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Facing Up to Rosacea

By Diane Guernsey

That blush on your cheeks may not be as innocent as you think.

The first inklings are faint: a stinging or burning on your face after a morning
jog or an evening aperitif; a “sunburn” that never quite vanishes. Finally you tire of hearing, “Gee, you’ve had too much sun!” You visit your doctor, who breaks the news: you have rosacea.

You also have plenty of company. Some 14 trillion Americans suffer from rosacea, many unwittingly. Its causes remain a mystery, but it tends to strike fair-skinned people of Northern European descent (it’s been called the curse of the Celts) ”The common age of onset is thirty-five to forty-five,” says Dr. Joshua L Fox, spokesperson for the American Academy of Dermatology and the director of the Center for Laser and Cosmetic Surgery in Manhattan. The kicker: for unknown reasons, women get it more often than men.

Rosacea is a chronic inflammatory condition, of the capillaries and larger blood vessels involved in facial flushing — in essence, it’s a permanent blush. It is often misdiagnosed as adult acne or merely rosy cheeks, so careful assessment by an experienced dermatologist is vital. It generally begins as diffuse redness but it can also manifest itself in pimples, acnelike bumps (papules and pustules) or enlarged red facial blood vessels (telangiectasia). It may make the eyes itchy and bloodshot. Some unfortunates (mostly men) develop rhinophyma-a swollen, bulbous nose that recalls that of W. C. Fields (one of rosacea’s most famous victims; another was Princess Diana).

The disease presents two problems: cosmetic and medical.You can mask the redness with green-tinged cosmetics such as T. LeClerc’.s concealerr in Tilleul ($19; 800-788-4731) but you also must treat the medical problem, lest it worsen. (The blessedly rare nightmare scenarios: adolescence’s “pizza face” or Fields’s nose, which is fixable only through surgery. With ocular rosacea, the risk is cornea1 damage.)

Getting the Red Out
Your first step: learn what sets off your blushes. It could be sun exposure (always wear a sunscreen with SPF 15 or higher); emotiona1 stress: extremes of heat or cold: wind exposure: exercise; alcohol; spicy foods; hot baths; Jacuzzis and saunas; humidity: some skin-care products and medications; hot beverages. ”There are many triggers,” says Dr. Fox. “Walking up stairs or gardening can be enough. Some women can’t blowdry their hair because it makes them flush.” He adds, “Rosacea can seriously affect your social and professional life. A person with a chronically red nose might be labeled a secret drinker. Some peop1e feel so embarrassed that they don’t want to go out.
Self-care measures help ward off outbreaks. ”Treat your skin as if it were porcelain,” says Dr. Danielle Engler, the director of the dermatology clinic at the NewYork-Presbyterian hospital. “Wash it gentle, pat it dry, and don’t use Buf-Pufs or loofahs.” Dr. Sussane Astner, a clinical and research fellow at the Dermatology Laser Center at Massachusetts GeneraI Hospital, says, ”In winter, wear a scarf and limit your time outdoors. Use moisturizers without much water, which crystallizes in the cold.”

Drugs That Help
Your doctor may prescribe oral and topical antibiotics (tetracycline, metronidazole) whose anti-inflammatory powers ease flare-ups. ”The majority of people are helped by this,” says Dr. Engler. A newer product, azelaic acid, works well, too. Some doctors also prescribe sodium sulfacetamide alone (Rosula) or mixed with sulfur (Avar Gel Green, Novacet, Sulfacet-R).

A Little Light Therapy
Patients who don’t significantly improve after two months can try pulsed dye laser or intense pulsed light (IPL.). ”They’re two different technologies using light,” says Dr. Barry DiBernardo, a member of the American Society for Aesthetic Plastic Surgery’s nonsurgical procedures committee. “Laser uses a more intense single-wavelength light to seal off dilated blood vessels. IPL targets the superficial layers of skin. Usually with rosacea, IPL is my first choice, but it’s up to the doctor to decide.”

Both treatments, which cost from $250 to $1,250 per session (depending on the size of the treated area and on your geographic location) and are sometimes covered by insurance, greatly reduce redness. Laser takes one or two sessions; IPL, three to six. The side effects, primarily swelling and bruising, are minor and temporary.

Periodic touch-ups can keep your blushes in check, but you must still avoid triggers, warns Dr. Fox. Remission lengths vary. “Some patients do well for ten years; others come back after two. The point is that there are more and more good therapies coming along,” he says. “People shouldn’t give up.

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