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Thursday, January 10, 2013

Rosacea

Rosacea is a chronic (long-term) condition characterized by facial erythema (redness)[2] and sometimes acne-like pimples.[3] Rosacea affects all ages and has four subtypes, three affecting the skin and the fourth affecting the eyes (ocular type). Left untreated it worsens over time. Treatment in the form of topical steroids can aggravate the condition.[4]

Although rosacea can develop in people of any skin color, it tends to occur most frequently and is most apparent in people with fair skin - primarily affecting Caucasians of north western European descent and has been nicknamed the 'curse of the Celts' by some in Britain and Ireland, although recently this has been questioned.[5] Rosacea affects both sexes, but is almost three times more common in women (particularly during menopause). It has a peak age of onset between 30 and 60. 

Symptoms

Rosacea typically begins as redness on the central face across the cheeks, nose, or forehead, but can also less commonly affect the neck, chest, ears, and scalp.[6] In some cases, additional symptoms, such as semi-permanent redness, telangiectasia (dilation of superficial blood vessels on the face), red domed papules (small bumps) and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red lobulated nose (rhinophyma), may develop.
Rosacea zones http://commons.wikimedia.org/wiki/File:Rasacee_couperose_zones.png. License: Copyleft. This work of art is free. Free Art License 1.3 http://artlibre.org/licence/lal/en.
There are several symptoms and conditions associated with rosacea. These include frequent flushing, vascular rosacea, inflammatory rosacea, and several other conditions involving the skin, eyes, and nose.

  • Frequent flushing of the center of the face, which may include the forehead, nose, cheeks, and chin, occurs in the earliest stage of rosacea. The flushing often is accompanied by a burning sensation, particularly when creams or cosmetics are applied to the face. Sometimes the face is swollen slightly.
  • A condition called vascular rosacea causes persistent flushing and redness. Blood vessels under the skin of the face may dilate (enlarge), showing through the skin as small red lines. This is called telangiectasia (tel-AN-je-ek-tay-ze-ah). The affected skin may be swollen slightly and feel warm.
  • A condition called inflammatory rosacea causes persistent redness and papules (pink bumps) and pustules (bumps containing pus) on the skin. Eye inflammation and sensitivity as well as telangiectasia also may occur.
  • In the most advanced stage of rosacea, the skin becomes a deep shade of red and inflammation of the eye is more apparent. Numerous telangiectases are often present, and nodules in the skin may become painful. A condition called rhinophyma also may develop in some men; it is rare in women. Rhinophyma is characterized by an enlarged, bulbous, and red nose resulting from enlargement of the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. People who have rosacea also may develop a thickening of the skin on the forehead, chin, cheeks, or other areas.


Classification 

Zones

There are four identified rosacea subtypes[7] and patients may have more than one subtype present[8]:

  1. Erythematotelangiectatic rosacea: Permanent redness (erythema) with a tendency to flush and blush easily. It is also common to have small widened blood vessels visible near the surface of the skin (telangiectasias) and possibly intense burning, stinging, and/or itching sensations. People with this ETR type often have sensitive skin. Skin can also become very dry and flaky. In addition to the face, symptoms can also appear on the ears, neck, chest, upper back, and scalp.[9]
  2. Papulopustular rosacea: Some permanent redness with red bumps (papules) with some pus filled (pustules) (can last 1 to 4 days or longer; extremely varied symptoms); this subtype can be easily confused with acne.
  3. Phymatous rosacea: This subtype is most commonly associated with rhinophyma, an enlargement of the nose. Symptoms include thickening skin, irregular surface nodularities, and enlargement. Phymatous rosacea can also affect the chin (gnathophyma), forehead (metophyma), cheeks, eyelids (blepharophyma), and ears (otophyma).[10] Small blood vessels visible near the surface of the skin (telangiectasias) may be present.
  4. Ocular rosacea: Red (due to telangiectasias), dry, irritated or gritty, eyes and eyelids. Watery eyes. Eyelids often develop cysts. Some other symptoms include foreign body sensations, itching, burning, stinging, and sensitivity to light. Eyes can become more susceptible to infection. About half of the people with subtypes 1-3 also have eye symptoms. Blurry vision and loss of vision can occur.

There are a number of variants of rosacea, including:[11]:


Triggers

Triggers that cause episodes of flushing and blushing play a part in the development of rosacea. Exposure to temperature extremes can cause the face to become flushed as well as strenuous exercise, heat from sunlight, severe sunburn, stress, anxiety, cold wind, and moving to a warm or hot environment from a cold one such as heated shops and offices during the winter. There are also some food and drinks that can trigger flushing, including alcohol, food and beverages containing caffeine (especially, hot tea and coffee), foods high in histamines and spicy food. Foods high in histamine (red wine, aged cheeses, yogurt, beer, cured pork products such as bacon, etc.) can even cause persistent facial flushing in those individuals without rosacea due to a separate condition, histamine intolerance.

Certain medications and topical irritants can quickly trigger rosacea. Some acne and wrinkle treatments that have been reported to cause rosacea include microdermabrasion and chemical peels, as well as high dosages of isotretinoin, benzoyl peroxide, and tretinoin. Steroid induced rosacea is the term given to rosacea caused by the use of topical or nasal steroids. These steroids are often prescribed for seborrheic dermatitis. Dosage should be slowly decreased and not immediately stopped to avoid a flare up.

A survey by the National Rosacea Society of 1,066 rosacea patients showed which factors affect the most people:[12]

  • Sun exposure 81%
  • Emotional stress 79%
  • Hot weather 75%
  • Wind 57%
  • Heavy exercise 56%
  • Alcohol consumption 52%
  • Hot baths 51%
  • Cold weather 46%
  • Spicy foods 45%
  • Humidity 44%
  • Indoor heat 41%
  • Certain skin-care products 41%
  • Heated beverages 36%
  • Certain cosmetics 27%
  • Medications (specifically stimulants) 15%
  • Medical conditions 15%
  • Certain fruits 13%
  • Marinated meats 10%
  • Certain vegetables 9%
  • Dairy products 8%

It should be noted however that there exists significant disagreement amongst sufferers and clinicians as to the validity of these aggravators/triggers being categorized as causes of rosacea. The claim of rosacea being caused (as opposed to aggravated) by the above list has not been established by epidemiological scientific study.[13] Many sufferers report that elimination of triggers has little or no eventual impact on the actual progression of the disease. The above list should in no way be taken as an explanation of rosacea causes, as the spectrum disease is more complex than simply a direct or sole result of habits and diet.

Cathelicidins

Richard L. Gallo, M.D., Ph.D, and colleagues recently noticed that patients with rosacea had elevated levels of the peptide cathelicidin[14] and elevated levels of stratum corneum tryptic enzymes (SCTEs). Antibiotics have been used in the past to treat rosacea but they may only work because they inhibit some SCTEs.[15]

Intestinal Bacteria: Small intestinal bacterial overgrowth

Intestinal bacteria may play a role in causing the disease. A recent study subjected patients to a hydrogen breath test to detect the occurrence of small intestinal bacterial overgrowth (SIBO). It was found that significantly more patients were hydrogen-positive than controls indicating the presence of bacterial overgrowth (47% v. 5%, p<0 .001=".001" br="br">
Hydrogen-positive patients were then given a 10-day course of rifaximin, a non-absorbable antibiotic that does not leave the digestive tract and therefore does not enter the circulation or reach the skin. 96% of patients experienced a complete remission of rosacea symptoms that lasted beyond 9 months. These patients were also negative when retested for bacterial overgrowth. In the 4% of patients that experienced relapse, it was found that bacterial overgrowth had returned. These patients were given a second course of rifaximin which again cleared rosacea symptoms and normalized hydrogen excretion.[16]

In another study, it was found that some rosacea patients that tested hydrogen-negative were still positive for bacterial overgrowth when using a methane breath test instead. These patients showed little improvement with rifaximin, as found in the previous study, but experienced clearance of rosacea symptoms and normalization of methane excretion following administration of the antibiotic metronidazole, which is effective at targeting methanogenic intestinal bacteria.[17]

These results suggest that optimal antibiotic therapy may vary between patients and that diverse species of intestinal bacteria appear to be capable of mediating rosacea symptoms.

This may also explain the improvement in symptoms experienced by some patients when given a reduced carbohydrate diet.[18] Such a diet would restrict the available material necessary for bacterial fermentation and thereby reduce intestinal bacterial populations.

Demodex folliculorum Mites

Studies of rosacea and demodex folliculorum mites have revealed that some people with rosacea have increased numbers of the mite, especially those with steroid induced rosacea.[19] Demodex folliculorum may be a cause or exacerbating factor in rosacea. When large numbers of the mites are present they may play a role along with other triggers. On other occasions demodicidosis (mange) is a separate condition that may have rosacea-like appearances.[20] Rosacea, as well as acne, has also been implicated in that it is theorised to be caused by a reaction to bacteria in the mite's feces.[21]

According to Kevin Kavanagh's "Potential Role of Demodex mites and bacteria in the induction of rosacea" published online ahead of print in the Journal of Medical Microbiology:

"Mites of a species called Demodex folliculorum live harmlessly in normal skin, dwelling inside structures surrounding hair follicles. Research now shows rosacea patients have more of these mites in their skin than those without rosacea,"

"The mites are known to contain bacteria called Bacillus oleronius, which produce a protein that provokes an immune reaction in rosacea patients. The research suggests this is what may trigger the condition," Kavanagh said.

"Moreover, these bacteria are sensitive to the antibiotics used to treat rosacea. (Antibiotics have been used to treat rosacea, but mainly for their anti-inflammatory effects, not because they kill bacteria)."

"When the mites die, the bacteria are released and leak into surrounding skin tissues — triggering tissue degradation and inflammation," Kavanagh said.

"Targeting these bacteria may be a useful way of treating and preventing this condition," Kavanagh said. Kavanagh also noted some pharmaceutical companies are already developing therapies to control the population of mites in the face of patients. 

Jarmuda S, O'Reilly N, Zaba R, Jakubowicz O, Szkaradkiewicz A, Kavanagh K. Potential role of Demodex mites and bacteria in the induction of rosacea. http://jmm.sgmjournals.org/content/61/Pt_11/1504.abstract?sid=eece9564-e359-43b7-9bde-6b53418f1420. doi: 10.1099/jmm.0.048090-0 J Med Microbiol November 2012 vol. 61 no. Pt 11 1504-1510. PMID: 22933353. Department and Clinic of Dermatology, University of Medical Sciences, Poznań, Poland.


Skin Cleansing

Note: Please do not self-treat or use any "home remedy" without the supervision of an attending physician or dermatologist! Thus, if there is any acute reaction, a physician is available and responsible to take care of the problem.

Using fingertips, wash face (do not scrub!) with an antiseptic/antimicrobial skin cleansing product such as Hibiclens® or an antibacterial cleanser such as CeraVe® or Cetaphil®. Rinse face with tepid (lukewarm) water and "pat dry" (do not rub!).

You may find that along with avoiding your "triggers", twice daily (morning and evening) skin cleansing will be all you need to help control microorganisms on the skin's surface, and to begin clearing up the papules and redness. Please keep in mind any remedy you use, whether it is a home remedy or a prescription from the dermatologist, to battle Rosacea is not an instant cure-all, and may need to be continued once or twice daily as a "maintenance routine" for at least a year, possibly longer.

After cleansing your skin, apply a non-comedogenic (will not clog pores), hypoallergenic moisturizing product such as CeraVe® or Cetaphil® to your entire face in the morning (preferably one that contains a SPF), and before bed to help alleviate any dryness of the skin. Also, putting a very thin layer of antibacterial ointment, such as Neosoprin® over the entire surface of the skin (or you can opt to put a dab of it directly onto the papule) - where ever there is redness and/or papules - will help to ward off any skin infections.

To cleanse the body from the inside and bring harmony to the immune system, add 1-2 tablespoons of organic raw apple cider vinegar, such as Bragg®, to an 8 ounce glass of purified water. Drink 3 (three) times a day.

If you are self-conscious about your Rosacea, there are fragrance free, non-comedogenic (will not clog pores) and hypoallergenic (formulated to minimize the risks of allergic reactions) water-based cosmetic products (avoid using oil-based) that can be applied to the face after cleansing to help cover the redness and papules. There are charts located in the cosmetics aisle to assist you to find one that closely matches your skin's natural coloring. I recommend the liquid form not powder.

Other Preventive measures to avoid mite reinfestation include:

  • Wash pillow case and bedding in hot water and dry on high-heat setting. If bed pillow is not washable, or you do not have a pillow protector (used to protect against dust mites, bed bugs) throw it away and buy a new one!
  • Women: discard all cosmetics currently used on the face, as the mite bacteria can infect them, and when they are applied to the face or eye area, the bacteria can then reinfect the skin. If you choose to continue to wear cosmetics on your face, choose those products that are fragrance free, non-comedogenic (will not clog pores) and hypoallergenic (formulated to minimize the risks of allergic reactions).
  • Men: Disinfect your razors or electric shavers by briefly soaking the blades in Isopropyl Rubbing Alcohol (make sure the label says 70% or 91%) after each use.
  • Use a clean towel for each face wash!
  • Some people apply a very thin layer of diluted tea tree oil along the lash line to kill any mites and/or their eggs. This is not recommended, as diluted tea tree oil can be very irritating to the eyes! Applying a very thin layer of petroleum jelly to the eyelashes and along the lash line before bedtime does help to trap the mites upon their emergence from the eyelash follicle. Upon waking, wash your eyelids and eyelashes with an antibacterial soap to remove the petroleum jelly and any trapped mites.

Diagnosis

Most people with rosacea have only mild redness and are never formally diagnosed or treated. There is no single, specific test for rosacea.

In many cases, simple visual inspection by a trained person is sufficient for diagnosis. In other cases, particularly when pimples or redness on less-common parts of the face are present, a trial of common treatments is useful for confirming a suspected diagnosis.

The disorder can be confused with, and co-exist with acne vulgaris and/or seborrhoeic dermatitis. The presence of rash on the scalp or ears suggests a different or co-existing diagnosis as rosacea is primarily a facial diagnosis, although it may occasionally appear in these other areas.

Map Summarizing Rosacea. Author: created by Maen K. Househ and Reem Al-Qudah using Clinical dermatology book[1]. Reference: 1Dahl, Mark V.; Weller, Richard E.; Hunter, John G.; Savin, John (2008) Clinical Dermatology, Wiley-Blackwell ISBN: 1-4051-4663-X. Link to original map file (.mmap)

Treatment

If rosacea is left untreated, it will continue to worsen. Treating rosacea varies depending on severity and subtypes. A subtype-directed approach to treating rosacea patients is recommended to dermatologists.[22]

Oftentimes, both women and men disregard mild cases of rosacea and do not seek treatment, instead opting to cover their facial redness with normal cosmetics. Unbeknownst to them, these cosmetics become contaminated with bacteria from the mites, and upon reapplying the cosmetic the bacteria is reapplied to the face right along with it.

Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of erythema and inflammatory lesions, decrease in the number, duration, and intensity of flares, and concomitant symptoms of itching, burning, and tenderness. The two primary modalities of rosacea treatment are topical and oral antibiotic agents.[23] While medications often produce a temporary remission of redness within a few weeks, the redness typically returns shortly after treatment is suspended. Long-term treatment, usually one to two years, may result in permanent control of the condition for some patients. Lifelong treatment is often necessary, although some cases resolve after a while and go into a permanent remission.

Behavior

Trigger avoidance can help reduce the onset of rosacea but alone will not normally cause remission for all but mild cases. It is sometimes recommended that a journal be kept to help identify and reduce food and beverage triggers.[24]

Because sunlight is a common trigger, avoiding excessive exposure to sun is widely recommended. Some people with rosacea benefit from daily use of a sunscreen; others wear hats with broad brims.

Like sunlight, emotional stress can also serve as a trigger for rosacea.

A recent publication discusses how managing pre-trigger events such as prolonged exposure to cool environments can directly influence warm room flushing.[25]

How Is the Eye Affected?

In addition to skin problems, many people who have rosacea have ocular (eye) problems caused by the condition. Typical symptoms include redness, dryness, itching, burning, tearing, slight twitching sensation of the eyelid, the sensation of having sand in the eye, and a thinning of or the loss of eyelashes (fortunately, the eyelashes will fully regrow in about 3-6 weeks). The eyelids may become inflamed and swollen. Some people say their eyes are sensitive to light and their vision is blurred or otherwise impaired.

People who develop infections of the eyelids must practice frequent eyelid hygiene. Daily, gentle cleansing of the eyelids with diluted baby shampoo or an over-the-counter eyelid cleaner, and applying warm (not hot) compresses several times a day is recommended. 

Prescription Medication

Oral tetracycline antibiotics (tetracycline, doxycycline, minocycline) and topical antibiotics such as metronidazole are usually the first line of defense prescribed by doctors to relieve papules, pustules, inflammation and some redness.[26] Topical azelaic acid such as Finacea (15%) or Skinoren (20%) may help reduce inflammatory lesions, bumps and papules. Using alpha-hydroxy acid peels may help relieve redness caused by irritation, and reduce papules and pustules associated with rosacea.[27] Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed.[28] Isotretinoin has many side effects and is normally used to treat severe acne but in low dosages is proven to be effective against papulopustular and phymatous rosacea. Some individuals respond well to the topical application of sandalwood oil on the affected area, particularly in reducing the prevalence of pustules and erythema.

The treatment of flushing and blushing has been attempted by means of the centrally acting α-2 agonist clonidine, but this is of limited benefit on just this one aspect of the disorder.[29] The same is true of the beta-blockers nadolol and propranolol. If flushing occurs with red wine consumption, then complete avoidance helps. There is no evidence at all that antihistamines are of any benefit in rosacea. However: people with underlying allergies and who respond strongly to foods that are high in histamine or that release a lot of histamine in the body do find sometimes that their flushing symptoms diminish with oral antihistamines (for instance loratadine). Another medication that can help some people with facial flushing and burning is mirtazapine (remeron).

Recently, a clinically trialled topical product combining plant-sourced methylsulfonylmethane (MSM) and silymarin showed effectiveness in one study treating rosacea, skin redness and flushing.[30]

Laser

Dermatological vascular (vein) laser (single wavelength) or intense pulsed light (broad spectrum) machines offer one of the best treatments for rosacea, in particular the erythema (redness) of the skin.[31] They use light to penetrate the epidermis to target the capillaries in the dermis layer of the skin. The light is absorbed by oxy-hemoglobin which heat up causing the capillary walls to heat up to 70 °C (158 °F), damaging them, causing them to be absorbed by the body's natural defense mechanism. With a sufficient number of treatments, this method may even eliminate the redness altogether, though additional periodic treatments will likely be necessary to remove newly formed capillaries.

The carbon dioxide laser (CO2 laser) can be used to resurface skin and treat wrinkles, uneven skin coloration, acne scarring, remove excess tissue caused by phymatous rosacea, and other skin concerns. CO2 lasers emit a wavelength that is absorbed directly by the skin. The laser beam can be focused into a thin beam and used as a scalpel or defocused and used to vaporise tissue. Low level light therapies have also been used to treat rosacea. Laser facial photorejuvenation can also be used to improve the appearance of rosacea and reduce the redness associated with it.[32][33][34] 

External Links

Rosacea May Be Caused by Bacteria from Mites - LiveScience.com.
Do You Have Rosacea? Take the Quiz - Galderma Laboratories, L.P. United States.
Rosacea: Information for Adults - Logical Images, Inc.
Red in the Face: Understanding Rosacea - National Institutes of Health (NIH)
Rosacea - American Academy of Dermatology (AAD).
Rosacea - American Academy of Family Physicians.

Diagnosis/Symptoms
Accurate Diagnosis "Right Stuff" to Relieve Redness, Swelling - American Academy of Dermatology (AAD).
Rosacea Has Many Signs and Symptoms - American Academy of Dermatology (AAD).
Rosacea: Signs and Symptoms - American Academy of Dermatology (AAD).

Treatment
Is Laser Treatment Right for Your Rosacea? - American Academy of Dermatology (AAD).
Rosacea Treatment: Bumps and Pus-Filled Lesions - American Academy of Dermatology (AAD).
Rosacea Treatment: Eye Problems - American Academy of Dermatology (AAD).
Rosacea Treatment: Redness, Flushing, and Visible Blood Vessels - American Academy of Dermatology (AAD).
Rosacea Treatment: Thickening Skin - American Academy of Dermatology (AAD).

Complementary and Alternative Medicine (CAM) Therapy
Good and Bad of "All Natural" Therapy for Rosacea - American Academy of Dermatology (AAD).

Coping
Controlling Rosacea Can Boost Self-Esteem - American Academy of Dermatology (AAD).
Coping with Rosacea: Managing Psychosocial Aspects of Rosacea - National Rosacea Society.

Disease Management
Coping with Rosacea: Tripwires - National Rosacea Society.
Gentle Skin Care Helps Control Rosacea - American Academy of Dermatology (AAD).
Managing Rosacea: A patient guide for controlling this chronic and often complex disorder - National Rosacea Society.

Specific Conditions
Ocular Rosacea - Mayo Foundation for Medical Education and Research.
What Is Ocular Rosacea? - American Academy of Dermatology (AAD).

Related Issues
Frequently Asked Questions about Rosacea - American Academy of Dermatology (AAD).
Seborrheic Dermatitis - National Rosacea Society.

Pictures and Photographs
Rosacea - Logical Images, Inc.
What Rosacea Looks Like - American Academy of Dermatology (AAD).

Health Check Tools
Flushing - DSHI Systems.

Clinical Trials
ClinicalTrials.gov: Rosacea - National Institutes of Health (NIH).

Research
Cosmetic Choices Can Blend with Therapy - National Rosacea Society.

Dictionaries/Glossaries
Glossary - American Academy of Dermatology (AAD).

Directories
Find a Dermatologist - American Academy of Dermatology (AAD).

Organizations
National Rosacea Society.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
American Academy of Dermatology (AAD).

Women
Women May Need Added Therapy for Rosacea - National Rosacea Society.

References
1. Koepsell, Thomas (2002). "Domenico Ghirlandaio: An Old Man and His Grandson (ca 1480-1490)". Arch Pediatr Adolesc Med 156: 966.
2. "rosacea" http://web.archive.org/web/20090616022448/http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/seven/000093684.htm. at Dorland's Medical Dictionary
3. "Glossary - Dermatology - Online Medical Encyclopedia - University of Rochester Medical Center". http://www.urmc.rochester.edu/encyclopedia/content.cfm?pageid=P01903#R.
4. "Rosacea". http://www.dermnetnz.org/acne/rosacea.html. DermNet, New Zealand Dermatological Society.
5. Wollina, U; Verma, SB (2009 Sep). "Rosacea and rhinophyma: not curse of the Celts but Indo Eurasians.". Journal of cosmetic dermatology 8 (3): 234–5. PMID 19735524.
6. "All About Rosacea". National Rosacea Society. http://www.rosacea.org/patients/allaboutrosacea.php.
7. Wilkin J, Dahl M, Detmar M, Drake L, Liang MH, Odom R, Powell F (2004). "Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea" (PDF reprint). J Am Acad Dermatol 50 (6): 907–12. doi:10.1016/j.jaad.2004.01.048. PMID 15153893.
8. Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. ISBN 1-4160-3185-5.
9. Slideshow: The Many Faces of Rosacea.
10. Jansen T, Plewig G (1998). "Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities". Facial Plast Surg 14 (4): 241–53. doi:10.1055/s-2008-1064456. PMID 11816064.
11. Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
12. Rosacea.org: The National Rosacea Society. Rosacea triggers survey http://www.rosacea.org/patients/materials/triggersgraph.php.
13. Lisa Faulkner: My unslightly rosacea - Celebrity gossip on Now Magazine. http://www.nowmagazine.co.uk/celebrity-news/237023/lisa-faulkner-my-unslightly-rosacea/1/.
14. Yamasaki K, Di Nardo A, Bardan A, et al. (August 2007). "Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea". Nat. Med. 13 (8): 975–80. doi:10.1038/nm1616. PMID 17676051.
15. Kenshi Yamasaki, Anna Di Nardo, Antonella Bardan, Masamoto Murakami, Takaaki Ohtake, Alvin Coda, Robert A Dorschner, Chrystelle Bonnart, Pascal Descargues, Alain Hovnanian, Vera B Morhenn, Richard L Gallo. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nature Medicine 13, 975 - 980 (2007). Published online: 5 August 2007. doi:10.1038/nm1616. http://www.nature.com/nm/journal/v13/n8/abs/nm1616.html.
16. Parodi A,Paolino S,Greco A,Drago F,Mansi C,Rebora A,Parodi AU,Savarino V (May 2008). "Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication". Clin Gastroenterol Hepatol. 6 (7): 759–64. doi:10.1016/j.cgh.2008.02.054. PMID 18456568.
17. UEGW Vienna 2008 - 16th United European Gastroenterology Week. http://www.worldendo.org/assets/downloads/pdf/publications/reports/2008_uegw_endoscopy_reports.pdf.
18. Intestinal Disaccharidase Activity in Rosacea - Paton et al. 1 (5485): 459 - British Medical Journal. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1843610/.
19. Erbagcaronci Z, Özgöztascedili O (June 1998). "The significance of Demodex folliculorum density in rosacea". Int J Dermatol. 37 (6): 421–5. doi:10.1046/j.1365-4362.1998.00218.x. PMID 9646125.
20. Baima B, Sticherling M (2002). "Demodicidosis revisited". Acta Derm Venereol 82 (1): 3–6. doi:10.1080/000155502753600795. PMID 12013194.
21. MacKenzie, Debora (30 August 2012). "Rosacea may be caused by mite faeces in your pores". New Scientist. http://www.newscientist.com/article/dn22227-rosacea-may-be-caused-by-mite-faeces-in-your-pores.html.
22. Aaron F. Cohen, MD, and Jeffrey D. Tiemstra, MD (May–June 2002). "Diagnosis and treatment of rosacea". J Am Board Fam Pract 15 (3): 214–7. PMID 12038728.
23. Noah Scheinfeld,MD,JD, and Thomas Berk, BA (January 2010). "A Review of the Diagnosis and Treatment of Rosacea". Postgraduate Medicine. 122 (1): 139–43. doi:10.3810/pgm.2010.01.2107. PMID 20107297. http://www.postgradmed.com/index.php?article=2107.
24. Eating a Healthy, Well-rounded Diet Can be the Best Recipe for Healthy Skin. http://www.newswise.com/articles/view/535198/.
25. Dahl, Colin (2008). A Practical Understanding of Rosacea - part one.. Australian Sciences. http://www.ausci.com/rosacea.htm.
26. Dahl MV, Katz HI, Krueger GG, Millikan LE, Odom RB, Parker F, Wolf JE Jr, Aly R, Bayles C, Reusser B, Weidner M, Coleman E, Patrignelli R, Tuley MR, Baker MO, Herndon JH Jr, Czernielewski JM (June 1998). "Topical metronidazole maintains remissions of rosacea". Arch Dermatol 134 (6): 679–83. doi:10.1001/archderm.134.6.679. PMID 9645635.
27. Tung, RC; Bergfeld, WF; Vidimos, AT; Remzi, BK (2000). alpha-Hydroxy acid-based cosmetic procedures. Guid... [Am J Clin Dermatol. 2000 Mar-Apr] - PubMed result. 1. 81–8. PMID 11702315.
28. Hoting E, Paul E, Plewig G (December 1986). "Treatment of rosacea with isotretinoin". Int J Dermatol 25 (10): 660–3. doi:10.1111/j.1365-4362.1986.tb04533.x. PMID 2948928.
29. Cunliffe WJ, Dodman B, Binner JG (January 1977). "Clonidine and facial flushing in rosacea". Br Med J 1 (6053): 105. doi:10.1136/bmj.1.6053.105. PMC 1604111. PMID 137764.
30. Berardesca E, Cameli N, Cavallotti C, Levy JL, Piérard GE, de Paoli Ambrosi G (2008). "Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation". J Cosmet Dermatol 7 (1): 8–14. doi:10.1111/j.1473-2165.2008.00355.x. PMID 18254805. http://www.blackwell-synergy.com/doi/full/10.1111/j.1473-2165.2008.00355.x.
31. Marla C Angermeier (1999). "Treatment of facial vascular lesions with intense pulsed light". J Cutan Laser Ther. 1 (2): 95–100. doi:10.1080/14628839950516922. PMID 11357295.
32. Rigel, Darrell S.; Robert A. Weiss, Henry W. Lim, Jeffrey S. Dover (2004). Photoaging. Informa Health Care. p. 174. ISBN 0-8247-5450-6.
33. "PHOTO REJUVENATION". Archived from the original on 2008-08-04. http://web.archive.org/web/20080804102039/http://www.topdocs.com/display_procedure.php?id=photorejuvenation.
34. "Research a cosmetic surgery procedure". http://www.cosmeticsurgery.com/research/cosmetic-surgery/Photo-Rejuvenation/.
35. Jane E. Brody (March 16, 2004). "Sometimes Rosy Cheeks Are Just Rosy Cheeks". New York Times. http://www.nytimes.com/2004/03/16/health/personal-health-sometimes-rosy-cheeks-are-just-rosy-cheeks.html.
36. Fergie back in business after heart scare - ABC News (Australian Broadcasting Corporation). http://www.abc.net.au/news/stories/2003/12/06/1004714.htm.
37. Burnham, Virginia (2003). The Two-Edged Sword: A Study of the Paranoid Personality in Action. Sunstone Press. p. 61. ISBN 978-0-86534-147-0. http://books.google.com/?id=zMoN2XhwNXEC&pg=PA61&dq=rosacea+morgan.
38. 4 May 2009-4-5 p.m. http://twitter.com/megcabot.
39. Rosie O'Donnell - ELLE. http://www.elle.com/featurefullstory/11455/rosie-odonnell-page3.html.
40. Armstrong, Lisa (2007-02-16). "Ive got thighs and buttocks Im never going to be a size zero". The Times (London). http://www.thetimes.co.uk/tto/life/fashion/article1751703.ece. Retrieved 2010-05-22.
41. Subscription Center - News Archive. http://www.pharmalive.com/News/Index.cfm?articleid=433576.
42. Amstell, Simon (2005-08-21). "Q&A". The Guardian (London). http://observer.guardian.co.uk/omm/qanda/story/0,,1550882,00.html.
43. Lisa Faulkner: My unslightly rosacea - Celebrity gossip on Now Magazine. http://www.nowmagazine.co.uk/celebrity-news/237023/lisa-faulkner-my-unslightly-rosacea/1/.
44. Dita Von Teese on conquering rosacea. http://news.beautybridge.com/hair-and-skin-conditions/dita-von-teese-on-conquering-rosacea.
45. Appleyard, Diana (2011-02-27). "I'm not drunk I have rosacea: Carol Smillie tells embarrassing story of facial flushes". Daily Mail (London). http://www.dailymail.co.uk/health/article-1360932/Im-drunk-I-rosacea-Carol-Smillie-tells-embarrassing-facial-flushes-common-skin-problem.html.
46. Living with Rosacea: An Interview with Cynthia Nixon. http://www.empowher.com/rosacea/content/living-rosacea-interview-cynthia-nixon. HW, LLC d/b/a EmpowHER Media.
47. Diane Kruger: Make-up swamps me. "I have rosacea so I use..." http://www.belfasttelegraph.co.uk/woman/fashion-beauty/diane-kruger-makeup-swamps-me-16170693.html. Belfast Telegraph. www.belfasttelegraph.co.uk.


NIH Publication No. 09–5038 provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH). The NIAMS gratefully acknowledges the assistance of the following individuals in the preparation and review of the original version of this booklet: Mark Dahl, M.D., Mayo Clinic, Scottsdale, AZ; Sam Huff, National Rosacea Society, Barrington, IL; Robert Katz, M.D., Rockville, MD; M. Carol McNeely, M.D., University Dermatology Associates, Washington, DC; Larry Miller, M.D., Chevy Chase, MD; Alan Moshell, M.D., NIAMS, NIH; and Gary Peck, M.D., Washington Hospital Center, Washington, DC. 

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