Patient Education/Resources

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Rosacea

If you suspect you have Rosacea, we recommend that you schedule an initial consultation with Dr. Walling, Dr. Schulz, Dr. Robson, or Jody McKee, PA-C to discuss your concerns. Rosacea affects millions of Americans. Men and Women over 30 are most commonly afflicted with this skin disease.

All About Rosacea

Rosacea (pronounced "roh-ZAY-sha") is a chronic and potentially life-disruptive disorder primarily of the facial skin, often characterized by flare-ups and remissions. Many have observed that it typically begins any time after age 30 as a redness on the cheeks, nose, chin or forehead that may come and go. Over time, the redness becomes ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue. This is the condition, called rhinophyma (pronounced "rhi-no-FY-muh"), that gave the late comedian W.C. Fields his trademark bulbous nose. Rhinophyma rarely occurs in women. In many rosacea patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

Although rosacea can affect all segments of the population, individuals with fair skin who tend to flush or blush easily are believed to be at greatest risk. The disease is more frequently diagnosed in women, but more severe symptoms tend to be seen in men -- perhaps because they often delay seeking medical help until the disorder reaches advanced stages.

While there is no cure for rosacea and the cause is unknown, medical therapy is available to control or reverse its signs and symptoms. Individuals who suspect they may have rosacea are urged to see a dermatologist or other knowledgeable physician for diagnosis and appropriate treatment.

What Should I Look For?

Rosacea can vary substantially from one individual to another, and in most cases some rather than all of the potential signs and symptoms appear. According to a consensus committee and review panel of 17 medical experts worldwide ( see Subtypes of Rosacea), rosacea always includes at least one of the following primary signs, and various secondary signs and symptoms may also develop.

Primary Signs of Rosacea

• Flushing - Many people with rosacea have a history of frequent blushing or flushing. This facial redness may come and go, and is often the earliest sign of the disorder.
• Persistent Redness - Persistent facial redness is the most common individual sign of rosacea, and may resemble a blush or sunburn that does not go away.
• Bumps and Pimples - Small red solid bumps or pus-filled pimples often develop. While these may resemble acne, blackheads are absent and burning or stinging may occur.
• Visible Blood Vessels - In many people with rosacea, small blood vessels become visible on the skin.

Other Potential Signs and Symptoms

• Eye Irritation - In some people with rosacea, the eyes may be irritated and appear watery or bloodshot, a condition known as ocular rosacea. The eyelids also may become red and swollen, and styles are common. Severe cases can result in corneal damage and vision loss without medical help.
• Burning or Stinging - Burning or stinging sensations may often occur on the face. Itching or a feeling of tightness may also develop.
• Dry Appearance - The central facial skin may be rough, and thus appear to be very dry.
• Plaques - Raised red patches, known as plaques, may develop without changes in the surrounding skin.
• Skin Thickening - The skin may thicken and enlarge from excess tissue, most commonly on the nose. This condition, known as rhinophyma, affects more men than women.
• Swelling - Facial swelling, known as edema, may accompany other signs of rosacea or occur independently.
• Signs Beyond the Face - Rosacea signs and symptoms may also rarely develop beyond the face, most commonly on the neck, chest, scalp or ears.

Subtypes of Rosacea

The consensus committee and review panel of 17 medical experts worldwide identified four subtypes of rosacea, defined as common patterns or groupings of signs and symptoms. These include:

Subtype 1 (erythematotelangiectatic rosacea), characterized by flushing and persistent redness, and may also include visible blood vessels.

Subtype 2 (papulopustular rosacea), characterized by persistent redness with transient bumps and pimples.

Subtype 3 (phymatous rosacea), characterized by skin thickening, often resulting in an enlargement of the nose from excess tissue.

Subtype 4 (ocular rosacea), characterized by ocular manifestations such as dry eye, tearing and burning, swollen eyelids, recurrent styes and potential vision loss from corneal damage.

Many patients experience characteristics of more than one subtype at the same time, and those often may develop in succession. While rosacea may or may not evolve from one subtype to another, each individual sign or symptom may progress from mild to moderate to severe. Early diagnosis and treatment are therefore recommended.

How is Rosacea Treated?

Because the signs and symptoms of rosacea vary from one patient to another, treatment must be tailored by a physician for each individual case.

Various oral and topical medications may be prescribed to treat the bumps, pimples and redness often associated with the disorder. Dermatologists usually prescribe initial treatment with oral antibiotics and topical therapy to bring the condition under immediate control, followed by long-term use of the topical therapy alone to maintain remission.

When appropriate, treatments with lasers, intense pulsed light sources or other medical and surgical devices may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Ocular rosacea may be treated with oral antibiotics and other therapy.

Skin Care

Patients should check with their physicians to ensure their skin-care routine is compatible with their rosacea. A gentle skin-care routine can also help control rosacea.

Patients are advised to clean their face with a mild and non-abrasive cleanser, then rinse with lukewarm water and blot the face dry with a thick cotton towel. Never pull, tug or use a rough washcloth. Patients may apply non-irritating skin-care products as needed, and are advised to protect the skin from sun exposure using a sunscreen with an SPF of 15 or higher.

Cosmetics may be used to conceal the effects of rosacea. Green makeup or green-tinted foundations can be used to counter redness. This can be followed by a skin-tone foundation with natural yellow tones, avoiding those with pink or orange hues.

Lifestyle Management

In addition to medical treatment, rosacea sufferers can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors that trigger rosacea flare-ups or aggravate their individual conditions.

Rosacea Triggers Survey

While the list of potential rosacea triggers in various individuals may be endless, a survey of 1,066 rosacea patients found that the most common factors included the following:

Factors	% Affected
Sun exposure	81%
Emotional stress	79%
Hot weather	75%
Wind	57%
Heavy exercise	56%
Alcohol consumption	52%
Hot baths	51%
Cold weather	46%
Spicy foods	45%
Humidity	44%
Indoor heat	41%
Certain skin-care products	41%
Heated beverages	36%
Certain cosmetics	27%
Medications	15%
Medical conditions	15%
Certain fruits	13%
Marinated meats	10%
Certain vegetables	9%
Dairy products	8%
Other factors	24%

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Acne

Town Square Dermatology, together with Infinity Skin Care & Spa, offers this area’s most comprehensive clinical and cosmetic skin care services for the treatment and improvement of facial, neck and back acne in patients of all ages. An initial consultation will identify a patient’s acne symptoms and determine which treatments will be most effective for his or her skin type. Ongoing daily acne care is strongly recommended to maintain optimum acne efficacy.

Acne: Myths & Facts

Myths

• Fatty foods and chocolate worsen acne.
• Blackheads and other acne are caused by not cleaning properly.
• Acne is an infection and therefore contagious.
• Acne always clears up after a few years.

Facts

• Mild acne is common, but sometimes worsens.
• Significant acne runs in families.
• Significant acne and scarring worsen self-esteem.
• Acne is worsened by stress and the onset of puberty.
• Acne lasts for years, sometimes decades.
• Acne can be worsened by some makeup and hair products. Use only noncomedogenic, and nonacnegenic products.
• Acne is an inflammatory condition, not an infection.

The process

• Acne starts when protein (from dead skin and oil, not dirt) forms a plug in a pore. This can be hereditary, hormonal or caused by some comedogenic lotions and cosmetics.
• Trapped oil cannot flow out to the skin surface and the dead skin cells and oil form a plug called a whitehead (closed comedo). Wider plugs develop pigment (not dirt) to become blackheads.
• Normal oil gland bacteria overgrow causing the plug to rupture into the deep skin. The whitehead quickly becomes red, swollen, and tender. Pus can soon develop. Squeezing, picking and even scrubbing increases inflammation, delays healing and promotes scarring.

Progress

• Improvement occurs slowly over several months.
• Routine treatment controls but does not cure acne, so treatment must be continued.
• Occasional flares occur even with effective treatment (premenstrual flares are common, for example).
• Despite the treatment, acne sometimes worsens and causes scarring. If acne worsens, please check with your physician or physician assistant.

How treatment works

• Topical retinoids (Retin-A, Tazorac, and Differin) all help the skin to exfoliate, “cleaning out” the pores and decreasing the formation of new whiteheads. This slowly decreases the number of whiteheads and blackheads over a period of several weeks to months. Therapy against whiteheads must be continued even if pimples become more noticeable (each whitehead is the "seed" for a new pimple).
• Topical antibiotics and antibiotic pills decrease oil bacteria overgrowth. In addition, oral antibiotics in the tetracycline family decrease the skin’s inflammatory response with chronic use. This decreases follicle rupture, decreasing red and pustular lesions. In general, topical antibiotics treat superficial and small pimples while oral antibiotics treat deep/large pimples.
• Some oral contraceptives decrease circulating male hormone levels to decrease plugs and follicle rupture and can be used for treatment. Spironolactone is used in females only and blocks the male hormone receptor leading to a significant improvement for many women.
  

Notes on therapy

• Topical therapy is often slightly irritating, especially at first. Decrease irritation by:
• Applying a thin-film of medication
• Following with a noncomedogenic moisturizer/sunscreen (e.g. Neutrogena brand products)
• Avoiding irritating over-the-counter scrubs or astringents (those with salicylic acid or drying alcohols)
• Don't spot treat! Topicals must be applied to entire affected area.
• Wash off traces of benzoyl peroxide before nightly retinoid application, since benzoyl peroxides inactivate retinoids.
• If you experience problems with any prescription medication, PLEASE call our office for recommendations.
  

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Melasma

Melasma is defined as brown irregular patches on sun-exposed skin of the face and neck. This eruption is triggered especially by UVA rays -- UVA penetrates through window glass and is not completely blocked by conventional sunscreens, even those that are labeled broad spectrum.

Melasma is worsened by estrogens (e.g., in birth control pills), in high estrogens states (like pregnancy or liver disease) and by some anti-seizure medications. Chloasma is melasma that occurs during pregnancy (a.k.a. mask of pregnancy).

Prevention is the key, allowing gradual fading and preventing recurrences after any treatment.

• Stop or decrease estrogens if not contraindicated.
• Change anti-seizure medications if not contraindicated.
• Minimize UV exposure and use a quality sunscreen every day year-round.

Chemical sunscreens must contain an ingredient called Parsol (aka avobenzone) in order to completely block the entire UVA spectrum in addition to blocking UVB. Sunblocks containing titanium dioxide or zinc oxide, will also block the entire UV spectrum (both UVA and UVB light). For maximum benefit, apply a chemical sunscreen containing Parsol, let dry, and then apply a chemical free sunblock containing titanium dioxide or zinc oxide prior to any significant sun exposure.

Treatment

• Hydroquinone “bleaching cream” is available as a prescription (four percent strength). Various prescription formulations are available and combination therapies (such as Triluma which contains Retin-A and a low strength topical steroid) can treat more aggressively.
• Topical medications work slowly over several weeks and only on superficial forms of melasma (deeper deposition of pigment requires laser therapy).
• These topical therapies can be irritating. If irritation is occurring, take a day or two off and resume therapy, perhaps applying less frequently. Do not allow significant irritation to occur as this may encourage increased pigmentation!
• Laser approaches (especially Fraxel), chemical peels and microdermabrasion are effective treatments, but are not covered by insurance. Used in conjunction with topical medication they can dramatically increase the speed of resolution. Fraxel laser treatments offer the fastest and most complete resolution.
  

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Dry Skin

Whether you suffer from dry, itchy skin year-round, or find it difficult to curb in the harsh winter months, your provider can provide you with the most effective tips, treatments and products to keep your skin smooth, hydrated and luminescent throughout the entire year.

Dry Skin Therapy

Dry, sensitive skin can lead to many skin problems including severe itching, rashes and open sores. The following is a list of recommendations to improve your skin ’s hydration leading to healthier looking and feeling skin.

1. Limit showers or baths to 10 minutes or less and use warm, but not hot, water. Hot, soapy water removes the skin’s natural protective oils.
2. Use mild or moisturizing cleansers such as Dove, Oil of Olay, Basis, Camay, Purpose or similar.
3. If your skin is severely dry or if you have eczema, consider using a non-soap cleanser such as Cetaphil, Cerave or Oilatum. These do not lather, but do clean the skin.
4. At the end of your shower or bath, pat dry with a towel. IMMEDIATELY, while your skin is still slightly damp, apply a healthy coat of moisturizing CREAM. Most lotions are too thin to effectively moisturize very dry or eczematous skin.
5. If your dermatologist has prescribed a topical medication to apply to a rash, apply the medication to the affected areas of skin FIRST, then apply moisturizer to the remaining skin second.
6. Reapply the moisturizer after rewetting the skin throughout the day if any area begins to feel or look dry again.
7. Avoid bath oils which make surfaces slippery and may result in a fall.
8. Consider softening your home’s water.
9. Consider humidifying your home during the winter months.

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Safe Sun Facts

Sun Facts

• Anyone can sunburn.
• Medical experts now believe that protecting the skin as a child and teenager can significantly reduce the risk of skin cancer and premature skin aging as an adult.
• Research shows a link between blistering sunburns in children and an increased risk of melanoma (deadliest form of skin cancer) and other skin cancers.
• Sun induced skin cancers are the most common cancers of caucasian adults.
• The incidence of skin cancer is increasing in epidemic proportions across our country.
• The risk of developing a melanoma, a deadly skin cancer, has been doubling every ten years.
• Protecting skin from the sun's rays could prevent about 80% of skin cancers.
• Light from the sun contains both ultraviolet A (UVA) and ultraviolet B (UVB) light. UVB light is responsible for the immediate burning after too much sun. UVA light penetrates more deeply due to its longer wavelength and causes significant photodamage (wrinkles and spots). Both are harmful and associated with skin cancer however not all sunscreens block both types of light effectively. Be aware that UVA light passes through window glass but UVB does not.
• Harmful ultraviolet rays (UV) reflect off water and light-colored surfaces such as concrete, water, sand and snow. UV rays also reach below water's surface.
  

Sunscreen tips

• Use every day of the year. Even on cloudy days up to 80 percent of the sun's harmful rays reach the earth. UVA light penetrates window glass and can account for a great deal of unintentional exposure.
• Wear sunscreen that has at least a sun protection factor (SPF) of 30.
• Sunscreens work by absorbing most of the sun's rays before they penetrate the skin, but some still get through. Effective sunscreen includes an ingredient called Parsol (avobenzone) that blocks the full spectrum of UVA light. Many ingredients block UVB light well.
• Sunblocks such a zinc oxide or titanium dioxide block or reflect the sun's rays. These are effective for blocking the full spectrum of UVA and UVB light.
• Water resistant sunscreens protect skin for 40 minutes of water exposure, waterproof sunscreens for 80 minutes.
• Use plenty of sunscreen/sunblock. Studies have shown that the average person uses about one-half the amount of sunscreen that the manufacturer used when determining the SPF factor. The average adult requires one ounce of sunscreen for adequate total body coverage. Children require about half this amount.
• Apply sunscreen/sunblock to dry skin about 15 to 30 minutes before going outdoors.
• Reapply sunscreen/sunblock every two hours, or after sweating, swimming or toweling off.
• Understand sun protection factors (SPF). SPF number refers only to UVB blocking ability, not UVA. An SPF of 8 filters out 86 percent of ultraviolet radiation. SPF 15 blocks 92 percent of damaging rays and SPF 30 blocks 96 percent of ultraviolet rays. Remember -- apply sunscreen to lips, ears and exposed scalp.
• Spray, gel and lotion forms are now available. Sprays work best on the scalp and back and are fun for children too.
• Stick balms are great for lips and ears. These also can be used around the eyes to avoid stinging.
  

Other Important Tips

• Wear hats. Each inch of hat brim can lower your lifetime risk of skin cancer by 10 percent. A hat brim of four inches or greater is recommended. Make certain that the top and brim of a straw hat have sun proof liners in place.
• Minimize sun exposure between 10 AM and 4 PM when the worst and greatest quantity of ultraviolet light exists.
• Wear protective eyewear. Sunglasses with UV blocking filters are very important. The eye is the second most common site in which melanomas develop.
• Some medications can increase sensitivity to the sun's rays. Certain antibiotics, birth control pills, diuretics, antihistamines and antidepressants may cause increased sensitivity to the sun. Dress accordingly and take extra precautions if you are taking any of these medications.
• Discourage use of tanning beds. Tanning devices emit UVA light which can damage the skin and eyes as much as direct sunlight and have been linked to an increased risk of developing melanoma.

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