Sensitive skin, rosacea, adult acne—how can you tell where you fit?
A recent article in the New York Times by Camille Sweeney, “In a Perfect World, Rosacea Remains a Problem” suggests that rosacea has become “the new cellulite.” That is, the people who “just have rosy cheeks” shouldn’t worry. However, and this is where the rub comes in, anyone who has rosacea knows they are not dealing with a case of just rosy cheeks, which can, I agree, be very attractive.
We rosacea-sufferers are painfully aware that a full-blown rosacea flare-up-- where the whole face is bright red or appears rashy-- is not at all attractive. Roscaea can be an embarrassment or even, as in the case of the airline pilot Sweeney mentions in her story, interfere with job performance. The airline pilot in question had rhinophema, the condition that affects men more than women and presents as tissue thickening and redness in the nose area. It has so often been referred to jokingly as a wino’s nose that people take it for granted that folks thus afflicted are heavy drinkers. The pilot has to work hard to cover up his nose with cosmetics and zinc oxide because it does not signal a drinking problem in his case, but a condition that is very hard to treat, and for which there is no known cure. The stigma of “wino’s nose” could have serious repercussions for him given his profession.
It is estimated that rosacea sufferers total up to 14 million in the US alone, and the number is climbing. As a sufferer myself I do not dismiss it as a cosmetic concern like cellulite, but a very embarrassing and potentially debilitating disease. True, it is not life-threatening but it does qualify, nonetheless, as a serious skin condition, especially if you are at stage two which presents with rashes and/or broken capillaries, or stage three rhinophema.
It is also true, as Sweeney points out, that many people do not know they have rosacea. If the condition is limited to rosy cheeks it probably doesn’t merit an emergency trip to the dermatologist to get a diagnosis. However I suggest that if you have any of the following: overall redness, patches of redness, areas that look broken-out, painfully dry skin or rough, scaly areas, then it might be time to pay that dermatologist a visit.
Many people are diagnosed with rosacea. Many others suspect they may suffer from rosacea because they have many of the symptoms—permanent redness and/or small eruptions on the cheeks that are not pimples Of course, it should go without saying that seeing your dermatologist is always the first step towards treating any skin condition. For example, a rash on the cheeks which looks like rosacea to you will suggest a host of differential diagnoses, some of which may have serious health consequences, to a specialist. It is crucial to rule out other medical problems before proceeding with treatment.
In addition, you need a specialist’s diagnosis before deciding on a treatment course. An error common to people acting on their own is to treat rosacea like a case of adult acne, understandable because they can have quite similar symptoms. However, rosacea-prone skin is sensitive and sulfer-containing topicals, astringents and alcohol routinely used to control acne can seriously aggravate a rosacea-type condition and create setbacks in controlling it. If you have a diagnosis of rosacea you will also want to avoid taking steroids like hydrocortisone. Steroids suppress inflammation so they may look like they are working at first, but it ‘s quite possible that a “rebound effect” could make matters worse down the road. With a rebound effect the rosacea symptoms return with a vengeance and are very difficult to control.
Another common source of confusion exists around differentiating sensitive skin from rosacea or rosacea-prone skin. From a strictly diagnostic point of view sensitive skin is characterized by an increased susceptibility to stinging, but is also characterized by other criteria such as: skin which tends to go red, skin of photo type I or II (very fair and fair), known allergy, a basic dermatological disease such as atopic dermatitis or psoriasis, known intolerances to cosmetic products, or the subjective feeling of a lack of oil and moisture content of the skin. As you can see, figuring out what category your skin falls into can be tricky, especially as categories can overlap. Here are some red flags, so to speak, that will help you distinguish between common skin conditions.
Rosacea: Rosacea is vascular instability aggravated by an underlying inflammatory condition which may or may not be chronic. While we do not know what causes rosacea we do know its identifying characteristics, and a primary one has to do with flushing episodes. Everyone is familiar with the sensation of blushing. The flushing may be triggered by UV exposure, exercise, certain foods, allergic reactions, emotional stress or heat, among other things. In normal skin flushing caused by capillary expansion recedes quickly--once the stressor is removed capillaries shrink, usually within minutes. With rosacea the capillaries expand and stay dilated for much longer periods of time. If you are still red after 10-15 minutes you may be dealing with rosacea.
Adult acne: adult acne looks much like teenage acne, with outbreaks of blackheads, whiteheads and pimples. Women are more prone to seeing outbreaks along the jawline and chin. Adults with acne tend to have skin that is dry and sensitive as opposed to oily, an indication that hormonal influences are at work. The formation of pus in the pimples distinguishes adult acne from roscea-type outbreaks that typically occur across the cheeks. Rosacea outbreaks look more like rashes, with little to no pus formation.
Sensitive skin: In humans with delicate, sensitive or vulnerable skin, a neurosensory phenomenon called "stinging" can be observed. This "delicate skin" differs fundamentally from "dry skin" characterized by thickened and hardened horny layers.
Typical reactions of "stinging" on delicate skin are reddening, tightening and burning of the skin and itching.
They can be caused by stimulating ambient conditions such as: massage and the action of surfactants and exfoliants, and the influence of weather like sun, cold, dryness and also damp heat, thermal radiation and UV radiation.
There is also the problem of topicals--a person who experiences "stinging effects" in contact with a topical application will with high probability experience it repeatedly on each further contact. However, it is a very individual matter, and people with sensitivity issues must monitor for themselves what works and what doesn’t with their particular skin. Interestingly, you may develop a sensitivity over time, so that a product you have used for years may suddenly cause a flare-up.
Crossover and multiple conditions are also common, which doesn’t help when you are looking to identify and treat your unique skin problems. However, there are some things all skin types should pay attention to.
1) UVB protection. Exposure to the ultraviolet component of solar rays in the range between 290 nm and 320nm, the UVB range, causes erythema (redness), simple sunburn or even burns of greater or lesser severity. Acneic, sensitive and rosacea skin types need daily UVB protection. Zinc oxide is anti-inflammatory and provides protection in the UVB range.
2) It has been proven that the UVA range between 320 and 400 nm damages the elastin and collagen fibres of connective tissue, which causes the skin to age prematurely. It can also cause numerous phototoxic and photo-allergic reactions, and the damaging influence of UVB radiation may be intensified by UVA radiation. Sensitive, mature and rosacea skin types especially require UVA protection daily and year round. Zinc oxide provides protection up to and even past the 400 nm range, and is the best non-allergenic ingredient available for protection against the longer wave-lengths of ultra-violet light.
3) UV radiation is also implicated in the formation of ionic species (free radicals), which are capable of intervening oxidatively in biochemical processes. To prevent these reactions additional antioxidants and/or free-radical scavengers should be incorporated into cosmetic or dermatological formulations. All skin types should look for anti-oxidants like Vit E, Vit C, alpha-lipoic acid, and Co-enzyme-Q (idebenone) in their topicals.
4) Sensitive, dry or problematic skin often starts with a compromised "permeable" barrier (the top layer of the epidermis, the stratum corneum, which retains moisture). Products having an occlusive action or lipid-substituting products which lower the TEWL (transepidermal water loss) are recommended for barrier regeneration. Sensitive, mature, rosacea and even acneic skin types should be aware that lipids are the skin’s first line of defense against invasion by bacteria, pollution and UV exposure. Your skin will be happier if you add oil to it rather than strip oil away—even If you have oily, blemish-prone skin!
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