Rosacea in .NET

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Baumann S2 sensitive skin is manifested by flushing and facial redness (Fig 12-3) Not all individuals who fall in this cateTABLE 12-2 Topical Ingredients in Skin Care and Hair Care Products That May Cause Acne12 14 Avocado oil Butyl stearate Ceteareth 20 Cocoa butter Coconut oil Decyl oleate Evening primrose oil Isocetyl stearate Isopropyl isostearate Isopropyl isothermal Isopropyl myristate Isopropyl palmitate Isostearyl neopentanoate Lanolin Laureth 4 Lauric acid Myristyl myristate Octyl palmitate Octyl stearate Oleth-3 PPG myristyl propionate Putty stearate Red dyes Soybean oil Stearic acid
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Baumann S3 sensitive skin is characterized by burning and stinging upon application of skin care products or exposure to environmental factors such as wind, cold, or heat These subjective signs are usually not accompanied by facial flush-
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FIGURE 12-2 Comedones seen in acne subtype
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on the rabbit ear model, it appeared that many ingredients used in cosmetics evoked a comedogenic response in animals As animal testing fell into disfavor, new methods of comedogenicity testing were developed Subsequently, Mills and Kligman published a study exploring the effects of these chemicals in human beings and found that the results were dissimilar from those observed in the rabbit ear model32 Human models of comedogenicity are currently used13
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Vasoreactive tests examine vasodilatation of the skin to ascertain susceptibility to flush The most popular test uses methyl nicotinate, a potent vasodilator MN is applied to the upper third of the ventral forearm in concentrations varying between 14% and 137% for a period of 15 seconds The vasodilatory effect is assessed by observing the induced erythema and measuring it with various devices such as a spectrometer or laser Doppler velocimeter (LDV) Another test used to measure the propensity for facial flushing is the red wine provocation test; however, this test is not very specific Susceptible patients report a sense of warmth beginning around the head or neck area and moving upward on the face 10 to 15 minutes after ingestion of six ounces of red wine Within 30 minutes, flushing becomes clinically evident33 The disadvantage of this test, though, is that it lacks specificity for S2 sensitive skin types; it may be positive when other conditions, such as alcohol dehydrogenase syndrome, are present
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FIGURE 12-3 Facial redness in the rosacea type patient
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applied, revealing increased transcutaneous absorption in those labeled as sensitive skin types or reactors
Sensitive skin of the burning, stinging, and itching type was found to be more frequent during the summer than the winter in one study3 In this same study, women were found to be more likely than men to have sensitive skin This may reflect the fact that women have a much higher exposure, in terms of frequency and variety, to personal care products than do men The thickness of the epidermis was observed to be greater in males than in females, which may mean that men have a stronger barrier to entry of irritants and allergens16 Hormonal differences may produce increased inflammatory sensitivity in females17
Studies suggest that blacks are less reactive and Asians are more reactive than whites, but no studies are conclusive18,19 A French study based on questionnaires showed that a fair skin type was more commonly associated with sensitive or very sensitive skin3 An American study, by Jourdain et al, used telephone surveys of approximately 200
each of African Americans, Asians, European Americans, and Hispanics and did not find any differences in the prevalence of sensitive skin among ethnic groups2 In a German Japanese study, Japanese women reported subjective feelings of skin irritation more frequently than German women This study demonstrated that Japanese women report skin stinging of greater severity than Caucasian women do20 A normal SC, as measured in Caucasians, has been reported to consist of around 15 cell layers21,22 The SC appears to be equally thick in black and white skin23,24 However, African Americans have been shown to have a higher lipid content in the SC, more SC cell layers, and required more tape strips to remove the SC as compared to Caucasians25,26 This was purported to be the reason that several studies have reported decreased erythema in blacks after topical application of known irritants27 29 Large-scale global studies looking at the ethnic differences in incidence of the various types of sensitive skin have not been performed At this time, the precise role of ethnicity in skin sensitivity remains to be elucidated
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