By Meg Nugent But about six years ago, she began to notice that her face was taking on a reddish cast. It started around her cheeks and, eventually, spread to her nose and chin. "I started getting more red and more red and more red," said Mikula, 31, of Rockaway. "I looked like this tomato." Pretty soon, the redness became more purple. It started to affect her life. "I would be embarrassed to go out to dinner or to go swimming because I had no makeup on," she said. "I really didn't know what it was. I didn't think there was an answer for it. I figured, maybe it's me, maybe it will go away. I'm outside a lot, so I thought it could be windburn. You come up with every excuse." Mikula finally sought the help of a dermatologist, who diagnosed her condition. Mikula is one of an estimated 14 million Americans with rosacea, a still incurable skin condition that's very common but often is confused with acne. It can also cause acute social embarrassment, especially when the redness and broken blood vessels that often accompany the disorder lead others to think the rosacea sufferer has a drinking problem. (Think satiric comedian W.C. Fields, well known for his portrayals of drunken curmudgeons, who had rhinophyma, a form of rosacea that results in a bulbous, purplish nose.) Excessive drinking tends to worsen rosacea, according to Livingston dermatologist Dr. Lewis Stolman, who counts Meg Mikula among his patients. "But it's wrong to think that all people who have rosacea are drinking an excessive amount of alcohol," he cautioned. Rosacea is most often found in people who are fair-skinned and have blue eyes, but the condition can affect all types of complexions, said West Caldwell dermatologist Deborah Rabner. While the cause isn't known, people with the condition tend to have a family history of rosacea. In addition, it tends to occur more often in adults aged 30-50, according to RosaceaNet (www.skincarephysicians.com/rosaceanet/), an online resource for rosacea information developed by the American Academy of Dermatology. Rosacea has been a recognized skin condition for decades, but more attention has been paid to it in recent years, in part because pharmaceutical companies have been producing and marketing more products designed to treat it, said Dr. Stolman. Rabner said she is seeing more patients with rosacea, which she attributes to greater public awareness because of the efforts of the National Rosacea Society, a nonprofit group with a mission to improve the lives of people with the skin disorder by providing public health information and supporting research related to the condition. She also says she's diagnosing the condition in younger people. Still, the ubiquitous Baby Boomers are having their own effect on the incidence of rosacea. The National Rosacea Society said the disorder is becoming more widespread as more boomers reach the most susceptible ages for developing it. The society also quoted a Gallup survey that found that 78 percent of Americans don't know about rosacea, including how to recognize symptoms and get help for treating it. "Early on, it may be mistaken for something else. People will ask if you are sunburned or angry," said Michelle Pelle, a dermatologist with a specialty in rosacea, who is a clinical assistant professor of dermatology at the University of California, San Diego. Treatment in the early stages is important because the condition can worsen and become more difficult to counteract without a prompt diagnosis by a dermatologist, according to RosaceaNet. Rosacea can involve the eyes in about half of the population with the condition, and it can affect the neck, ears, chest and back. In addition to persistent flushing or blushing and the presence of broken blood vessels on the face, the main symptoms include the appearance of small, red, solid bumps or pus-filled pimples, which is why it's often confused with acne. Other potential symptoms include burning or stinging sensations on the face, facial swelling, raised red patches and a thickening of the skin. Symptoms can vary from person to person and they can appear intermittently, according to RosaceaNet. In addition, not everyone who thinks they have rosacea actually has the disorder, said Rabner. "There are people who are just flushers and blushers, so rosacea medication will not help them. That's where it gets a little tricky in terms of helping people." Any treatment plan a dermatologist devises needs to be based on the needs of the individual, Rabner added. "There's no one treatment that's right for everyone. An evaluation is based on the type of lesions they have and the type of products they would want to use because you need to make this long-term." "You want something that's safe and convenient, effective and pleasant," Rabner said. "If you have to do something every day, you don't want it to be a chore. You want it to be a part of your routine skin care, and there are products that are elegant and easy to use. It's just a matter of finding the right fit." Rabner said she usually starts by educating her patients about the various environmental triggers that can spark a flare-up of rosacea, such as taking a hot shower or bath, drinking hot beverages or vigorous exercise. She also instructs her rosacea patients about avoiding or counteracting these triggers. "Simply taking a cooler shower is already something," she said. Exercise can also be a trigger, said Rabner, but "I never tell people not to exercise. People can put ice chips in the mouth and cool down their body temperature. It tricks the body's thermal regulator." If you tend to drink red wine, try switching to white to decrease flushing, she advised. Medical treatments are designed to diminish symptoms and bring them under control. Topical and oral medications, including antibiotics, can effectively treat the acne-like bumps and pus-filled pimples, known as papules and pustules. Dr. Stolman said the redness and enlarged blood vessels usually don't respond very well to oral and topical treatments. For those symptoms, he uses a more recent laser therapy known as V-Beam or pulsed dye laser treatment. He explained that pulsed dye treatment emits a particular wavelength that's attracted to red objects, which are then eliminated from the skin. Meg Mikula is a big fan of pulsed dye treatment because it worked well for her. After three treatments by Dr. Stolman, Mikula said, her rosacea is "all gone." She's also consistent about protecting her skin from the sun and avoiding her other triggers, which include spicy foods. She sticks to being a social drinker only. "Laser and light therapies are invaluable because they're a quick answer," said Pelle, but they're not a panacea. She explained that these types of therapies can lead to "a nice, long remission time," but only as long as the patient is diligent about protecting her skin from the sun by avoiding overexposure and using sun screen, as well as by avoiding triggers that can lead to a flare-up. For people who have undergone laser or light therapies but failed to take those avoidant measures, she said, "I've seen, seven to 10 years after therapy, their face is a wreck again." What to look for
What you can do Making some changes in your day-to-day routine, along with appropriate
medical treatment, go hand in hand in the successful treatment of
rosacea, according to RosaceaNet, an online rosacea information
resource established by the American Academy of Dermatology. Here
are some tips from RosaceaNet (www.skincarephysicians.com/rosaceanet/)
to help minimize flare-ups:
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