Tuesday, November 1, 2011

I thought I was just a blusher

Have you experienced flushing of the face throughout your life and always just thought nothing of it until the redness stopped fading off?  You may be suffering from a common dermatological complaint known as rosacea.  It is most common in Celtic women between the ages of 30-50 with a peak occurrence between the ages of 40-50.  As mentioned, the first stage of rosacea generally involves periodic flushing of the face triggered by hot weather, consumption of greasy and spicy foods, alcohol, or emotional triggers such as stress.  As the flushing continues over time the transient nature of the flushing fades and becomes more persistent lasting days, weeks, or months.  With persistent flushing the capillaries becomes damaged and the appearance of broken blood vessels (telangiectasia) occurs.  For some the formation of papules occurs.  These papules do not typically hurt as is the case with acne.  Pustules may also form for some, but this only occurs in about 20% if patients.  In more severe cases, rhinophyma, where there is hyperplasia of the connective tissue and sebaceous glands of the nose,  may occur but this is often only seen in males.

Rosacea also takes on a very characteristic distribution on the face.  The areas most often affected are the cheeks, chin, nose, and forehead.  On very rare occasions the neck can be affected.  Ocular changes are often times associated with rosacea and can be seen in about 60% of cases.  The typical complaint is one of dry, gritty eyes and there is often redness visible on the conjunctiva.   So looking into the history of past episodes of conjunctivitis, blepharitis, keratitis, etc. are often useful in clarifying the diagnosis of rosacea due to its sometimes subtle appearance.

In Chinese medicine we see rosacea as a pathology involving excess heat in the body as well as an element of blood stasis.  As the pathology persists for longer periods of time we typically see a larger amount of blood stasis in the presentation.  Therefore, depending on the presentation of the rosacea, the Chinese herbal formula will vary for each individual.  Also, as the treatment moves forward changes in the formulation will occur as well.  This is because the body will be healing during the course of treatment and certain aspects of the disease become less relevant as they improve.

Western medicine typically treats rosacea through the use of topical antibiotics such as metronidazole and other oral antibiotics.  When topicals are proving to be ineffective, the use of oral antibiotics such as minocycline, tetracycline, or doxycycline are utilized.  Oral antibiotic use typically involves long term use to control rosacea and this type of approach can be detrimental to the health of the patient's gut.  The use of these harsh antibiotics will damage the natural gut flora and could further aggravate the digestive tract.  In rosacea, there is often a prevalence of low stomach acidity and slow gastrointestinal transit time and so the aggravation of the gut through long term antibiotic use could further irritate the situation.  It is this concept of addressing the manifestation of the problem rather than the root cause that can be problematic in stabilizing the condition long term.  The skin may improve through the use of the antibiotics but there is the consequence of irritating the gut that will prevent the skin from remaining stable and healthy following the discontinuation of the medication.

If you suffer from rosacea and would like to address this condition with a more natural approach I would encourage you to seek out a qualified Chinese herbal practitioner such as myself that has specialized in the treatment of these stubborn dermatological conditions.  If you're going to put time and money into this form of treatment make sure that your practitioner has done the same. 

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