Friday - - Fashion -

Q I’m a 55 years old, Swedish, and have been suf­fer­ing from ‘red face’, which has started to de­velop yel­low­ish pim­ple-like le­sions. My fore­head, nose and cheeks are more in­tensely af­fected. My lower in­ner eye­lids are also be­com­ing itchy, sore and red, while my nose is start­ing to look dis­fig­ured. Is there any­thing I can do to stop the process? A From your let­ter and the de­scrip­tion of your skin com­plaints, there ap­pears to be a clear in­di­ca­tion of in­flamed pa­palo­pus­tu­lar rose­cea.

This con­di­tion af­fects all of the ar­eas you have men­tioned in your let­ter.

In­volve­ment of the eye­lids is called con­junc­ti­val rose­cea, while the con­di­tion’s ef­fect on the nose is known as rhino­phy­ma­tous rose­cea.

Through a range of clin­i­cal vari­a­tions in its pre­sen­ta­tion, it can cause prom­i­nent bro­ken/ di­lated blood cap­il­lar­ies on cheeks and up­per neck, in which case it will be la­belled as tel­len­giactatic rose­cea.

In the nor­mal course of events, it starts as tran­si­tory episodes of se­vere fa­cial red­ness (blush­ing or flush­ing).

This can later turn into a more per­sis­tent fea­ture and sub­se­quently starts de­vel­op­ing pim­ple-like papules and yel­low­ish pus­tules. It can mis­tak­enly be iden­ti­fied as in­flamed acne.

Rose­cea is one of many com­plex der­ma­to­log­i­cal is­sues. There is global con­sen­sus among re­searchers that rose­cea is a vas­cu­lar dis­or­der of cu­ta­neous blood ves­sels, where th­ese ves­sels tend to over­re­act in the form of va­sodi­lata­tion, ei­ther through ther­mal stim­u­la­tion, ex­ces­sive sun ex­po­sure or cer­tain foods.

Di­etary trig­gers in­clude al­co­hol, ex­tra-spicy food or the con­sump­tion of cer­tain food ad­di­tives. This can trig­ger red­ness of the fa­cial skin.

Sim­i­larly, any neu­ropsy­cho­log­i­cal stim­u­lus in the form of se­vere stress or anx­i­ety can pre­cip­i­tate such vas­cu­lar re­ac­tions.

Rose­cea has a sig­nif­i­cant ge­netic and racial pre­dis­po­si­tion. White-skinned in­di­vid­u­als con­sti­tute the ma­jor­ity of the suf­fer­ers.

To treat your skin con­di­tion ef­fec­tively, I would ad­vise you to con­sult a der­ma­tol­o­gist for a de­tailed ex­am­i­na­tion. Among the rou­tinely used treat­ment op­tions, oral an­tibi­otics such as tetra­cy­clines, to­gether with top­i­cal metron­ida­zole creams or gels and lo­tions, are widely pre­scribed.

How­ever, I must men­tion here that the rhino­phy­ma­tous rose­cea is a most re­sis­tant and clin­i­cally chal­leng­ing sit­u­a­tion. In its early stages, a course of oral isotriti­noin is usu­ally ben­e­fi­cial. In its ad­vanced stage, lasers have of­fered suc­cess­ful re­sults in many cases.

Fi­nally, avoid­ance of the trig­ger­ing or pre­cip­i­tat­ing fac­tors re­mains the only ef­fec­tive re­me­dial tool to pre­vent fur­ther re­cur­rence of rose­cea.

DR IKRAMULLAH AL NASIR is a Dubai-based der­ma­tol­o­gist

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