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Rosacea, a little-known but widespread facial disorder, is having a dramatic impact on worker morale and productivity, according to a survey of 700 patients conducted by the Barrington, IL-based National Rosacea Society.
According to the survey:
• 66% of those participants with severe symptoms said the disorder had affected their professional interactions.
• 33% had canceled or postponed business meetings because of their appearance.
• 28% reported they had missed work because of their condition.
• 28% also said it may have influenced their being chosen for a new job or promotion.
Even those with more moderate symptoms said the disease was affecting their work lives:
• 55% reported it had affected their professional interactions.
• 17% said it might have influenced whether they were selected for a new job or a promotion.
"People, especially in professional positions, are obviously concerned with their appearance during meetings," notes Diane Thiboutot, MD, associate professor of dermatology at Pennsylvania State University College of Medicine, at the Hershey (PA) Medical Center. "My patients notice that most people will question them, saying things like, Why is your face so red?’ They get asked that continually and they find it to be embarrassing. Rosacea affects adults, and patients can develop pimples; adults are much less accepting of an acne-like appearance than teen-agers would be. For women, it’s a little easier. Certain makeups can be used to hide the symptoms, but men are not into wearing facial cosmetics so it’s often more noticeable and prominent."
Rosacea usually first strikes after the age of 30 as a redness on the cheeks, nose, chin, or forehead that comes and goes. As the disease progresses, the redness becomes ruddier and more persistent, and tiny blood vessels may become visible. Left untreated, bumps and pimples often develop, and in some individuals the eyes may feel gritty and appear bloodshot.
In advanced cases, especially in men, the nose may become bumpy, red and enlarged from excess tissue; this is the condition that gave the late comedian W.C. Fields his trademark bulbous nose.
"A lot of rosacea tends to run in families," explains Thiboutot. "It’s associated with certain genetic skin types — people who tend to flush or who blush easily. People may note they have family members who have persistent facial redness that tends to come on as an adult."
The good news is that rosacea can often be detected early, and if it is, there is effective treatment available. In fact, more than 70% of the survey respondents said that effective treatment of rosacea had improved their work lives.
"Rosacea is easy for a physician to diagnose early; if more people knew about the signs, they might be able to determine it themselves, and if so, check with their physician," says Thiboutot. "Probably the first thing they may notice is a persistent redness in the face, made worse by sunlight, heat, wind, changes in temperature, alcohol, hot or spicy foods, or hot beverages. All of these can increase the blood flow to the skin, and can make it redder."
Ironically, notes Thiboutot, the therapies available today are more effective with the severe symptoms than with the mild ones.
"Unfortunately, the most common symptom is redness and this is the most difficult to treat," she explains. "The creams we have and the antibiotic pills do little for background redness. The way to minimize redness is avoid the different factors I mentioned before, or using a sunscreen. The most effective way to treat persistent redness is using a pulsed dye laser; this destroys the small, dilated blood vessels." For pimples, she adds, there are excellent treatments — either topical or oral antibiotics. "With proper use, patients can most likely then avoid the really severe effects of rosacea," Thiboutot says.
Wellness professionals should definitely educate themselves about the symptoms of and the effective treatments for rosacea, says Thiboutot, but she does not encourage them to become directly involved with an employee who appears to be suffering from the disease. "Approaching someone with rosacea is a very, very difficult issue — even for me as a dermatologist," she notes. "If you bring the subject up, the person will feel badly. If it ever comes around to where an employee mentions it, then you can say you know there are effective treatments, and that the employee might consider meeting with their doctor."
Beyond that, she says, the best approach would be educational programs — and even there, she recommends treading carefully. "I would handle it more in the context of a general skin wellness program," she recommends. "You can cover skin cancer, the use of sunscreens, and general strategies for sun protection — which are also play a key role in keep rosacea under control."
Thiboutot suggests contacting the American Academy of Dermatology in Schaumburg, IL. Their Web site is www.aad.org. "They have a lot of information available, including brochures," she notes. "If a wellness coordinator is interested in having someone speak to their employees, the Academy will provide a list of contact names in the area."
• Diane Thiboutot, MD, Division of Dermatology, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033. Telephone: (717) 531-7437.
• The National Rosacea Society, 800 S. Northwest Hwy., Suite 200, Barrington, IL 60010. Telephone: (888) NO-BLUSH. Web site: www.rosacea.org.