Hi all,

this definitely applies to me. i wonder if it also applies to those parkies
who have the 'reds' problem?

janet

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Rosacea
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More Americans Now Enter Danger Years For Rosacea

by Mary Erhard

With the 77 million baby boomers born between 1946 and 1964 (nearly one in
three Americans) now entering the most dangerous years for developing
rosacea, the number of adults suffering from this embarrassing and
potentially disfiguring disorder of the facial skin is expected to increase
in the years ahead.

According to a recent National Rosacea Society survey of more than 2,000
rosacea sufferers, 44 percent reported that their symptoms had first
appeared in their 30s and 40s, and 43 percent first experienced rosacea
after age 50. Now that the oldest members of the baby boom generation are
turning 50 and the youngest are 32, they have fully reached the prime years
for developing this conspicuous condition that today affects an estimated
one in 20 Americans.

"While the incidence of rosacea appears to be rising sharply as more people
enter the most susceptible age, many mistakenly think it's just a complexion
problem that will go away by itself -- but in fact it usually keeps growing
worse if left unchecked," said Dr. Joseph Bikowski, assistant clinical
professor of dermatology at the University of Pittsburgh. "Of greatest
concern is that only a small percentage of rosacea sufferers
realize that medical help is available from dermatologists to halt its
progression and reverse its symptoms."

According to a Gallup survey, only 27 percent of Americans had heard of
rosacea. Because of its alarming, acne-like effect on personal appearance,
however, it can cause devastating psychological and social problems in
addition to its physical effects.

What is rosacea, and how does it progress? Now widely believed to be a
vascular disorder related to flushing, rosacea may be described in three
stages, according to Dr. Mark V. Dahl, professor and chairman, Department of
Dermatology, University of Minnesota Medical Center.

Although it may first appear as early as the teen years, rosacea most
frequently begins when sufferers enter their 30s, 40s or 50s as a flushing
or transient redness on the cheeks or nose, and in some cases the chin or
forehead. In this earliest stage, some patients may report stinging or
burning sensations, including the feeling of dry or tight skin. This can
cause "angry face syndrome," Dr. Dahl said, in which almost anything that
the patient puts on his or her face stings or burns.

Regardless of comfort level during the early stage, tiny visible blood
vessels called telangiectasia may eventually appear on the surface of the
skin in addition to the subtle redness that may come and go.

As rosacea progresses to middle stage, the redness becomes ruddier and more
permmanent, and usually occupies a larger area of the face. Bumps, pimples
and swelling often develop, and noticeable facial pores later may appear.

Swelling sometimes occurs in the cheek area close to the nose, Dr. Dahl
noted, resulting in a "baggy cheek" appearance.

If left untreated, rosacea may advance to a third stage, in which the spread
of excess facial tissue called fibroplasia may develop. In its severe form,
this may distort facial features enough to cause what Dr. Dahl describes as
"lionization." Red bumps bridge across progressively larger areas of the
face, and the nose may become swollen, red and bumpy from excess tissue.
This condition, called rhinophyma, gave the late comedian W. C. Fields his
famous bulbous nose.

In some cases, the eyes may also be affected by rosacea, resulting in a
gritty feeling and bloodshot appearance. As the severity advances, the
symptoms may include swollen blood vessels in the eyes, and in rare cases
small hard bumps may develop on the eyelids and vision may be affected.

Rosacea can affect all segments of the population, particularly those with
fair skin who tend to flush or blush easily. The disorder may be somewhat
more common in women, but is often more severe in men -- perhaps because men
tend to delay seeking medical help until the condition reaches advanced
stages.

People of northern European origin, whose paler skin flushes more easily,
appear to be especially vulnerable to rosacea, and the disorder has also
been called the "Curse of the Celts." According to another National Rosacea
Society survey, 39 percent of more than 300 sufferers who responded had at
least one parent of Irish ancestry. In addition, Americans of English,
Scottish or eastern European descent were found particularly at risk. While
less frequent, rosacea has also been reported in Asian, Hispanic and African
Americans.

Though rosacea is sometimes referred to as "adult acne," it is a distinctly
different and often more serious condition than acne vulgaris, which most
commonly occurs during adolescence. While both conditions can cause pimples,
rosacea requires different therapy -- acne treatments can actually make it
worse -- and rosacea rarely goes away by itself.

"For baby boomers in the prime years of their careers, the psychological
effects of rosacea can pose particularly severe problems," Dr. Bikowski
said. In National Rosacea Society surveys of more than 400 rosacea
sufferers, nearly 75 percent said rosacea lowered their self-esteem and
self-confidence and 60 percent said it negatively affected their jobs. Sixty
percent reported they avoided face-to-face contact because of their
condition, and 56 percent said the disease had robbed them of pleasure and
happiness.

The good news, however, is that 70 percent of the survey respondents
reported that their emotional well-being improved following successful
medical treatment.

Rosacea Review, a newsletter for rosacea sufferers, as well as a broad range
of information on rosacea are now available online from the National Rosacea
Society at

http://www.rosacea.org.

People who suspect they may have rosacea can contact the Society via e-mail
at [log in to unmask] or call its hotline at (847) 382-8971 to receive general
information and issues of Rosacea Review, as well as a list of
dermatologists in their areas who are experienced in treating the condition.
Information is also available by writing the

National Rosacea Society,
800 S. Northwest Highway,
Suite 200,
Barrington, Illinois 60010.

The Society also offers a rosacea tripwires chart and patient diary
checklist to help rosacea sufferers identify and avoid those lifestyle
factors that may cause flare-ups in individual cases. Rosacea flare-ups can
be triggered by an astonishing array of factors, ranging from sun exposure
to emotional stress, hot beverages and spicy foods.

Lifestyle changes, prescription therapy and, if necessary, laser treatment
for visible blood vessels and excess tissue can eradicate rosacea's
symptoms.

"The key to controlling rosacea is awareness and early intervention," Dr.
Bikowski said. "Anyone with possible signs of rosacea should see a
dermatologist for diagnosis and appropriate therapy."

Editor's note:
Mary Erhard is a medical writer for the National Rosacea Society.

For additional information on rosacea, go to:

http://www.derm-infonet.com/Rosacea.html Rosacea --

AAD Derminfo Net
A public service of the American Academy of Dermatology

or contact:

American Academy of Dermatology
930 N. Meacham Road
P.O. Box 4014
Schaumburg, IL 60168-4014 USA
Telephone:(847) 330-0230
-------------------------------------------------------------------------

ps
i certainly qualify for the pale skinned, flushing and blushing celt
stereotype described above. as i grew older, i noticed that an alcoholic
drink on an empty stomach would sometimes make my face turn red. and
sometimes an early morning cup of coffee would do the same thing. if i
stayed outside in the winter in a medium wind for more than half an hour, my
face would be red and blotchy for the next day or two, from 'windburn'.

after i moved to bermuda, my skin got much worse, [i think from a
combination of lots of 'windburn' and the change in climate] i went to a
dermatologist, who diagnosed acne rosacea. an acne medication with 5%
benzoyl peroxide, used daily for a couple of weeks, was all that was needed
to reverse most of the damage.

my next major battle with 'the zits' came with the advancement of pd
symptoms, before i was officially diagnosed. i developed some severe
'clusters' of acne, which were deep and painful. but when i was diagnosed
with pd, the neurologist at that time said that the pd 'slowdown' was the
cause of my skin problems, which eventually included some scalp problems as
well.

i tackled both situations with topical prescription medications, and that
treatment, maybe in combination with the sinemet that was also prescribed,
seemed to get everything pretty much back under control. i have noticed
lately, though, that some 'clusters' have been appearing up on my fore-arms.
..acne on my arms!?!.... what's next?

maybe i had these pd-related skin problems to this degree, because i already
had a genetic tendency to rosacea.

so then i dug these up from:

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An Algorithm For The Management Of Parkinson's Disease
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a supplement of the American Academy of Neurology
Reprinted in Neurology 1994;44:S1-S52.

Editors:
William Koller, M.D. Ph.D
Dee Silver, M.D.
Abraham Lieberman, M.D.


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SEBORRHEA
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Excessive secretion of oil by sebaceous glands is common in PD.

Management. Coal tar shampoos can be used not only for dandruff but also for
seborrhea over the eyebrows and forehead. They should not be used more than
once or twice weekly. Selenium-based shampoos also work in some patients
when used in a similar manner. Topical hydrocortisone is most effective on
the face but needs to be applied daily.

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THERMOREGULATION
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The neurochemical and anatomic regulation of temperature is complex and
poorly understood. Preoptic and hypothalamic areas appear to have
thermoregulatory function. Noradrenergic, serotonergic, and cholinergic
systems have an incompletely understood role in thermal homeostatais.
Sweating is mediated by efferent sympathetic cholinergic fibers, which may
be damaged in PD. Lewy bodies and cell loss in the hypothalamus have been
implicated in PD-associated sweating abnormalities.

Management. Abnormal sensations of heat or cold, impaired sweating
responses, and hypothermia all can occur in the untreated patient. Excessive
sweating of the head and neck in response to external heat has been
associated with poor heat dissipation. Some of these phenomena disappear
with levodopa treatment, which suggests a role for central dopaminergic
systems in thermoregulation. Severe drenching sweats occur as an end-of-dose
"off" phenomenon in patients with motor fluctuations, further supporting a
role for dopamine systems in vasomotor tone and heat regulation. Dopamine
agonist therapy may be of benefit to such patients.

Although peak-dose chorea can cause sweating, it is rarely if ever as severe
as that seen in the "off' state. For patients who experience it, however, a
reduction in the dopaminergic medications may help but often at the price of
more "off" time. These patients are more likely to respond to
beta-adrenergic blockers than are patients with "off"-period sweating.

Severe hyperpyrexia after levodopa withdrawal resembles the neureleptic
malignant syndrome and needs to be treated promptly with reinstitution of
dopaminergic agents.

Other causes of excessive sweating must not be neglected simply because the
patient has PD. Benign sweating can occur with either a visual, olfactory or
gustatory stimulus. Ethanol and aspirin in high doses also can cause
increased intermittent sweats. Therefore, taking a thorough history usually
will clarify these situations. Thyrotoxicosis and postmenopausal states need
to be considered and appropriate endocrine evaluation initiated. Finally,
chronic infections such as tuberculosis must not be forgotten in the
differential diagnosis.

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