Rum, Rudolf and Rosacea
By Dr. Michael Richie, MD
Richie Eye Clinic – Faribault, MN
Thanksgiving has come and gone, the lights are on the tree, the Christmas
cookies are in the oven, and the radio plays soft carols. You have finished
the greeting cards; the shopping is almost complete so you take time to read
the grandkids your favorite story…Rudolf the Red Nosed Reindeer.
Think about that story for a moment, though…a reindeer
with a bright red nose? How could that be? Just a “kid’s
story” you say? But what about W.C. Fields, Dean Martin, or
even Uncle Frank who shows up at every family function
three sheets to the wind with his big red nose? Was Rudolf
just an alcoholic reindeer?
In medical terms, the red nose in all of these examples, human at least, can
be explained by a skin condition known as acne rosacea.
Rosacea is a chronic inflammatory skin condition in fair-skinned adults
aged 30-60 years involving the face, usually across the nose, cheeks and
lower forehead. It tends to come and go, may cause red pimple-like lesions
called pustules, often makes the face “flushed” and creates the big red nose
(rhinophyma).
Although the actual cause of rosacea is unknown, this list of aggravating
“triggers” is lengthy and includes: hot beverages, spicy food, alcohol, sun
exposure, stress, and hot tubs.
In the early stages, “pre-rosacea” is a nuisance characterized by blushing
and redness of the nose, but damage to small blood vessels in the skin
indicates progression to “vascular rosacea.” The skin becomes overly
sensitive and oily with pustules; the eyelid margins become vascularized
and thickened, irritating the eye, reducing tear production and causing dry
eye symptoms. “Inflammatory rosacea” leads to scarring of the mucusproducing glands in the skin, especially the nose, with a build-up of tissue
that is the “big red nose” called rhinophyma.
With no definitive test for rosacea, we make the diagnosis based on history,
family history (yes, that means Uncle Frank is significant), and examination
of the skin, looking for evidence of the vascular damage and the thickened
eyelid margins.
Likewise, since we have no cure for rosacea treatment is geared to
controlling symptoms. For early rosacea, simple things like cool compresses
and artificial tears can bring relief while fish oil supplements help calm
most skin conditions.
For more advanced rosacea, topical antibiotics like metronidazole
(Metrogel), tretinoin (Atralin), azelaic acid (Azelec), and benzoyl peroxide
can be helpful. For some, oral antibiotics like tetracycline can provide relief.
In extreme cases, even isotretinoin (Accutane) may be necessary, despite its
many side-effects.
Most people with rosacea, however, have mild to moderate symptoms
where some simple suggestions can be all that is really needed. Start every
day by applying SPF 30 or higher sunscreen, protect your face in summer
with a wide-brimmed hat and in winter with a scarf or ski mask, wash your
face with a gentle cleanser, and reduce your alcohol consumption, whether
from a glass, a bottle, or in your skin care products.
Alternative therapies like colloidal silver, emu oil, laurelwood, oregano oil,
and vitamin K are as yet unproven.
In summary, the “big red nose” immortalized by W.C. Fields could, in all
probability, have been averted by a few simple lifestyle alterations and
some basic skin care ideas. But then, what would Christmas be without
Rudolf?
Note: Thanks to Heather Breck, clinical esthetician, and Jessica Kelm, RN,
for their advice and wisdom in compiling this report.