Rosacea Demystified
Rosy cheeks aren’t always a good thing
By Janet McCormick
Originally published in Skin Deep, November/December 2009. Copyright 2009. Associated Skin Care Professionals. All right reserved.
An esthetician might look across a room full of people and, noticing one person's reddened cheeks, think to herself she is looking at a case of rosacea. After all, 14 million Americans have the disorder and it seems as though it would be easy to spot. However, according to the National Rosacea Society, rosacea is common but frequently misdiagnosed. It can easily be confused with simple blushing, overheating, or sunburn. At times, it simply goes undiagnosed.
Symptoms
An in-the-know esthetician will recognize possible symptoms of rosacea in a client and, without suggesting a diagnosis, make a referral to a dermatologist. Clients can halt, slow, or otherwise improve their skin by seeking medical help early and adhering to preventive measures and medical treatments. Following are the most common symptoms of the disorder.
Redness. The skin looks sunburned or as though the person is blushing. This redness is caused by flushing, or excess blood moving rapidly through blood vessels. The vessels dilate to allow movement of the blood. Over time, this redness becomes persistent.
Heating of the Skin. The skin may feel warm when flushing, especially as the disorder progresses. This heat increases the redness and discomfort.
Butterfly Pattern. Rosacea redness appears from the jawbone to cheekbones, and across the nose. While it may affect the chest, neck, and rarely the back, it is distinctive for its butterfly pattern on the face.
Pimples and Papules. Small, red papules or pus-filled pimples may appear on the face and resemble those found with severe acne. In contrast with acneic skin, rosacea-affected skin is usually very dry and never has the whiteheads or blackheads (comedones) common to acne.
Red Lines. The expansion of small blood vessels eventually becomes visible through the skin as thin, red lines (telangiectasia) on the face. These tiny but expanded arterial vessels are especially present on the thinner skin of the cheeks. They are also noticeable on the nose of rhinophemic clients.
Rhinophyma. Rosacea can cause a rough texture (orange-peel skin) on the nose, making it appear swollen and misshapen. Called rhinophyma, this condition is an enlargement of the sebaceous glands and the constant irritation of contiguous tissues. This symptom is most common in men.
Eye Irritation. Though it's rare, red, dry eye tissues, known as ocular rosacea, may develop. Left untreated, it can negatively affect vision.
Other Locations. One study1 indicates that, in extremely rare cases, rosacea may be absent on the sufferer's face, but occur on the back or elsewhere. These cases are extremely difficult to diagnose and treat.
Stages of Rosacea
Early treatment can make a big difference in a client's rosacea, so it's important estheticians know the symptoms and stages of the disorder so they can make an appropriate referral.
Pre-Rosacea. This stage features frequent episodes of facial flushing and redness, triggered by certain stimuli. Clients appear embarrassed, overheated, or sunburned in the cheek area and may say their skin is sensitive. These clients are best referred to
a dermatologist.
Stage One. This stage features minor telangiectasia and more persistent flushing and redness. Facial skin may frequently appear swollen and warmer than normal. This is considered the vascular stage of rosacea. While most cases that are treated never progress beyond this stage, it's now that a client's extreme annoyance with the condition often begins. Sometimes, sufferers go to an esthetician before going to a physician.
Stage Two. Inflammatory rosacea initiates with this stage and features pustules and papules, though without the blackheads or whiteheads associated with acne. Even so, it may be misdiagnosed as acne. The telangiectasias have begun to enlarge and pores can become distended. The butterfly pattern will be evident
in this stage.
Stage Three. Skin will have an orange-peel appearance and previous symptoms will be exacerbated. Hyperplasia, an enlargement of the sebaceous glands, is established as an ongoing condition. Roughness on the reddened cheek, nose, and forehead begins to develop.
Stage Four. The orange-peel appearance, skin thickening, and roughening may progress to rhinophyma. Small, pus-colored or red bumps, along with telangiectasia, are more severe on the cheeks and forehead. This stage can also feature ocular rosacea. Clients may experience these stages in succession, or more than one stage at a time. Some may start with rhinophyma, without ever having experienced any of the other stages.
Emotional Effects
Many experts believe the social and emotional effects of rosacea can be worse than the physical symptoms. In one survey, nearly 70 percent of diagnosed rosacea patients said their self-confidence and self-esteem suffered from the physical effects of the disorder.2 Forty-one percent said the condition caused them to avoid public contact or cancel social engagements during flare-ups. Greater workplace absenteeism was associated with the disorder.
Estheticians should be sensitive to the emotional needs of rosacea clients, focusing instead on the positive prospects of their condition improving under the care of a dermatologist.
Rosacea Treatment
There is no cure for rosacea, though it can be controlled with a dermatologist's intervention. In a study of 1,077 rosacea patients, 87 percent reported that treatment was controlling their symptoms.3 Rosacea is often treated with daily use of topical medications, such as the antibiotics MetroGel or MetroCream. Results can be dramatic or there may be no results at all. Laser treatments can be used to reduce dilated blood vessels or to remove excess nose tissue. Some severe cases are treated with surgical dermabrasion to remove the excess nose tissue associated with rhinophyma or to improve skin texture.
Clients with pre- and first-stage rosacea can improve their skin irritation with esthetic treatments, though a dermatologist's intervention at these early stages is optimal. Clients in all other stages must be referred to a dermatologist. Estheticians can recommend anti-inflammatory creams to reduce redness in these early stages. Many esthetic product lines feature these creams in their treatment and home care regimens. Emu oil is known to aid pre- and first-stage cases, and many esthetic product companies combine it with anti-inflammatory ingredients for this use.
According to the National Rosacea Society, clients who may have rosacea should be told to gently cleanse their faces with mild, soap-free cleanser. They should avoid products that contain alcohol, eucalyptus, fragrance, menthol, and peppermint, as well as those with acids, such as alpha and beta hydroxy acids. These ingredients tend to aggravate the condition.
The caring esthetician will develop a positive referral relationship with a dermatologist, then tactfully refer clients with symptoms. Though not a deadly disease, rosacea can seriously affect the social and psychological lives of clients who reach a chronic or skin-damage stage. For your clients' welfare, and to stay within your scope of practice, do not diagnose, but do refer early on. Clients will love you for it.
Janet McCormick is an esthetician, manicurist, and former salon owner and spa director. She holds a master's degree in allied health management, as well as a Comite International D'Esthetique Et De Cosmetologie (CIDESCO) diploma. She has written more than 300 articles and is owner of Spa Techniques Consulting. She can be reached at 863-273-9134 or janetgmccormick@aol.com.
Notes:
1. Joel Bamford et al., "The Relationship of Rosacea Phenotype and Extrafacial Lesions." Paper presented at the annual meeting of the Society for Investigational Dermatology, Los Angeles, May 15, 2002.
2. "Survey Reveals Rosacea Patients Often Have Other Skin Conditions." National Rosacea Society. Available at www.rosacea.org/rr/2002/spring/article_3.html (accessed July 2009).
3. Ibid.
An esthetician might look across a room full of people and, noticing one person's reddened cheeks, think to herself she is looking at a case of rosacea. After all, 14 million Americans have the disorder and it seems as though it would be easy to spot. However, according to the National Rosacea Society, rosacea is common but frequently misdiagnosed. It can easily be confused with simple blushing, overheating, or sunburn. At times, it simply goes undiagnosed.
Symptoms
An in-the-know esthetician will recognize possible symptoms of rosacea in a client and, without suggesting a diagnosis, make a referral to a dermatologist. Clients can halt, slow, or otherwise improve their skin by seeking medical help early and adhering to preventive measures and medical treatments. Following are the most common symptoms of the disorder.
Redness. The skin looks sunburned or as though the person is blushing. This redness is caused by flushing, or excess blood moving rapidly through blood vessels. The vessels dilate to allow movement of the blood. Over time, this redness becomes persistent.
Heating of the Skin. The skin may feel warm when flushing, especially as the disorder progresses. This heat increases the redness and discomfort.
Butterfly Pattern. Rosacea redness appears from the jawbone to cheekbones, and across the nose. While it may affect the chest, neck, and rarely the back, it is distinctive for its butterfly pattern on the face.
Pimples and Papules. Small, red papules or pus-filled pimples may appear on the face and resemble those found with severe acne. In contrast with acneic skin, rosacea-affected skin is usually very dry and never has the whiteheads or blackheads (comedones) common to acne.
Red Lines. The expansion of small blood vessels eventually becomes visible through the skin as thin, red lines (telangiectasia) on the face. These tiny but expanded arterial vessels are especially present on the thinner skin of the cheeks. They are also noticeable on the nose of rhinophemic clients.
Rhinophyma. Rosacea can cause a rough texture (orange-peel skin) on the nose, making it appear swollen and misshapen. Called rhinophyma, this condition is an enlargement of the sebaceous glands and the constant irritation of contiguous tissues. This symptom is most common in men.
Eye Irritation. Though it's rare, red, dry eye tissues, known as ocular rosacea, may develop. Left untreated, it can negatively affect vision.
Other Locations. One study1 indicates that, in extremely rare cases, rosacea may be absent on the sufferer's face, but occur on the back or elsewhere. These cases are extremely difficult to diagnose and treat.
Stages of Rosacea
Early treatment can make a big difference in a client's rosacea, so it's important estheticians know the symptoms and stages of the disorder so they can make an appropriate referral.
Pre-Rosacea. This stage features frequent episodes of facial flushing and redness, triggered by certain stimuli. Clients appear embarrassed, overheated, or sunburned in the cheek area and may say their skin is sensitive. These clients are best referred to
a dermatologist.
Stage One. This stage features minor telangiectasia and more persistent flushing and redness. Facial skin may frequently appear swollen and warmer than normal. This is considered the vascular stage of rosacea. While most cases that are treated never progress beyond this stage, it's now that a client's extreme annoyance with the condition often begins. Sometimes, sufferers go to an esthetician before going to a physician.
Stage Two. Inflammatory rosacea initiates with this stage and features pustules and papules, though without the blackheads or whiteheads associated with acne. Even so, it may be misdiagnosed as acne. The telangiectasias have begun to enlarge and pores can become distended. The butterfly pattern will be evident
in this stage.
Stage Three. Skin will have an orange-peel appearance and previous symptoms will be exacerbated. Hyperplasia, an enlargement of the sebaceous glands, is established as an ongoing condition. Roughness on the reddened cheek, nose, and forehead begins to develop.
Stage Four. The orange-peel appearance, skin thickening, and roughening may progress to rhinophyma. Small, pus-colored or red bumps, along with telangiectasia, are more severe on the cheeks and forehead. This stage can also feature ocular rosacea. Clients may experience these stages in succession, or more than one stage at a time. Some may start with rhinophyma, without ever having experienced any of the other stages.
Emotional Effects
Many experts believe the social and emotional effects of rosacea can be worse than the physical symptoms. In one survey, nearly 70 percent of diagnosed rosacea patients said their self-confidence and self-esteem suffered from the physical effects of the disorder.2 Forty-one percent said the condition caused them to avoid public contact or cancel social engagements during flare-ups. Greater workplace absenteeism was associated with the disorder.
Estheticians should be sensitive to the emotional needs of rosacea clients, focusing instead on the positive prospects of their condition improving under the care of a dermatologist.
Rosacea Treatment
There is no cure for rosacea, though it can be controlled with a dermatologist's intervention. In a study of 1,077 rosacea patients, 87 percent reported that treatment was controlling their symptoms.3 Rosacea is often treated with daily use of topical medications, such as the antibiotics MetroGel or MetroCream. Results can be dramatic or there may be no results at all. Laser treatments can be used to reduce dilated blood vessels or to remove excess nose tissue. Some severe cases are treated with surgical dermabrasion to remove the excess nose tissue associated with rhinophyma or to improve skin texture.
Clients with pre- and first-stage rosacea can improve their skin irritation with esthetic treatments, though a dermatologist's intervention at these early stages is optimal. Clients in all other stages must be referred to a dermatologist. Estheticians can recommend anti-inflammatory creams to reduce redness in these early stages. Many esthetic product lines feature these creams in their treatment and home care regimens. Emu oil is known to aid pre- and first-stage cases, and many esthetic product companies combine it with anti-inflammatory ingredients for this use.
According to the National Rosacea Society, clients who may have rosacea should be told to gently cleanse their faces with mild, soap-free cleanser. They should avoid products that contain alcohol, eucalyptus, fragrance, menthol, and peppermint, as well as those with acids, such as alpha and beta hydroxy acids. These ingredients tend to aggravate the condition.
The caring esthetician will develop a positive referral relationship with a dermatologist, then tactfully refer clients with symptoms. Though not a deadly disease, rosacea can seriously affect the social and psychological lives of clients who reach a chronic or skin-damage stage. For your clients' welfare, and to stay within your scope of practice, do not diagnose, but do refer early on. Clients will love you for it.
Janet McCormick is an esthetician, manicurist, and former salon owner and spa director. She holds a master's degree in allied health management, as well as a Comite International D'Esthetique Et De Cosmetologie (CIDESCO) diploma. She has written more than 300 articles and is owner of Spa Techniques Consulting. She can be reached at 863-273-9134 or janetgmccormick@aol.com.
Notes:
1. Joel Bamford et al., "The Relationship of Rosacea Phenotype and Extrafacial Lesions." Paper presented at the annual meeting of the Society for Investigational Dermatology, Los Angeles, May 15, 2002.
2. "Survey Reveals Rosacea Patients Often Have Other Skin Conditions." National Rosacea Society. Available at www.rosacea.org/rr/2002/spring/article_3.html (accessed July 2009).
3. Ibid.
