In a Perfect World, Rosacea Remains a Problem

In a Perfect World, Rosacea Remains a Problem
By CAMILLE SWEENEY

VISITING the skin care aisle at the drugstore has long been a walk of shame. Are you old enough to pay rent, but still need an oil-control face wash? Can you no longer deny it’s time for anti-aging cream?

Now that beauty norms dictate that any blemish or off-color patch requires immediate care, it’s become harder to remain calm. And a slew of lotions and cleansers that cater to the desperate and the red-faced has entered the market in the last two years. Products like Eucerin Redness Relief Soothing Cleanser claim to tame not only run-of-the-mill crimson cheeks but also the persistent skin condition known as rosacea.

Not to say that rosacea — which is characterized by redness on the cheeks, nose, chin or forehead, or by visible blood vessels, bumps or pimples on the face — hasn’t been around for centuries.

One of Chaucer’s pilgrims is believed to have had it as he trotted toward Canterbury with his “fyr-reed cherubynes face” of which “children weren sore aferd.” And, an epigram from a 16th-century compendium describes an ancient Roman’s nose as four-cubits broad and surrounded by towers Bacchus had dyed vermilion.

Fyr-reed face and Bacchus-dyed nose towers are just some of the humiliations driving today’s consumers to recheck their complexions in the mirror and sample the anti-redness arrivistes in drugstores. The condition, which usually hits people age 30 to 50 for reasons unknown, can be a never-ending embarrassment.

“The feeling out there is if there’s any facial skin imperfection, something must be done about it,” said Elaine D’Farley, the beauty director for Self magazine, whose annual new product survey yielded more anti-redness products this year than last. “Facial redness is the new cellulite.”

Of late, big cosmetic companies like Clinique and Prescriptives have made it their business to stamp out red. “The bigger brands from larger beauty companies didn’t get into this game until recently,” said Anna Wang, a senior consultant with Kline & Company, a market research firm.

Sales of anti-redness facial care products grew by 35 percent from 2002 to 2007, an increase of $300 million, according to Kline’s 2007 global cosmetics and toiletries report. That figure, Ms. Wang said, doesn’t include products designed for sensitive skin or uneven complexions, which also purport to quell rosacea.

And sales of Oracea, an antibiotic and the only oral drug approved by the Food and Drug Administration for rosacea, are projected to increase to $60 million this year, up from $9.1 million in the first half of 2006, said Sheila Kennedy, a senior marketing director for Galderma, which acquired CollaGenex, the maker of Oracea, this month for $420 million.

No one knows what causes rosacea, but dermatologists suspect inflammation plays a role. They frequently prescribe antibiotics to those patients. The advantage of Oracea, its maker says, is that it’s such a low dose that only its anti-inflammatory properties (and not its anti-microbial ones) are in effect, so users avoid side effects of regular antibiotics.

It’s hardly surprising that rosacea tends to strike the fair-skinned, especially people of Celtic or Northern European extraction, according to the National Rosacea Society, an association that receives financing from pharmaceutical and cosmetic companies that market rosacea remedies. But, the society also reports, more women have rosacea than men.

Based on data from small samples, the society estimates that there are 14 million people with rosacea nationwide. “I see rosacea everywhere,” said Dr. Jonathan Wilkin, a dermatologist and the former president of the National Rosacea Society, “Millions of people are out there who have rosacea but don’t know it.”

Which raises a question: If you don’t know you have rosacea, and are not bothered by it, then does it help to be made aware of the ailment? After all, rosacea is not life-threatening, and only life-hampering for those who consider their symptoms problematic.

In the last decade, Dr. William James, a dermatologist in Radnor, Pa., said he has seen a significant increase of patients with rosacea, and patients who think they have it, but don’t.

“People are educating themselves more about skin conditions, and so rosacea comes up,” said Dr. James, the vice chairman of the department of dermatology at the University of Pennsylvania. “They are more sensitized to their appearance and seeking treatments because everyone hopes, and maybe even believes, that something can be done.”

Allison Preece, 47, long sought a way to treat dilated blood vessels on her nose. Ms. Preece, an information technology analyst in Boston, saw a few primary care doctors and dermatologists who recommended topical creams and antibiotics. Nothing worked to her satisfaction.

Then she underwent Vbeam laser treatment, which collapsed the offending blood vessels. She had to spend 10 days indoors before her nose no longer resembled “a speckled egg,” she said. Her dermatologist, Dr. Niels Krejci, the director of Boston University Center for Cosmetic and Laser Surgery, charges $275 for treatments, which may be as often as every eight weeks.

Rosacea is often mistaken for acne vulgaris, that teenage scourge. But rosacea not only has closed bumps but it should not be treated with benzoyl peroxide, a common ingredient in acne remedies.

“In most cases, using acne treatments for rosacea is not going to help, and in fact, can do a lot of damage,” said Dr. Herbert Goodheart, a dermatologist in Poughkeepsie, N.Y., and author of “Acne for Dummies,” which urges readers with facial redness not to panic.

“I think that the 14 million number of rosacea sufferers is overblown,” Dr. Goodheart said. “It’s a condition that is often misdiagnosed and overdiagnosed. Sometimes a rosy cheek is just a rosy cheek.”

A few years ago, when pimples began dotting her cheeks, Carol Petrovitz, 48, didn’t panic. She assumed it was acne and procrastinated rather than slathering on a gel. Her mother finally persuaded her to see a dermatologist. After Dr. Goodheart determined that Ms. Petrovitz had rosacea, she said she felt relieved. “My mother was convinced it was something much worse,” she said.

And soon the situation was under control. “I took antibiotics for about a month, and still use my cream, but I have no bumps or any real redness on my face anymore,” she said. “Except for when it’s warm out, that’s my only trigger.”

The Rosacea Society has brought attention to the numerous so-called triggers of rosacea: red wine, spicy food, going from cold to hot temperatures, prolonged sun exposure or vigorous exercise, which can cause prolonged facial flushing for hours for a person with rosacea.

Online support groups devoted to rosacea have become a way for the uninitiated to make a diagnosis. (Not a recommended practice.)

Still people in rosacea support groups incessantly debate the merits of treatments and products. David Pascoe, 39, the founder of rosacea-support.org , which has 8,000 members, 2,500 of whom are active, used various topical gels and antibiotics for 15 years, but he remained a “Rudolph,” he wrote in his online biography. It wasn’t until he developed a meticulous skin regimen, including the application of flesh-tinted zinc SPF 20 cream, that his nose went from ruddy to inconspicuous.

Mild rosacea may not inspire sympathy or scorn, but the worst cases are hard to miss. One rosacea patient, a commercial airline pilot who requested anonymity for privacy, said he would never show up to work without first cleansing, moisturizing and applying of a green-tinted powder to counteract his facial redness.

He has rhynophyma, the most severe form of rosacea that causes bumps, pimples, redness and thickened skin on the nose. “I have to greet people and inspire confidence in them, and having a red nose has so often has been associated with drinking alcohol,” he said. “Making sure my nose isn’t glowing is a tedious, time-consuming task. I’d rather not have to do it, but we’re talking about my face.”