An article on rosacea from The Scotsman

"Rosacea is a common yet little recognised skin condition. Some people can have it for years with only minor flare ups, others soon get more advanced symptoms and run the risk of disfigurement and even blindness"

*Report by Moyra Bremner in The Scotsman

What medical condition is as plain as the nose on your face, has been around for at least 500 years, yet is only just being recognised? Perhaps a clue from Shakespeare might help "Good Bardolph, put thy nose between the sheets and do the office of a warming pan." If you have guessed "drinker's nose", you're right - but also wrong.

What Shakespeare didn't know - and few people know today - is that the "grog blossom" nose, which made Bardolph the butt of Falstaff's wit, is not produced by drunkenness. It's one of the later symptoms of the common, yet little recognised, skin problem rosacea (pronounced rose-Asia). This progressive condition can start with a symptom as innocent as very rosy cheeks but, if not controlled, can disfigure the face and even lead to blindness.

It is most common among Celts - whether drinkers or teetotallers - and, in Britain, affects at least one adult in 15. Yet it is so seldom recognised that people often suffer for years, untreated. A recent survey of 400 sufferers found that most had seen their GPs for years, about other complaints, without the doctor mentioning the rosacea - though it was staring him or her in the face. Equally, patients seldom ask directly for help until they have permanent redness, by which time the skin is often irreparably marked - and the disease hard to control.

Unfortunately, early recognition is sabotaged by the onset of rosacea looking so innocent. Would you, for example, go to a GP if you blushed excessively or were sometimes very hot and flushed after spicy food or a drink? Or if you went very red after sun or cold wind? Probably not. Yet many of these can be the first sign of rosacea.

Some people can have rosacea for years with only minor flare-ups, others soon get more advanced symptoms. The redness usually begins to last longer. Raised red patches, or blotches, on the cheeks, forehead, nose or chin may come and go - often leaving the mouth area pale. The veins in the cheeks and nose can enlarge and clusters of clear or pussy spots erupt on the red patches - often being confused with acne. Eventually there is usually a fixed redness with tender swollen patches and, finally, permanently rough, bumpy or leathery skin. Also, if untreated, in one in three cases the eyelids and membrane over the eye become inflamed - and this can lead to scarring and loss of eyesight. Men may develop the bulbous "drinker's nose". Like asthma, rosacea can be triggered and exacerbated by stress or other factors in daily life. Almost any food, drink or skin product could be a trigger, but the most common are:

Drinks containing alcohol or caffeine;

Spicy, pickled or smoked foods;

Toners, aftershaves and other skin or hair products containing alcohol;

Greasy skin or hair products;

Detergent based products and soaps;

Exfoliants, facial scrubs, and rough washcloths and skin buffers.

And the menopause can make it worse.

This triggering is another reason why people do not seek early medical help. Sue Mann, 32, an estate agent, now realises rosacea began when she was 27. "It would come and then go away. I thought it was a reaction to something I'd eaten. So I didn't go to my GP till it looked really bad."

Mrs Florence Luby, now 70, has a "drinker's nose" and florid complexion. She has been deeply hurt by the slur of being stigmatised as a drinker when she has been teetotal all her life. Equally, her daughter Mary, who has rosacea more mildly, believes she failed a job interview for the same reason. The Lubys exemplify both the ignorance of some GPs and the difference that good treatment can make. Florence used to get rosacea every winter. And every winter her GP told her to avoid dairy products. It did no good but she was never sent to a dermatologist. Mary, who developed rosacea in her teens, repeatedly saw various GPs. None diagnosed rosacea. Instead she was given unsuitable creams and told to "dry her skin out" - which aggravated the condition. So she grew up shy and depressed, to taunts of "red face", wore stage make-up to go out, and spent a fortune on creams hoping they would help.

For example, Anne Lovell, Agony Aunt of Bella magazine, discovered her rosacea at 45, in its early stages. She got immediate treatment and advice on prevention. But, though her skin looks normal, flare-ups can still be triggered." I went for a walk on the moors in cold wind and returned to a log fire and wine. And came up in big red blotches which were impossible to cover with make-up and made me very self-conscious."

Here again many GPs seem to be failing their patients. The survey of 400 patients showed that many felt bewildered. Half of them had not had their conditions fully explained. And half had not been told how to look after it or warned about trigger factors. Moreover, the survey of 400 sufferers showed one in four had been treated with steroid creams - now known to thin the skin and aggravate rosacea in the long term. See article about Iatrogenic Rosacea.

As Seaman put it: "It's tragic that so many people neglect this condition and are disfigured or look as if they have a drink induced syphilitic rash, when that can so easily be prevented."