Sometimes Rosy Cheeks Are Just Rosy Cheeks

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http://www.nytimes.com/2004/03/16/health/16BROD.html?ex=1080450000&en=d1a29a

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.... In a report in the journal Women's Health in Primary Care titled " Is It

cea, or Just Rosy Cheeks? " Dr. Herbert P. Goodheart, a dermatologist in

private practice in New York, suggests that rosacea may be overdiagnosed,

possibly resulting in unnecessary or inappropriate treatment. ...

In any given month, Dr. Goodheart says he sees about 10 new patients to

confirm diagnoses of rosacea or to treat it. " Some of these patients, " he

said, " have typical findings of rosacea ‹ central facial inflammatory

acnelike lesions, often accompanied by a history of blushing or flushing as

well as persistent facial redness and `broken' blood vessels. "

But he added, " Others may prove to have other diagnoses, such as adult acne

or acnelike conditions, and a subset, perhaps 20 percent of these patients,

have what I consider to be simply rosy cheeks. Generally, such patients are

fair-skinned, and many are of Celtic ancestry. "

.... The main symptoms of rosacea, experts agree, affect the central face:

flushing, persistent redness, bumps and pimples and visible blood vessels.

Other possible signs and symptoms include eyes that are irritated, watery or

bloodshot; burning or stinging sensations on the face; roughness of the

central facial skin; raised red skin patches on the face; thickening of

facial skin, especially on the nose (mostly in men); facial swelling; and

sometimes symptoms like those of facial rosacea on the neck, chest, scalp or

ears.

But the expert committee identified two main subtypes of rosacea: one

characterized by flushing and persistent redness in the center of the face,

perhaps accompanied by visible blood vessels and possibly facial swelling or

stinging, and the second resembling acne, with pimples and pustules often

accompanied by persistent redness but, unlike acne, without blocked pores.

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Two other subtypes were noted. One involves thickened skin, which gave one

famous rosacea patient, W. C. Fields, his bulbous nose. The other involves

eye irritation that can become so severe it damages the cornea and threatens

sight.

.... One man with a face red from rosacea who had witnessed an accident was

rebuffed by police when he offered to provide an account. " Who would believe

you? " said an officer, assuming the man was drunk.

Other substances and situations that can set off symptoms are exposure to

sunlight; emotional stress; hot or cold weather or wind; intense exercise;

hot baths; spicy foods; hot drinks (but not caffeine per se); hot rooms;

high humidity; and various skin care products, cosmetics or medications,

including beta blockers, niacin and topical steroids. Certain foods can also

cause flare-ups. Keeping a diary correlating symptoms with recent exposures

can help uncover the causes of flare-ups.

It is critical for people with rosacea to stay out of the sun and to use a

sunscreen with an S.P.F. of 15 or higher year-round. Those who enjoy outdoor

exercise do best if they limit workouts to the early morning or evening

hours and to shaded areas. It may also help to reduce exercise intensity and

instead work out more often or for longer sessions. Water-based activities,

which keep the body cool, are other good options.

In cold weather, cover the cheeks and nose with a scarf or ski mask and use

a moisturizer daily.

For people with facial redness, the use of a green-tinted cosmetic can

neutralize the skin tone. Topical medications to reduce redness and oral

antibiotics may be prescribed for more severe cases.

Some dermatologists use laser therapy to ablate the tiny blood vessels in

the face that are cosmetically disturbing.

Ocular symptoms are commonly treated with warm compresses and daily lid

cleansing to unplug lubricating glands; more severe cases may require oral

antibiotics and medicated eye drops.

In a survey of more than 400 rosacea patients who were treated medically by

physicians, 70 percent reported improvements in emotional well-being, 60

percent said their professional interactions had improved and 57 percent

noted improvements in their social lives.