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Survey finds rosacea impacts work lives, including new job position or promotion
Ocular rosacea is effectively treated with oral doxycycline/minocycline.
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BARRINGTON, Ill. — A survey of more than 700 rosacea patients conducted by the National Rosacea Society found that 66% of those with severe symptoms were adversely affected in their professional interactions. Specifically, 33% of these respondents said they had cancelled or postponed business meetings because of their appearance, 28% reported missed work and 28% said it may have influenced their being chosen for a new job or promotion.
The society, which is headquartered here, estimates that 13 million Americans suffer from the widespread but little-known chronic facial disorder. Rosacea is also growing in prevalence as the baby-boom generation ages.
According to Guy F. Webster, MD, PhD, vice chairman in the Department of Dermatology at Jefferson Medical College in Philadelphia, “Rosacea is a disease of increased vascular reactivity. People who get rosacea blush and flush easily. They get red-faced.” The earliest stage of rosacea “is sort of a fixed blush, where you develop telangiectasia on the skin. This can progress to having papules and pustules,” he said. “Sometimes, you get overgrowth of the oil glands, which can lead to a bulbous nose like W.C. Fields.”
About 50% of patients with skin rosacea also have ocular rosacea. “Sometimes, it is manifested simply as blepharitis or a sense of irritation in the eye,” Dr. Webster said. Patients may develop sties or even corneal problems. However, “the degree of facial rosacea severity is in no way proportional to the eye. You can have a reasonably trivial face and bad eye and vice versa,” he said.
Effective treatment
--- The earliest stage of rosacea “is sort of a fixed blush, where you develop telangiectasia on the skin. This can progress to having papules and pustules,” Dr. Webster said. “Sometimes, you get overgrowth of the oil glands, which can lead to a bulbous nose like W.C. Fields.”
The only treatment for ocular rosacea that is effective uniformly is oral doxycycline or oral minocycline. “Virtually all patients see some improvement,” Dr. Webster said. In addition, “steroids applied topically make rosacea symptoms improve temporarily, but they damage the skin, so it is not something that you would want to use on the skin of the face or in the eye for any length of time.”
Left untreated, rosacea often progresses to bumps and pimples, and in some cases the eye may feel gritty and appear bloodshot.
Survey results indicated that even moderate symptoms of rosacea can negatively impact people’s work lives. Of those with moderate symptoms prior to treatment, 55% reported that it had affected their professional interactions, and 17% said it might have influence whether they were selected for a new job or promotion. Furthermore, 13% said they had cancelled or postponed business meetings, and 11% had missed work because of their disorder.
On the other hand, regardless of whether symptoms were moderate or severe, more than 70% of respondents said that effective treatment of rosacea had improved their work lives. In addition to medical therapy, avoidance of lifestyle and environmental factors can alleviate rosacea. Common rosacea triggers are sun exposure, emotional stress, excessive exercise, extreme weather, alcohol, spicy foods, hot baths, heated beverages and irritating skin-care products.
Prevalence varies
--- Ocular rosacea or chronically inflamed eyelid margins may be confused with seborrheic dermatitis.
The prevalence of rosacea varies greatly. “Almost everyone in Dublin, Ireland, has it to some degree,” Dr. Webster said. “But, in Philadelphia, where most people are pigmented to some degree, it is relatively less common.” Fair-skinned individuals are most prone to rosacea; however, sex does not impact prevalence rates in any meaningful way. “You don’t tend to see it in teenagers. It usually begins in the twenties and thirties and forties,” Dr. Webster said.
In his dermatologic practice, Dr. Webster finds that rosacea is the most common cause of blepharitis. “A fixed blush on the cheeks or a lot of telangiectasia is all it takes to diagnose rosacea,” he said.
The National Rosacea Society offers numerous tips for toning down rosacea redness. These include camouflaging makeup (green-tinted foundations, concealer sticks and even green-tinted moisturizers) and good fashion sense when selecting a wardrobe (plain black and white will accentuate the redness). In addition, protection from the sun with a sun protection factor of 15 or higher (for sensitive skin, a non-oily or pediatric formulation) and avoiding skin-care products that sting may help. Compliance with daily medication is also beneficial.
Dr. Webster said there is not much current research in rosacea. Still, the National Rosacea Society last fall issued its first research grants, which are funded by individual donations. Interim results of a society-funded study on the role of vascular endothelial growth factor (VEGF) in rosacea development suggests that after irradiation of the skin with ultraviolet light, VEGF increases in the skin, where it might affect blood vessels. Endothelial cells also appear to be more susceptible to VEGF after exposure to ultraviolet light.
For Your Information:
Guy F. Webster, MD, PhD, can be reached at 211 S. 9th St., Ste. 500, Walnut Towers, Philadelphia, PA 19107; (215) 955-1108; fax: (215) 955-1106; e-mail: guy.webster@mail.tju.edu. Dr. Webster has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
For further information and educational materials on rosacea, contact the National Rosacea Society, 800 S. Northwest Highway, Ste. 200, Barrington, IL 60010; (847) 382-8971 or (888) NO-BLUSH; fax: (847) 382-5567; e-mail: rosaceas@aol.com; Web site: www.rosacea.org.