BY SUNNDEEP CHOPRA:
Rosacea is a chronic disease that manifests or imposes itself gradually on the visage of a person who is past the first flushes of middle age and on his way onto the senior citizen category. The same is generally restricted to or then localized in the flush areas or then areas around the nose, cheeks, forehead and chin and is known to mark it’s presence with special reference to the above mentioned areas. The unique characteristic attributed to this disease or rather it’s distinguishing feature is the reddish hue that appears on the affected parts of the visage as the disease begins to take root.
Flushing (becoming markedly red in the face and other areas of the skin) begins to appear under certain specific conditions such as emotional or mental stress, prolonged exposure to either intense or chilling cold, sub-human heat, remaining in the sun for a little too long for comfort or then after imbibing one alcoholic beverage too many. The flushing associated with these conditions or causatory factors tends to remain or then linger on for a little longer than usual.
Acne rosacea or then rosacea has been found most commonly in either Caucasians or then people hailing from northern Europe, but though rare, this skin disease/condition has also included people with darker skins or hues under it’s wings. The same is almost exclusively restricted to adults and has a special affinity or liking for members of the thirty plus club. Rosacea is far more commonly prevalent in women, but, ironically affects or bothers men far more severely or then tends to wreak havoc on or then ravage the ruddy complexions of men with a vengeance.
The presence of erythema (redness on the skins surface), telangiectastes (spider shaped or then spider like redness on the skin’s surface) and superficial pustules (or then roundish pus filled eruptions on the skin’s surface that can be felt by running your hand over them), but has little or no relation with the appearance or then presence of comedones and more often than not spares the chest and back from it’s ravages.
TREATMENT (S): Acne rosacea can be treated both topically (by taking recourse to the application of skin creams, gels or lotions) or systemically (by treating the root cause or causal systems). Mild or less virulent manifestations of the disease are optimally treated or then responds favourably to repeated and periodic applications of topical metronidazole or sodium sulfacetamide creams or skin ointments. More severe or virulent forms or manifestations of the disease are treated by taking recourse to the ingestion of antibiotics belonging to the tetracycline family in 250- 500 mg doses, doxcycline in 100 mg doses or then last but not the least, minocycline in 50-100 mg doses. The pustular part or then component of acne rosacea always responds favourably to oral or then ingested oxytetracycline and the doses or repetitions of the same can be gradually reduced if not completely ruled once the disease begins to lose it’s first flushes of youth and progress into middle and older ages within then trivial matter of a pithy few months.. But a unfortunate few could have to continue ingestion of the above mentioned antibiotics for a prolonged period extending well beyond a few months to weed out any/all manifestations of the disease from their systems.
Local or area specific treatment is similar to or almost synonymous with the treatment in vogue for acne vulgaris with particular emphasis or stress being laid on skin lotions.
SYMPTOMS: The hyperemic (most virulent or then toxic state of the disease) tends to linger on or then persist on the skin in due course of time and could also assume a permanent residency status in a few cases. The intensity varies form individual to individual and from season to season with the skin’s hue ranging from a pleasant pinkish to dull red. The underlying blood vessels show a proneness towards becoming dilated (enlarged or expanded) as time goes on. The resultant telangiectasia tends to occupy pride of place and hog the limelight while showing a preclusivity towards dominating the clinical picture.
The development of acne related lesions on the seborrhoeic soil (fungus or yeast that seems to thrive on the skin’s surface (soil) ), and the follicular openings are far more visible or prominent. Acne lesions of the pustular variety might appear or then do definitely make an appearance on the affected surfaces without as much as a second invitation and the same eruptions may or may not necessarily originate or trace their roots to comedones. Infiltration or then seeping below the skins upper recesses or surface and hypertrophy ( a consequential or resultant increase in the volume of an organ or tissue on account of the enlargement of it’s component) tend to most commonly manifest themselves on the hapless nose of the patient. Rhinophyma (inflammation of and pus secretions from within the inner mucous or recesses of the nose) is a consequent development in cases of untreated rosacea especially amongst men, the skins pores tend to show a proclivity towards widening and begin to leak oily secretions in addition to the pus and grime.
Cases of rosacea can assume more threatening or serious connotations or proportions when allied with various inflammatory eye disorders including keratitis, blepharitis, iritis and recurrent or repetitive chalazion. These ocular or then eye related problems can lead to permanent loss of sight if left untreated and hence warrant or demand a dispassionate ophthalmologic evaluation.
TREATMENT OR MANAGEMENT:
1. General or commonplace Measures:
Ø Proper and periodic cleaning of the affected areas.
Ø Complete avoidance or abhorrence of use of cosmetics
Ø Aversion to or strict avoidance of picking or then disturbing a pimples head/mouth/face.
Ø Adequate periods of relaxation.
Ø Avoiding the incidence of constipation at all costs.
Ø Adopting a diet rich in both fruits as well as salads.
A patient’s diet should be extremely light. Easy to digest and fibrous. The intake of food and beverages like hot tea and coffee, alcohol and overtly spicy foods which can contribute significantly in aggravating already existing cases of the disease should be steadfastly avoided. Non-vegetarian food should be avoided like the plague and the patient should go green as if there’s no tomorrow. Sudden to abrupt exposures to vacillating or fluctuating temperatures should be kept at the bare minimum and every conceivable effort should be made towards eradicating causes of stress or nervous tension.
LASER TREATMENT: Local or then area specific treatment is akin to that of acne vulgaris, with particular emphasis being laid on the application of lotions that need to be shaken well before application, Dilated or distended vessels can be successfully obliterated or exterminated by injecting 25 p.c. saline solution into them by taking recourse to or then falling back upon an extremely slim needle.
Patches or closely grouped together manifestations of aggregated telangiecstases will almost always react favourably to treatment with Freezing carbon dioxide treatment or then freezing the affected areas of the visage with carbon dioxide snow in 10 second intervals under the application of moderate pressure. Massaging the affected areas of the skin with a mild astringent is also strongly recommended.
X-ray therapy is the chosen mode of treatment or most commonly resorted to in extremely virulent or long standing cases of the disease. Rhinophyma is most often treated by resorting to dermabrasive surgery or then the surgical removal or extrication of the excessive or extra skin. The active advice of an ophthalmologist should always be sought in cases of ocular or eye related lesions.
Roentgen ray therapy is a highly effective and efficacious course of treatment in highly resistant or most virulent cases of severe acne. The same should however be used with due diligence and extreme discretion and expert guidance or ministrations of an experienced or reputed dermatologist (skin specialist).
CAUSES: Rosacea is a prime example or manifestation of multi-causal (or resulting from more than one cause) dermatosis (skin disease). The same can be caused by a plethora of factors ranging from prevalent atmospheric influences, sudden and abrupt exposure to extreme climatic conditions, excessive or limitless intake or then imbibing beverages like extremely hot and strong tea or coffee and alcoholic drinks/beverages. Gastrointestinal or constipation related troubles, pelvis related and menstrual disturbances or turbulences in women, and both physical as well as mental stresses with particular emphasis on the latter.
The psychogenic factor (produced or then caused by mental or psychic factors) is another significant factor in both the incidence/onset and aggravation of the disease, The rate of incidence of this disease in India is amongst the lowest in the world and women more often fall prey or then succumb to it’s wiles when compared with or then in comparison to men. Patients afflicted by the disease have been known to complain of /about an exacerbated or increased sense of heat, easy or then frequent excitability related episodes and losing their temper frequently.
DIAGNOSIS: Is generally far from difficult as it’s distinguishing symptoms are a dead giveaway; and is most commonly based on the under mentioned factors:
Ø The disease more often than not affects people above 30 years of age.
Ø Is generally restricted to the central area of a victim’s face.
Ø Seborrhoeic skin or then skin that secretes both pus as well as oily substances/secretions.
Ø The presence of redness, telangiectasia and acneiform or acne like lesions without the conspicuous presence of blackheads.
The disease (rosacea) is distinguished or differentiated from acne vulgaris on account of the age of the patient, the conspicuous absence of comedones, and localisation or then limitation of the disease to the central areas of the face.
PROGNOSIS: Rosacea is a chronic disease with a marked proclivity towards rapid and speedy aggravation. The response to conservative forms of treatment is more often than not far from satisfactory.
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