It tends to redden especially on the cheeks and forehead and, in severe cases, can create skin rashes, often mistaken for acne. Sufferers – including stars Renée Zellweger, Dita Von Teese and Ireland Basinger Baldwin – feel embarrassed because rosacea is one of the most difficult skin diseases to control. April is the international month dedicated to this chronic skin disease that affects about 415 million people around the world and over 3 million in Italy, or 7-8% of the adult population in our territory.
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The cause
Rosacea is a common inflammatory skin disease that mostly affects the central areas of the face, such as the cheeks and nose. It affects both adult males and females, often after the age of 30. The causes of rosacea are still debated, but several triggers are known, including the consumption of spicy foods or alcoholic beverages, emotional stress, sun exposure, hot baths. On the skin of people with rosacea, mites of the genus Demodex, generally harmless, can also be detected in high quantities.
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The study of heredity
Heredity is also one of the possible causes. Just recently, an Italian retrospective observational study published in Journal of Clinical and Aesthetic Dermatology who evaluated data on intra-family transmission of rosacea over six generations. The analysis examined rosacea patients who referred to the Dermatology Clinic of the University of Catania from June 2018 to June 2019. The researchers collected demographic information relating to anamnestic and clinical characteristics and data, including grade severity of skin disease according to the recommendations of the ROSaceaCOnsensus (ROSCO). This resulted in a prevalence of familial rosacea of 69.2%.
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Skin-deep symptoms
The more or less persistent redness of the skin is certainly the most visible and perhaps also the most annoying symptom of rosacea which can be aggravated by other clinical manifestations such as slight swelling, papules / pustules, as well as tingling, burning and increased sensitivity of the skin. The eyes can also often be affected, which present redness accompanied by a feeling of dryness and itching. Precisely for this reason, the disease represents a concern not only from a clinical point of view but also from an aesthetic point of view, consequently causing feelings of anxiety and embarrassment in those who suffer from it.
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Damage to the bezel
Worsening the situation in the last two years has been the use of the anti-Covid mask. An Italian multicenter study, published in Dermatologic Therapy Journal, analyzed the impact of wearing a mask, worn for at least 6 hours a day, in patients with rosacea and acne not being treated. In both cases, prolonged use of the device was found to have worsened disease symptoms, significantly affecting the patients’ quality of life. In particular, for rosacea, a worsening of the disease was found after 6 weeks, detected both by the clinician and by the patient’s self-assessment, with a statistically significant decrease in the quality of life.
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The emotional impact
Seeing yourself like this and feeling the sudden heat caused by redness on your skin can be embarrassing and undermine self-confidence. This is also shown by data from an online survey recently conducted by Galderma among people with rosacea in several countries. Up to 69% of respondents reported a negative impact on their mental health and psychophysical well-being due to the stigma associated with the disease, yet only one in five have addressed the issue with their doctor or dermatologist. Furthermore, almost half (48%) felt diminished by their peers, because the disease is considered by them to be a simple redness of emotion or shame and not a serious skin condition.
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Also treat psychological distress
Especially in the early stages, in fact, symptoms such as tingling and burning of the face are traced back to situations of emotional stress and therefore underestimated during a medical consultation, so much so that about 63% of survey participants reported having come across an incorrect diagnosis. . “Like many other skin and face diseases, rosacea causes embarrassment and discomfort, due to the clinical manifestations that affect the person’s image,” he explains Giuseppe Micali, Director of the Dermatological Clinic of the Department of General Surgery and Medical-Surgical Specialties of the University of Catania. “It is essential that the person with rosacea not only explains their symptoms in detail to the referring physician, but also that they talk about the psychological distress resulting from the disease. Attention to the patient’s psychophysical well-being, in fact, is part of the process of identifying a personalized, and consequently, more effective, therapeutic path “.
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Pharmacological therapies
Medical therapy is generally based on the use of drugs that are chosen based on how the disease presents itself, which is generally characterized by permanent redness of the face and / or inflammatory manifestations such as papules and pustules. “In the first case – explains Giuseppe Micali, – the use of a gel with a vasoconstrictive action is useful, in the second a cream based on ivermectin with anti-inflammatory and antiparasitic activity that has shown to be superior to conventional treatments”. Dilated capillaries may often be present. In these cases, how can we intervene? “The treatment of choice – replies the expert – is laser therapy. For the most serious forms, a novelty is represented by a low-dose systemic antibiotic that has no antibacterial activity (therefore it does not create antibiotic resistance) but has a powerful anti-inflammatory activity “.
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Daily cosmetics
Not all cosmetic products and creams are suitable for rosacea and therefore it is necessary to correctly choose the products to use daily. The skin of rosacea patients is very sensitive and for this reason it is advisable to avoid cosmetics containing alcohol or perfume and to favor dedicated cosmetic lines, available in pharmacies and produced by companies with proven experience in the dermatological field.
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Things to avoid for prevention
The sun is a common cause of facial redness, so it is recommended that people with rosacea avoid prolonged exposure and protect the skin with adequate photoprotectors (SPF 50+). Spicy food should be avoided: chilli, paprika, pepper and other spices can exacerbate the redness of the face. Is chocolate allowed? “In reality – Micali replies – chocolate can worsen redness since it contains cinnamic aldehyde as well as other foods that contain it such as tomatoes and cinnamon. Even too hot drinks and foods favor vasodilation and can therefore be aggravating factors “. An excessive physical activity in terms of duration and intensity can cause overheating of the body and therefore also of the face and this could be a source of worsening of the problem and it is therefore advisable to maintain an active lifestyle without exaggerating. Finally, sudden changes in temperature must be avoided, i.e. the sudden passage from very hot or very cold environments and vice versa.
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The diet that helps
Some foods, on the other hand, can help: they are those with anti-inflammatory properties based on vitamin B, ginger, turmeric, omega-3, olive oil. A diet rich in fiber is also useful for keeping the intestinal microbiota, that is the set of microbes that populate the intestine, healthy. “The diet can be integrated with the intake of probiotics – continues Micali – living microorganisms which, when administered in adequate quantities, bring a benefit to the health of the host. Probiotics are also contained in some fermented foods, such as yogurt “.
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Medical consultations and a community for patients
On the occasion of the international month of rosacea, a directory accessible to all users was launched on the Larosacea.it site to facilitate the request for a medical consultation in case of symptoms, even mild ones. In addition, an online space completely dedicated to the disease, Rosaceaspace, was created to provide information and create a community to break down the stigma. In this space, it will be possible to see and hear the experiences of those with rosacea around the world. Everyone can tell about their relationship with rosacea and see their contribution published, according to their sensitivity, with photographs, selfies and videos, but also poems, letters and music: anything related to their own experience with rosacea.