors that cause rosacea facial vessels to dilate or contract. But not all persons who easily blush, have flushing and redness, or who responder to triggers like cold have rosacea. Some people genetically have more blood vessels, but they don’t become inflamed and constricted. The only way to tell the difference is by observing over time whether it progresses to lumps and bumps rosacea.
Many people have sensitive skin, and will get redness, itching, stinging and swelling (inflammation) from coming into contact with an allergen (makeup, lotion, dust,, etc.). It usually subsides quickly once the offending substance is removed.
Nervous Blushing & Redness
Embarrassment and social anxiety are familiar feelings, but some people feel these more than others. Personality traits such as shyness may predominate. Blushing, in earlier times, was assumed to be a positive thing in women, evidence of their sensitivity and purity. It is possible to speculate that many with rosacea were getting credit for undeserved wholesomeness.
Redness of this type is caused by nervous connections from emotional centers of the brain which stimulates the sympathetic nervous system. Any activation of these nerves causes ‘constriction of our body blood vessels’ except in the ‘facial blush/flush areas, where dilation occurs. Adrenaline release can also be involved, in situations of fear, anxiety, or fright. It’s part of our ‘fight or flight” reaction in response to danger. Chronic stress and anxiety can lead to prolonged facial redness.
Exercise & Redness
Exercise opens blood vessels in many parts of the body, especially the face and neck, to helps us maintain a normal body temperature when faced with heat production from activity. Lactic acid may accumulate, further stimulating vascular dilatation. This is normal, but can be annoying for persons who do have rosacea.
Smoking & Redness
Nicotine is a vascular dilator. It also depletes the skin of key nutrients, interferes with collagen formation, accelerates the cross linkage of collagen and the hardening of elastin in the dermis, and creates an abundance of free radicals which can then damage capillaries. Smoking, which robs the skin of oxygen, is a potent initiator of telangiectasis.
Cold Weather Blushing & Redness
Redness may result from coming in from the cold into a warm room. When outside in cold weather the distal parts (feet, hands, ears, and nose) get less blood flow than the rest of the body, to maintain body temperature. Upon returning indoors, the higher temperature quickly warms the facial skin and extremities while the cardiovascular system is still in a moderately high exercise mode. The familiar stinging sensation upon rewarming (nose, ears fingers, toes) reflects that rapid change. This is made worse by dryness, as the skin becomes less pliable, and less able to accommodate the sudden increase in blood flow. Cold weather blushing is exaggerated in people suffering from rosacea. They may get more redness, and the redness last longer.
Redness of the Eyes
Many rosacea sufferers have ocular rosacea with symptoms of redness or flushing of the eyes. Any of the above “redness triggers” may be involved. It is often mistaken for eye infections or allergies, with inappropriate medication given, which actually exacerbates the problem if it is true ocular rosacea.
Alcohol & Redness
Alcohol causes the blood vessels to dilate causing redness. The hops in beer, and some of the resins in red wines, can also be vasodilators.
Although these recommendations can help to minimize flushing, still the best thought is “not to drink any type of alcohol”. Even though alcohol sedates, it can prevent a good night sleep as the alcohol stimulates the brain when the brain has its normal pH of 7.4 altered to an acidic range of 7.2; in addition, when the brain pH is lowered to 6.9, the social life ends forever as intoxication is excessive, rosacea terminates, and the sleeper does not awaken “ever”. This would be a very “sad social rosacea diet plan” or a lack of good planning and control.
Foods, Supplements, Medications & Redness
Many medications, supplements, and foods can cause flushing and therefore worsen rosacea symptoms. Niacin, as an example, is a very potent vasodilator. But there are many others. Many antibiotics, including those prescribed for rosacea, can cause skin to flush. Foods, and certain spices in particular, can cause flushing (we will gather a list for you).
The Sun and Redness.
I guess this is an obvious one. What is less obvious is the underlying connection between solar stress “free radical generation), and the progression of rosacea from earlier to later stages. Photoageing is a large contributor.