Those with this face rash condition will often will be asked if there are unwell, hot or blushing, No single cause for Rosacea has been identified but recent researched has suggested a number of potential triggers for this skin condition. Without knowing what causes Rosacea specifically it can be difficult to treat. This often leads to undo stress and depression in those who worry about their appearance which will often make the condition worse. Luckily many of the possible causes and factors involved that aggravate Rosacea are responsive to treatment. With some medical assistance the patient can dramatically reduce the impact the skin disorder by identifying the Rosacea triggers and having treatment prescribed accordingly, It affects approximately 3% of the population of European decent, women 3 times more than men and the peak of on set is between 30 and 60 years old. It will initially start as redness to primarily to the centre part of the face although it can involve the eyelids, forehead and scalp. As mentioned, there often will be no identifiable single cause but there are many lifestyle, diet and environmental factors, that are linked to aggravating skin conditions. Also a skin mite called Demodex, that hangs out in hair follicles and skin cells has been found in higher numbers in those suffering from Rosacea.

Before and After 3 treatments

There are four main sub types and variants of these. Often one sub type will exist along with another. The trend is for the gradual change from redness to developed broken vessels with acne-like bumps and pustules in the area and often accompanied with dry, gritty, red eyes and eyelids. In the more advanced stages the skin becomes very red, thickened, with irregular surface and nodular changes, creating distortion of the tissue in particular the nose (Rhinophyma). Fortunately most seek help before this advanced stage has a chance to develop.

AGGREVATORS /TRIGGERS

Any factors that cause episodes of flushing or blushing play a role in the development of Rosacea. There does not appear to be a genetic marker. The primary factors are as follows:

• Chronic and excessive sun exposure (>75%)
• Emotion stress (>75%)
• Heat
• Wind
• Excessive exercise
• Alcohol, caffeine, spicy foods, high histamine foods (Red wine, aged cheese and cured meats)

Less intense factors

• Skin care products
• Cosmetics
• Medications

In other words a huge spectrum of possibilities! Topical irritant procedures such as chemical peels, microdermabrasion, acne and wrinkle treatments, and topical uses that have Vitamin A, Benzyl Peroxide and Steroid based nasal sprays, and topical creams for other conditions such as Seborrhea Dermatitis, are all known potential triggers.

Unfortunately elimination or avoiding these triggers will not reverse or have any significant impact on the actual process of the diseased once established.

A WORD ABOUT INTESTINAL FLORA AND MITES

There has been some support with scientific studies to suggest that those with GI problems (i.e. stomach infections with heliobacter) peptic ulcer disease and Rosacea have a common denominator. As the GI conditions are treated with anti-biotic and mucous anti-inflammatory products, the rosacea improves.

Also as far back as late 1990 a class of skin mites “Demodex “was found in large numbers particularly with men suffering from rosacea. It is believed it is the several strains of bacteria from the feces of these mites which triggers an auto immune response prompting an inflammatory infective reaction from the infested skin cells and hair follicles.

The individual’s reactions to their mites are dependent on their general health and defense mechanisms of the skin, environmental l factors and the overall health of the auto immune system.

These bacteria carrying mites have also been associated with types of eczema and an auto immune disease called Lupus.

TREATMENTS

It makes sense that with a skin disease that is multi factorial including so many potential triggers as well as bacteria from Demodex mites that any hope for control for a “cure” involves a multi prong treatment protocol. Dermatologists now have a war chest involving better options for skincare, safer sunscreens and topical antibiotics and anti-inflammatories. The Gold Standard of treatment for the vascular damage that evolves has been specific laser treatments.

The Intense Pulse Light Laser (IPL) offer the “cure” for Rosacea sufferers when treatments starts in the earlier phases. Some natural products that are helpful have been incorporated into skincare lines. Green Tea, Aloe Vera, Vitamin C, and B vitamin to mention a few.

LIFE STYLE AND DIETARY REMEDIES

• The most obvious is to control sun exposure and continuing damage
• Avoiding excessive heat and wind as well as sauna treatments and excessive exercise.
• Overall stress reduction by incorporating yoga, tai chi and mediations methods in your lifestyle.
• Avoiding spicy foods, coffee, garlic and onions.
• Adding more Vitamin C and Vitamin B foods to your diet to promote healthier skin.
• Avoid smoking which decreases the skins defence systems and increases the vascular disease of the skin.
• Avoiding alcohol which causes gut damage and capillary damage.

Laser and Skin Care Medspa is able to provide a full complement of treatment that will involve an accurate diagnosis along with sub typing, appropriate products for cleaning, hydrating, protecting and nourishing the face. We can also provide effective laser treatments (for most the “cure”) of this distressing skin condition.

The Laser and Skin Care Medspa war chest includes water based Jane Iredale Makeup which offers excellent coverage while protecting, controlling infection and supporting the healing processes. Alyria and Revoderm anti redness creams soothe and calm inflamed skin.

The Palomar/Cynosure laser system provides an economical efficient removal of the vascular damage.

The best news is Rosacea does not need to control your life or make you feel bad!

Your consultation is covered by Alberta Health Care.

Melasma, a condition primarily seen in women, involves increased pigmentation (hyperpigmentation) of the skin on the face. Frequently associated with hormonal upheaval, it often occurs during pregnancy or with the use of oral contraceptives.

Thought to have an incidence of 50-70% in pregnant women, the onset of melasma is usually during the second half of pregnancy. It also occurs in at least 20% of women taking birth control pills which means, of course, that the condition has increased in frequency now that the use of oral contraceptives is more widespread amongst women. The age of onset is also becoming lower as women in their early teens often use oral contraceptives. Melasma can also occur in women who have never been on birth control pills and who have never been pregnant. The skin condition occasionally occurs in children too, as well as in men, with the estrogen and progesterone hormones in the human body involved in stimulating melanocyte activity (i.e. increasing production of the pigment melanin).

Causes

1)      As previously mentioned it is known that increased estrogen levels associated with pregnancy and oral contraceptive use are the main triggers for Melasma. However, ultraviolet radiation exposure is the next major cause of the condition, either through exposure to SUNLIGHT or from tanning beds.

2)     Around 25-30% of those with Melasma are thought to be genetically predisposed to the condition.

3)     Perfumed ingredients in cosmetics, creams, lotions and cleansers also appear to play a significant role in Melasma development. Therefore, it is wise to avoid the use of such agents on the skin of the face and hands so as to minimize sensitivity and reduce the risk of exaggerated photo-reaction to UV light exposure resulting in increased melanocyte activity.

Clinical Features

Hyperpigmentation can occur on any part of the body, although Melasma tends to follow a specific pattern as it develops on the face, giving rise to the longstanding name the ‘mask of pregnancy.’ Melasma generally presents as an asymmetrical, irregular brown or tan discoloration on the face, albeit with rather sharp borders. The coloration varies from very light to dark brown and this tends to be dictated more by the natural undertone of the skin. It can start out very subtle and barely noticeable but with each year the affected area is further affected by sun exposure as the cells retain the memory of the previous effects leading to the discoloration darkening and increasing in scope.

Various Treatment Options

Dr. Bakken has been treating this condition in her dermatology practice since 1978. For decades the mainstay of treatment has been the application of topical ‘bleaching agents’ of which the main one has been Hydroquinone. Hydroquinone is an enzyme inhibitor that works on three different melanin production pathways. Over time, Dr. Bakken has incorporated this long used inhibitor with other enzyme inhibitors in various formulas for better effect. The Circadia peel offered by Laser and Skin Care Medspa for the past several years includes two of these known enzyme inhibitors, Mandelic Acid and Retinoic Acid (vitamin A). This formulation continues to offer great success in treating some of the superficial Melasma.

In addition to the use of Circadia there are other topical options that Dr. Bakken may suggest during your consultation.

Fractional Lasers

Over the last decade there have been great advances in the development of technology in the successful treatment of Melasma. A special category of lasers, called fractional laser systems, have been designed, as the name implies, to break up sub particles in the skin and create pigmentation changes. Refinement of these lasers and techniques has revealed one of the three main types of laser, the Irbium- YAG laser as particularly adept in Melasma treatment. Laser and Skin Care Medspa has been providing this advanced laser alongside the Palomar system since 2007 as part of our anti-aging technology.

The great thing about this advanced treatment is that there is little to no downtime required afterwards and the skin can be protected with water based products such as Skin Medica Total Defense & Repair SPF 50, Alyria SPF 45 or the Jane Iredale makeup line. In most cases it is necessary to repeat the treatments at monthly intervals until the Melasma is cleared. Dr. Bakken often recommends the use of a topical preparation for one to two months prior to use of the fractional laser, having found that this leads to a higher success rate overall with fewer treatments required and increased patient satisfaction.

Spectra Laser

Spectra (nanopulse Nd: YAG laser) was introduced in 2012 for the treatment of Melasma, and has shown to be very effective in reducing the appearance of the condition.  It is important to be diligent with sunblock application as Melasma can reappear with sun exposure. The laser energy targets the pigment which breaks it down and ablates it. The body’s immune system then naturally removes the pigment particles.

Preventing Recurrence

Avoiding further pregnancy and the use of birth control pills is not, unfortunately, sufficient to avoid the return of Melasma. All it takes is one day of unprotected sun exposure and the hyperpigmentation can all come back as before. The key, then, to preventing Melasma in the first place, and minimizing the risk of recurrence, is the diligent use of SUNBLOCK. Elsewhere on the site I have discussed the difference between chemical and physical sunblock and why physical barriers are safer and more effective. (See blog -The Confusing Story of Sunscreens and Sunblocks) Physical blocks are more effective for sun protection as they reflect UV light, as opposed to absorbing UV light and then chemically treating it, which is what chemical sunscreens do. Controlling Melasma requires a dedicated lifestyle change to include an effective physical sunblock as part of your daily routine. Laser and Skin Care Medspa carries several physical sunblocks, such as, Total Defense & Repair SPF 50 or Alyria SPF 45 among our cosmetic medical dermatology lines which are easy to wear and which do not aggravate acne or sensitive skin.

It should go without saying that it’s a good idea to avoid spraying and applying perfumes or perfumed cosmetics/toiletries to the face to reduce the risk of Melasma recurrence and to prevent initial onset of Melasma.

MELASMA is essentially an aesthetic condition that is undesirable and can affect self confidence and self-esteem. That blotchy complexion tends to add years to the appearance when you may be trying hard with other skin treatments to rejuvenate the face. The good news is that the majority of those affected can be effectively treated and offered a long term Melasma management plan to prevent the condition recurring.

Skin or laser resurfacing is an effective and non-invasive way to reduce the signs of aging. It’s especially effective for reducing the appearance of wrinkles around the mouth and eyes, reducing brown spots or other changes in the skin, and treating precancerous growths. These are all unattractive changes in the skin that will prompt the need for resurfacing. It’s not for everyone, but for those who want to treat areas of their skin that they find unattractive, it’s one of the least invasive and effective methods out there. Continue reading “Skin Resurfacing Reduces the Signs of Aging” →