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Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healingby Christiane Northrup
Author Q & A
Rosacea: Get the Red Out
Christiane Northrup, M.D.
It is estimated that nearly 14 million Americans have rosacea, a common but little-known inflammatory skin condition characterized by dilation of the blood vessels in the face. Rosacea is often misdiagnosed as acne or discoid or systemic lupus erythematosus (SLE). It usually occurs on the cheeks, nose, central forehead and chin, and can also occur on the upper back and upper chest. If you were to look at the skin of someone with rosacea under a microscope, it would show swelling, dilated blood vessels, and, where red bumps known as papules are present, you would see collections of white blood cells.
People with rosacea often experience periods of remission and exacerbation. As with acne, rosacea flare-ups often occur the week before a woman’s period, perhaps because the body is working to rid itself of impurities at that time.
Because of its acne-like effects on personal appearance, rosacea can cause significant psychological and social problems in people who do not know what to do about it. Surveys performed by the National Rosacea Society showed that nearly 70 percent of people with rosacea have lower self-confidence and self-esteem, and 41 percent reported that it had caused them to avoid public contact or cancel social engagements. Among those with severe symptoms, nearly 70 percent said the disorder had adversely affected their professional interactions, and nearly 30 percent said they had even missed work because of their condition. (Source: www.rosacea.org.)
Who Gets Rosacea and Why?
Rosacea affects both men and women, but occurs more often in women after the age of thirty and is most commonly diagnosed in women in their forties and fifties. Rosacea almost always worsens when women are under significant emotional stress. Given our culture, it is not surprising that more women than men get rosacea at mid-life. It is most common in women with fair skin, because fair skin is often more reactive, but rosacea has also been diagnosed in Asian and African American women.
There are several theories behind the cause of rosacea. One theory is that the disease may be a subcomponent of a more generalized vascular disease, as indicated by the tendency of rosacea sufferers to flush. Another theory suggests that changes in normal skin bacteria or infection of the stomach by Helicobacter pylori may be involved. Various other unproven theories indicate that microscopic skin mites (Demodex spp.), fungi, malfunction of the connective tissue under the skin, and emotions could all be potential causes. Allergies may also play a role, as allergies can cause flushing, which frequently triggers rosacea symptoms.
Signs and Symptoms of Rosacea
The diagnostic criteria indicative of rosacea include the presence of one or more of the following:
1. Flushing (transient erythema), redness on the cheeks, nose, chin or forehead. This may appear similar to a blush or sunburn. One potential cause is flushing due to the large amount of blood rushing through the vessels quickly. Redness tends to become worse over time and can be accompanied by stinging or burning sensations as well as swelling. Persistent redness (non-transient erythema) occurs later.
2. Telangiectasia, or small, visible blood vessels on the face. These enlarged blood vessels look like thin red lines. They usually appear on the cheeks and nose. They can be hidden by redness, but are visible when the redness disappears.
3. Papules, which look like bumps, and pustules, if they are filled with pus. These are not like the bumps you get from acne, in that they do not contain the blackheads or whiteheads.
4. Watery or irritated eyes. Sometimes rosacea patients report feeling like something is in their eyes. They may feel dry or swollen. People with rosacea tend to get styes. In severe cases, some vision loss can occur. Another quite common symptom is redness of eyelids, often misdiagnosed as an infection and mistakenly treated thus.
5. Rhinophyma, or enlarged nose. Severe cases of rhinophyma cause the nose to swell from excess tissue and knobby bumps. It is more common in men, probably because men do not seek treatment early for their other symptoms. This is what W. C. Fields had. Former president Bill Clinton also suffers from it.
While the causes are unknown, rosacea can be controlled. Many experts believe that early diagnosis and conventional treatment are key to managing rosacea. While I have seen people with rosacea who fare much better with self-treatments and a holistic approach that includes behavior modification, it is usually a good idea to know what you are dealing with first. That way you can avoid irritating products and other triggers.
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