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The first draft of the ELAP ...
What in the #Hashtag is going on with Facebook?
Facebook has adopted the ‘hashtag’ ...
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Bill Brown became the new ...

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Alternative Health News
Treating Rib Joints to Protect Thoracic Stability
It is an exciting world that awaits us when we go to work every day. We deal with all types of people who present with varying health conditions we can (hopefully) help alleviate.

News in Brief
In Remembrance: A Moment of Silence for Robin McKenzie (1931-2013); DC Re-Elected to Co-Chair AMA Code Review Board; WFC Celebrates 25 Years.
Lateral Femoral Cutaneous Nerve Entrapments
The lateral femoral cutaneous nerve arises from the 2nd and 3rd lumbar nerves. It is formed in the psoas muscle and emerges from its lateral border to cross the iliacus muscle and exit the pelvis.
A Solution for the Primary Care Crisis?
A white paper generated by the ACCAHC Primary Care Project and UCLA Center for Health Policy Research Senior Research Scientist, Michael Goldstein, PhD, addresses a clear oversight noted in recent workforce analyses designed to assess the nation's primary care needs.
Dry Needling is Acupuncture: But What of Education? What of Public Safety?
One of my patients told me recently, that their physical therapist used a "dry needle" and that it wasn't acupuncture. Apparently, physical therapists (PT) are taught to tell their patients that "only acupuncturists practice acupuncture."
Becoming a Concussion Expert in Your Community: What You Need to Know (Part 2)
What makes an individual an expert in concussions? Obtaining education about concussions and treating concussed patients are two factors that lead to expertise.
Keeping Up With Western Medicine Advancements: The Amazing World of Imaging Studies
When patients with neuromuscular problems come to you for treatment there is usually a lot you can do for them to improve their mobility or reduce their pain, whether it is a middle age woman with a frozen shoulder.
A Medication Primer for Alternative Health Care Practitioners (Part 2)
Morphine is arguably the greatest drug of all time, at least in the sense that it is so powerful in relieving pain.
Study: Acupuncture for Acute Low Back Pain More Effective Than Drugs
New research by Korean doctors of Oriental Medicine suggested that an acupuncture method could reduce acute lower back pain faster and more effectively than conventional drug injections.
Pre-Conception Wellness: What Do Your Patients Need to Know?
Deciding to have a baby is one of the most important decisions a woman will ever make. But how many women are really prepared for a healthy pregnancy?
The Monkey on Your Back
Many practitioners run their clinic without any extra help—at least initially. I've always been pretty good at multi-tasking. Having nine kids taught me how to wear multiple hats and juggle a lot of responsibilities. Running a clinic is similar.
Chiropractic Care for Veterans: Serving Those Who Served (Pt. 2)
To what extent do you think the role of chiropractors in the VA can serve as a model for greater chiropractic integration elsewhere in the American health care system? That's a very important question.
We Get Letters & E-Mail
The "Great Opportunity" for Chiropractic: Expanded Scope of Practice; The SOAP Note: An Effective Tool for Documentation; Treating Patients Goes Beyond Following Established Protocol.
Three Essential Herbal Products For Your First-Aid Kit

There are three Chinese patent medicines that belong in everyone's first aid kit. All three are for topical application, and all three provide extraordinary benefits unavailable from any domestic over-the-counter.


Weight Training: Are Cheat Reps Worth It?
While resting between exercises at the gym recently, a young lifter asked me for a spot on a set of barbell bench presses. The bar was loaded with a moderately heavy amount of weight that at first glance appeared to be too heavy for his frame.
It's About the Word
The new patient was already a fan of chiropractic. "I liked the guy a lot," he said of the previous DC he had consulted. "But he is on the other side of town, and I just can't get there after work. So he sent me to you, since you're his buddy."
Protein and Weight Loss
Recently I was asked by the staff at Dynamic Chiropractic to referee some of their water-cooler discussions regarding nutrition. Topping their list was this one about protein and weight loss: "Why is protein important for weight loss and how much should I eat?"

10 Life Lessons That Will Change the Way You Practice
"What would you do if you knew you couldn't fail?" I have posed this question for years to groups I've spoken to across the country and around the world.
Healing the Qi: The Boston Marathon Bombing
On Monday, April 15 2013, locals and visitors from around the globe gathered for the world's largest marathon in the city of Boston. With 23,000 participating in the race and many more on the sidelines, the marathon represents a Boston institution.
Maintaining Professional Boundaries in a Facebook World: Social Media Guidelines for DCs
A few months ago, I received an unexpected message on my Facebook account: "Hi Doc, do you remember me? I'm so happy to find you here on Facebook. It's been years since I have seen you and I'm glad to reconnect with you.
Beauty is Averageness
After seeing Kim Kardashian's face all over the Internet -and my inbox- following her posting on getting facial acupuncture, I recalled the work of Michael Cunningham who was at the University of Louisville when I was doing my doctoral work.
Changing Times
If you visit the website of the JAMA and search on the word chiropractic, more than 200 results appear. If you sort that list chronologically and look at the oldest entry, you will find "Medical News" that includes the following.
Extraordinary Vessels and Emotional Healing
In addition to the 12 primary Organ-related meridians in the body, there are other energy circulation channels that have been mapped out by Traditional Chinese Medicine. Probably the most significant of these are called the Eight Extraordinary (or Extra) Vessels.
Obesity is a Shen Problem
The expressions "obese" and "obesity" are not pejorative terms. They are scientific terms, determined solely by the Body Mass Index scale, which combines a person's height and weight in a mathematical formula. A number of 30 and above denotes "obesity."
Weaving Eastern & Western Medicine Together: Q&A with Beijing's Dr. Kezhen Zhang
Dr. Kezhen Zhang M.D., is currently the founder and president of Beijing Taijitang Traditional Chinese Medicine Hospital.
The Physiology of Anger
Most of us recognize and have felt anger at some point in our lives. Anger can be seen as a natural response to some kind of pain, whether emotional or physical.

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Massage Today
April, 2009, Vol. 09, Issue 04

Acne Rosacea

By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President

Dear Readers,

In this issue we will discuss a common, frustrating, but not particularly threatening condition – acne rosacea. Sometimes called “adult acne,” this idiopathic condition is usually benign but it has some complications that are worth noting. Imagine being a fair-skinned man in your 50s. You have noticed that over time, much of your face now appears to have become permanently reddened—like a sunburn that never fades. You outgrew adolescent acne 30 years ago, but now you see bumps and pimples over your cheeks and on your chin. Occasionally they sting or itch. Your nose has become enlarged and the skin has become thick and bumpy. Tiny red lines appear on your face: these are especially noticeable when you drink hot beverages or eat spicy foods. Worst of all, some friends and acquaintances assume that your skin is a sign of chronic alcohol abuse: you find yourself constantly defending yourself against that prejudgment. These are the signs and symptoms of acne rosacea.

What is acne rosacea?

Acne rosacea is a skin condition that affects mostly middle-aged, fair-skinned adults. It is most common among 30 to 60-year-olds. Although it is diagnosed in women slightly more often than in men, men tend to have it in a more severe form. Rosacea is very common; estimations suggest that about 14 million Americans may have it, although not always so severely that treatment is required.

Despite being common, acne rosacea remains mysterious. It runs in cycles of flare and remission, but does not appear to be auto-immune in nature. It can lead to the appearance of pustules that clear up with antibiotic use, but it is not a specific bacterial infection that can be cultured and identified. Some research points to two microbial infestations, but research on these factors remains inconsistent and inconclusive. Because the cause or causes of this condition remain elusive, its treatment is limited to addressing symptoms only. Acne rosacea is considered to be a manageable, but not curable, condition.

Symptoms of Acne Rosacea

Acne rosacea typically affects the skin of the face, focusing especially on the cheeks, forehead, and chin—often the places that acne vulgaris (“common” acne associated with the changes in testosterone secretion that occur during puberty) appears. Many people find that their skin becomes reddened and bumpy or even pimply, and may stay that way for weeks and months. Then, for no known reason, symptoms resolve and the skin goes back to normal for an undetermined period of time. Other people find that the changes are permanent and progressive. Acne rosacea usually spares the skin around the eyes, but one version can affect the conjunctiva and even lead to the risk of corneal damage.

Causes of Acne Rosacea

Causes of acne rosacea are mainly unknown. One of the frustrating things about this condition is that triggers may vary widely for people, and that the tissue changes seen in skin biopsies of people with this condition are inconsistent. Some of the features that occur often include:

  • Vascular changes in the skin. The affected areas of skin appear to have more blood vessels than in unaffected skin, and these tiny arterioles, venules and capillaries are hyper-reactive to signals for dilation. This is what leads to the permanent tiny red lines or “spider veins”; the technical term is telangiectasias.
  • Reactions to climate changes. Some people with acne rosacea find that their symptoms flare with UV radiation (i.e., sun exposure). Others find that moderate sun exposure helps to resolve symptoms. Many report that exposure to cold winds or rapid changes in humidity are triggers.
  • Matrix degeneration. Irritating chemicals related to cellular injury can lead to long-term microscopic damage to the skin and superficial blood vessels. This can exacerbate and prolong the inflammatory response.
  • Microbial infestation. Some patients with acne rosacea appear to have a higher-than-average population of common microscopic mites that colonize hair follicles. These patients sometimes have a positive reaction to the same treatment that is used for a different mite infestation called scabies. Other research points to the possibility of a skin infection with H. pylori bacteria, but this doesn’t address the fact that the vast majority of people exposed to this pathogen don’t develop acne rosacea.
  • Medication and foods. Oral and topical steroid use appears to exacerbate symptoms for some patients, and many people find that hot beverages and spicy foods cause flushing and flares of their condition.

Types of Acne Rosacea

In 2004, a committee of specialists convened to compare notes and create some clear guidelines for subtypes of acne rosacea in an effort to create more awareness and to strategize the best treatment options for each type. The types of rosacea that they identified are:

  • Type 1: Erythematotelangiectatic rosacea. This involves chronic flushing, red skin, and the development of tiny telangiectasias, aka spider veins.
  • Type 2: Papulopustular rosacea. This type involves persistently red skin and transient bumps, pimples, and pustules.
  • Type 3: Phymatous rosacea. This type involves permanently thickened, bumpy skin around the nose, called “rhinophyma.” Readers who remember the comedian W.C. Fields will recognize rhinophyma from his image.
  • Type 4: Ocular rosacea. This is perhaps the most dangerous form of acne rosacea. It affects the eyes, beginning with conjunctivitis and frequent styes, but it can progress to cause scarring and permanent vision loss if it damages the cornea.

Treatment

This idiopathic disorder has no permanent cure, and so is treated palliatively. Patients are taught to recognize their specific triggers, and to avoid them when possible. Acne medication like Accutane is often prescribed. If mites are suspected, patients may be counseled to try the same skin cream recommended for scabies infestation. Photodynamic therapy (combining oral medication with careful doses of UV radiation) works for some patients. Laser surgery or dermabrasion may help the appearance of the skin and mask telangiectasias. Plastic surgery may be considered for a person with advanced rhinophyma. None of these interventions are considered to be a permanent solution for acne rosacea, however.

What about massage?

Specific massage promotes local blood flow as the skin warms and capillaries dilate in the area being addressed. For most clients this is a benefit, but for clients with acne rosacea facial massage could be a trigger for uncomfortable flushing and redness. As long as no infection is present, lymph drainage modaliies may help decrease fluid retention and any local edema. Therapists must be careful about using a lubricant that doesn’t irritate the skin or lead to a hyper-reaction.

Massage is unlikely to make any direct or specific changes to acne rosacea, but the chance to receive educated, non-judgmental touch may be an important positive factor in the life of someone who lives with this common and frustrating condition.

Well readers, do you have questions about medical issues that are presented in your contact with clients? Let me know – what’s on your table? Until then, many thanks and many blessings.

Resources

  1. Alai NN. “Rosacea.” MedicineNet.com. http://www.medicinenet.com/rosacea/article.htm.
  2. “All About Rosacea.” National Rosacea Society. http://www.rosacea.org/patients/allaboutrosacea.php.
  3. Kupiec-Banasikowska A. “Rosacea.” Medscape. http://emedicine.medscape.com/article/1071429-overview.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.

 

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