Rosacea is a chronic inflammatory condition that usually affects the face. Typically, the most common areas are the cheeks, chin, nose and forehead. The main symptoms of rosacea are facial flushing, irritated skin, pimples, and eye problems. Rosacea is a common skin disease affecting around 1-20% of the population in the US
Presently in the United States, more than 16 million people are diagnosed with rosacea. World wide, as high as 18% of the population. Rosacea occurs usually between 30-50 years of age onset, with females more effected than males. Accurate incidence is not available because people commonly receive the wrong diagnosis with this disease
Rosacea disproportionately affects persons of fair skin and European and Celtic ancestry. A Sweden study revealed 1 case in 10 middle class workers. Famous people with Rosacea include Bill Clinton, Princess Diana, W.C. Fields.
Rosacea also occurs in people of color but less frequently. It is unknown if the lower rate is due to the protective effects of melanin against UV light or because the common sign of facial flushing cannot be readily seen in patients of color. One variant of rosacea called caseating granulomatous may occur more commonly in people of Asian or African origin.
Symptoms
- Skin Discoloration- Appears as a blush that does not go away. Caused by capillaries near the skin surface that dilate.
- Flushing- Appears the face darkens and this flushing may spread to neck and chest area, the skin may feel hot.
- Skin Bumps and Pimple like Eruptions- Small red acne like.
- Blood Vessels- Blood vessels become more prominent called “spider veins” or telangiectasias usually on nose, cheeks and central aspect of the face.
- Skin Thickening- Excess tissue may develop on the nose called a Rhinophyma.
- Eyes- Watery bloodshot eyes. Styes are common as are swollen red irritated lids called Blepharitis- 50% of patients with rosacea have eye involvement.
Rosacea is a very common condition characterized by the symptoms described above.
Rosacea is defined by the National Rosacea Society as a condition with persistent erythema of the central portion of the face lasting for at least 3 months.
The prevalence of the symptoms designates the subclassification of rosacea and the therapeutic options.
Classification
- Erythematotelangiectatic Rosacea- Central facial flushing accompanied by burning and stinging is the predominant presentation. The face may have a rough appearance with scale formation
- Papulopustular Rosacea- This is the classic type of rosacea. Women present in middle age with a red central portion of their face. They will also have small papules and pimples.
- Phymatous Rosacea- Marked thickened skin and irregular surface nodularity on the nose chin and forehead. The nose area can be enlarged
- Ocular Rosacea- The eye manifestations may precede the skin manifestations by years. The eyes, lids are involved with irritation to light and a chronic foreign body in the eye sensation. Stye formation is common as is blurring of vision.
Triggering Factors That Can Exacerbate Rosacea
- Hot and Cold Temperatures
- Wind
- Hot Drinks
- Alcohol
- Caffeine
- Exercise
- Emotions
- Spices
- Medications such as corticosteroids
Causes of Rosacea
The cause of Rosacea is unknown but there are contributing factors;
- Abnormalities in the blood vessels. Facial flushing is caused by the small blood vessels dilating, however it is not known what causes the changes.
- Infection- A common skin mite usually causes no problems but in Rosacea, people have more of these mites than normal. It is not clear if the mite causes the rosacea or rosacea causes increase mite population.
- Helicobacter pylori- This gut bacteria produces bradykinin causing blood vessels to dilate. This causes the flushing and may play a role in the overall development of this condition.
- Genetics- many people with rosacea have a close family member with the condition.
Treatment
Rosacea ranges from a minor cosmetic disability to a severe disfiguring disease. Most patients can be stabilized with their condition and others have a chronic relapsing or progressive course.
Skin Creams- Creams are used to decrease the inflammation and skin discoloration
- Topical Antibiotics
- Benzoyl Peroxide
- Azelaic Acid
- Retinoids
Oral Antibiotics- These can also have anti-inflammatory effects as well as anti-infective
- Tetracyclines are the primary treatment for ocular conditions
- Erythromycin
- Metronidazole
Eye Drops- To reduce inflammation
- Steroid eye drops to reduce redness and swelling
- Antibiotic drops for infection
- Eye scrubs for lid margins
Isotretinoin
Accutane is an oral medicine used in severe cases of Rosacea. It prevents the skin fom making oil. Potential of severe side effects
Laser
Lasers are used on visible blood vessels to shrink them.
Dermabrasion
Used to remove the top layer of skin
Surgery
Used to reduce the skin buildup especially on the nose
Platelet-Rich-Plasma
Platelet-Rich-Plasma is an autologous blood derived product containing supra-physiologic concentrations of platelets. These platelets have cytokines and growth factors utilized to accelerate the regeneration of damaged tissues.
Studies
- Excellent Response with Platelet-Rich-Plasma Treatment in a case of Steroid Induced Rosacea
J Cosmet Dermatol 2021 Sept 24;dol:10.1111/jocd.14469 PMID 34559462
Conclusion-Excellent results in this case with the use of PRP
- Successful Treatment of Corticosteroid- Induced Rosacea- Like Dermatitis with Platelet-Rich-Plasma Mesotherapy- Report of 7 Cases
Dermatol Ther 2021 Apr;11(2):615-623 PMID 33539001
Cases- Corticosteroid induced rosacea is one of the cutaneous side effects of excessive application of topical steroids resembling rosacea. Most patients undergo a variety of long- term treatments before their symptoms are relieved and there is no accepted standard therapy. 7 patients were given 2 PRP facial treatments and the author found the patients symptoms and appearance were greatly improved and needed no further treatments.
Conclusion- PRP may mitigate sensitivity and inflammation in patients in steroid induced rosacea dermatitis by reducing erythema, telangiectasia and papules
Evaluation of the Efficacy and Safety of Platelet-Rich-Plasma Injection in Treatment of Rosacea
Dermatologic Therapy/Vol 34, Issue 5/e15049 doi.org/10.1111/dth.15049 Jul 2021
Purpose- To evaluate the role of PRP in the treatment of rosacea
Study was 40 patients receiving PRP on one side of the face and P-PRP on the other side of the face. They had treatment every 2 weeks for 3 months (total of 6 sessions)
Conclusion- There was a statistically significant decrease in the rosacea grading scale with 50% showing excellent and 50% showing good improvement. The improvement was significantly better in the platelet-rich vs the platelet-poor groups. Skin biopsies showed a marked decrease in inflammatory cells.
The author concluded PRP was an effective and safe technique in treatment of rosacea and an alternative to other systemic modalities especially if they are contraindicated.
Juventix Regenerative Medical has a Platelet-Rich-Plasma Medical Kit that is safe, cost effective, easy to use and FDA approved.
This kit has been scientifically proven to give representative similar containing product from the same sample source.
Juventix Regenerative Medical has a patent pending LED activator, that activates the platelets without the use of chemicals such as Thrombin and Calcium Chloride.
Juventix Regenerative Medical has a Bio-Incubator that can produced a flowable Platelet- Rich-Fibrin Matrix which is important in cosmetic facial applications.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
