Rosacea - the Red Face

Rosacea describes a red facial mask that spreads symmetrically over the nose to involve both cheeks and sometimes the forehead. The skin capillaries dilate with heat, causing flushing, and grow slowly to form permanent reddening ( telangiectasias.).  The pilosebaceous glands in the affected skin are often involved and may enlarge. Exposure to sun and heat may cause exacerbations.  In Canada it is estimated that 2 million people ( about 7%) have Rosacea. The greatest incidence is in white women between the ages of 30 to 50 years. The red face and bulbous nose of chronic Rosacea has been associated with high living and heavy drinking; however most people with Rosacea are not overindulgent hedonists. A food connection has also been implicated and standard Rosacea advice has included abstinence from alcohol, coffee, tea, and spices that cause flushing.

Standard treatment involves oral and topical antibiotics - usually metronidazole cream or gel. The response to antibiotic treatment is partial at best and seldom cures the condition. The role of infection has never been determined.  The response to metronidazole suggests that bacteria may play a role in perpetuating the inflammation but do not necessarily cause the disease. Inflamed skin tends to support more vigorous microorganism growth and nonpathogenic bacterial and fungi may become more invasive and pro-inflammatory. This is the situation in eczema caused by food allergy and many cases of psoriasis where topical antifungal treatment is sometimes helpful. Seborrhea is a related condition that involves the hair-bearing skin of the scalp and face and has been related to the fungus, p. ovale, and is best treated with Nizoral shampoo - seborrhea can involve the central forehead, skin under the eyebrows and beard and may be confused with Rosacea.

Significant cosmetic disfigurement may occur in the most severe Rosacea with skin swelling and enlargement. This   is more common in men - the red face and bulbous nose of a chronic alcoholic is the classic presentation of the chronic, severe version of the disease. The disease has been staged according to severity.

Stages - Plewig and Kligman Classification

Rosacea & Food Allergy

Flushing and stage I  Rosacea are typical signs of delayed pattern food allergy. In our experience, many patients with Rosacea  have other symptoms that suggest the diagnosis of food allergy. ( See type III pattern)  The involvement of the central face has always been a puzzle. In children red cheeks and red ears act like warning lights that turn on when a food reaction starts and we encourage parents to identify reactive foods when the see this flushing. Flushing in infants may be associated with the development of facial eczema with involvement of the cheeks and forehead suggesting the Rosacea distribution. The early   systemic lupus rash also resembles Rosacea and is associated with delayed patterns of hypersensitivity.  Often, it is the other symptoms of food allergy  that motivate people to do diet revision and improvement in Rosacea is noted along with improvement in other symptoms such a gastrointentestinal disturbances, headache, aching and fatigue.

Lesions:

Papules and nodules are round, dome-shaped (2 to 3 mm), pustules often  small (<1mm) and on the apex of the papule. Telangiectasias are clusters of capillaries that overgrow and leave the skin permanently red.

Chronic Rosacea can be associated with  sebaceous gland hyperplasia and lymphedema, causing disfigurement of the nose, forehead, eyelids, ears, and chin. Rhinophyma is an enlarged nose; metophyma is a cushion-like swelling of the forehead, blepharophyma is swelling of the eyelids related to marked sebaceous gland hyperplasia, otophyma a cauliflower-like swelling of the ear-lobes and gnathophyma is swelling of the chin.

Solution:  Try Diet Revision With Alpha Nutrition