tag:theconversation.com,2011:/au/topics/rosacea-24940/articlesrosacea – The Conversation2017-09-27T20:01:04Ztag:theconversation.com,2011:article/752882017-09-27T20:01:04Z2017-09-27T20:01:04ZHealth Check: do we have to clean out our pores?<figure><img src="https://images.theconversation.com/files/185212/original/file-20170908-19911-1a3hd2u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pores are self-cleaning, so you don't need to rip out or scrub off their contents. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Many of us would have seen, if not tried, various products claiming to clean the dirt out of our pores. From scrubs to cleansers to plasters that stick to our faces, there are many tools at our disposal. </p>
<p>But do we actually need to clean out our pores? Or are the little black stems on the other side of the sticky plaster or mask fine where they are? </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/tTXHoN3jkM8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">There are many products on the market to clean out pores.</span></figcaption>
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<p>The pores on our face, just like our ear canals, are designed to clean themselves. So for most people, leaving them to their own devices is fine, and just cleansing the face is enough. But there are a variety of reasons why pores can become blocked, causing blackheads to form under the skin. These blackheads are made up mostly of dead skin, and some dirt.</p>
<p>Hormones, bacteria or sometimes too much cleansing (because this can irritate the skin, causing it to thicken) can cause pores to block. This is a common cause of acne. This is because when the pore blocks there is back pressure in the oil gland which can then rupture, releasing very irritating oils. It’s these that cause the red lesions known as acne.</p>
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Read more:
<a href="https://theconversation.com/health-check-is-makeup-bad-for-your-skin-82820">Health Check: is makeup bad for your skin?</a>
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<p>It’s important to never squeeze a blackhead too much because you might cause the oil glands to rupture back into the skin, causing an even worse reaction. You can buy a special blackhead removing tool from the chemist and this avoids breaking a blackhead under the skin. There are also medical prescription gels that can clear pores. Vitamin A products stop the skin lining the pores from thickening, so they don’t block the oil glands, leading to acne. </p>
<p>Some people have genetically bigger and more noticeable pores, and pores get bigger as we age. This doesn’t mean they’re more likely to fill up with dirt. The only issue is some people don’t like the way this looks and can feel self-conscious about their bigger pores.</p>
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<a href="https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some people don’t like their visible pores.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<h2>What are you trying to achieve?</h2>
<p>There are a few different ways to think about your pores. Some people have normal skin and just want to clean their face. In some people pores are blocked with a condition such as acne. And some have normal skin and just want their pores to appear smaller.</p>
<p>If your skin is normal (no acne and the pores are not prominent) and you just want to clean your face, just wash your face gently to avoid irritating your skin, which can cause your pores to appear bigger. Using hot water can inflame your face and dry it out, so stick with lukewarm or cool water. Use a gentle cleanser, but if your skin is on the dry side, you don’t need to use a cleanser. </p>
<p>If you want to use one, make sure it’s non-abrasive and doesn’t contain chemicals that will dry out your face. Pat your face dry with a soft towel and don’t rub it or scrub it. This can irritate the pores and cause them to swell and block.</p>
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Read more:
<a href="https://theconversation.com/helen-mirren-was-probably-right-about-moisturiser-so-heres-an-owners-guide-to-looking-after-your-skin-82781">Helen Mirren was probably right about moisturiser, so here's an owner's guide to looking after your skin</a>
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<p>If you have acne, using a chemical exfoliant such as alpha hydroxy and or beta hydroxy acid will exfoliate your skin without having to scrub it. This means there is no damage to the pore. The longer you leave the cleanser on the more it works.</p>
<p>If you overdo it, the skin will dry and start to flake and scale. Importantly, a break from the cleanser is better than just putting on moisturiser, which could add to the pore blockage.</p>
<p>If your aim is cosmetic and you want to make your pores appear smaller, many opt for micro-dermabrasion. This is a process that many dermal technicians perform with an abrasive device and suction to wear away the very top layer of the skin (the epidermis). The process is usually performed with the aid of a strong cleanser. </p>
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<a href="https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Micro-dermabrasion wears away the very top layer of skin, but has to be performed by a technician, and not too regularly to avoid irritation.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>This treatment is not something to try yourself. The suction can help unblock the pores, but too much friction can irritate them. So you have to ensure you’re not getting worse after these treatments. This treatment should be used no more than once a month, since it can damage your skin if it’s done too often.</p>
<h2>What can be harmful?</h2>
<p><strong>Steaming</strong>: heating the face can make the blood vessels stand out and cause rosacea (a red rash) in those who are prone to it. The oils are dissolved more readily and stripped from the face, which means, unless you really have very oily skin, it will dry out. <a href="https://link.springer.com/referenceworkentry/10.1007%2F978-3-540-89656-2_42">We now know heat ages the skin</a> so it makes sense to avoid this type of treatment for most people.</p>
<p><strong>Facial brush</strong>: while a facial brush will exfoliate your skin, the risk is that the pore will swell due to the irritation, causing more blockage.</p>
<p><strong>Facial scrub</strong>: gels, creams, cleansers and scrubs containing tiny particles that exfoliate your face can also cause swelling and block the pores.</p>
<p><strong>Pore strips</strong>: clay masks and pore-strips pull out the substances that accumulate in pores. They do remove the pore contents faster than nature intended, but they are relatively gentle on the pore compared to the scrubs. They can, however, leave the skin more sensitive to anything applied shorty after.</p><img src="https://counter.theconversation.com/content/75288/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Freeman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many of us would have seen, if not tried, various products claiming to clean the dirt out of our pores. But do we need to?Michael Freeman, Dermatologist, Associate Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/828202017-09-04T02:27:58Z2017-09-04T02:27:58ZHealth Check: is makeup bad for your skin?<figure><img src="https://images.theconversation.com/files/183915/original/file-20170830-5619-9vgg3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people cover their face with makeup every day, potentially causing irritation. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Makeup is an everyday item for many people and non-negotiable for some. Is it bad for our skin? As always, the answer is not clear-cut and depends on the individual, their skin type, and the products they use.</p>
<p>With an overwhelming choice of cosmetic products available, most people don’t even know where to start with makeup. Organic? Natural? Fragrance free? Hypoallergenic? Non-comedogenic? Paraben free? What does this all mean, and are they any better?</p>
<p>The term makeup generally describes the group of cosmetics that are used for beautification. Other cosmetics include products that are used to cleanse, treat or protect the skin and hair. These days, though, we commonly see all-in-one products, such as BB or CC creams, which combine makeup for coverage together with other ingredients to provide sun protection and skin benefits. Reducing the total number of products can be helpful for those with problematic skin, but may complicate things for some. </p>
<h2>What does makeup do to our skin?</h2>
<p>While in most cases makeup is harmless, certain products may cause problems for some individuals. It’s very important to use makeup and cosmetics that are suitable for your skin type or skin condition. </p>
<p>Skin types are broadly classified into four groups:</p>
<p>• oily - excess oil production, large pores, blackheads and acne prone</p>
<p>• sensitive - tight, stinging, intolerant to many products and prone to redness</p>
<p>• dry - dull, rough or flaky and prone to itchiness</p>
<p>• normal/combination - may be oily in the T-zone (forehead, nose and chin) but problem-free elsewhere</p>
<p>Although most people have a good idea of their basic skin type, they may fail to recognise the existence of an underlying skin disorder. Conditions such as eczema, contact dermatitis, rosacea and sun damage may cause inflammation and disruption of the skin barrier.</p>
<p>Inflammation causes itchiness or tenderness, redness, lumps and bumps, while barrier disruption results in tight, sensitive, dry and easily-irritated skin. These symptoms can be identical to those caused by reactions to cosmetics, and therefore should be considered before assuming makeup to be the cause. Conversely, an ongoing reaction to products being applied to the skin may explain why the skin is not responding to regular treatment.</p>
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<a href="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Skin irritations can cause itchy, scaly red rashes.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<h2>Skin problems caused by cosmetics</h2>
<p>Acne cosmetica is a form of acne triggered by the use of certain cosmetic products. It is linked to certain ingredients that cause comedone formation (a blockage in the pore) and typically presents as small rash-like bumpy pimples. A common misconception is that the makeup physically blocks the pore, whereas actually the block is made of dead skin cells. </p>
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Read more:
<a href="https://theconversation.com/health-check-why-do-i-still-get-zits-29143">Health Check: why do I still get zits?</a>
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<p>Mild inflammation results in excess skin turnover and clogging of the pore, with mineral oils being the most common culprit. It’s not always possible to determine makeup is the cause simply from the ingredient list, as it may be influenced by formulation, quantity and delivery methods.</p>
<p>Irritant dermatitis accounts for the majority of reactions to makeup and other cosmetic products. It can occur in anyone but is more likely in those with pre-existing sensitive skin or in those with underlying barrier disruption caused by a condition like eczema or rosacea. It typically causes an itchy, scaly red rash but can even blister or weep. Symptoms can occur immediately but may take weeks or even months to develop with weaker irritants, making it difficult to identify the cause. </p>
<p>Allergic contact dermatitis occurs when a person has become sensitised to an ingredient that has been applied to the skin. A red, itchy rash sometimes associated with swelling or blisters develops 12-48 hours after exposure, and may become chronic with ongoing use. The allergen can be very difficult to identify, because in some cases the product is used for months or years before sensitisation occurs.</p>
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<a href="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People put many different products on their face, isolating a cause of irritation can be tricky.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<h2>Are there ingredients we should avoid?</h2>
<p>Fragrances and preservatives are the most common cause of contact allergy resulting from cosmetics. There are over 5,000 different fragrances used in skin care products, many of which are natural plant extracts and essential oils. </p>
<p>Other common allergens include preservatives, lanolin, coconut diethanolamide (a foaming agent) and sunscreen agents. Preservatives, such as parabens, formaldehyde and Quaternium-15 are required in all liquid products to stabilise them and prevent the growth of microbes. A common misconception is that natural and organic ingredients will not cause allergy or irritation, but in prone individuals these can in fact be quite problematic.</p>
<p>Unless you have a known allergy or sensitivity, there are no specific ingredients that everyone should avoid. But looking for hypoallergenic, fragrance-free and non-comedogenic products is wise. Those with an oily skin type or a history of acne should also limit oil-based cosmetics. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-eczema-and-what-can-you-do-about-it-45318">Explainer: what is eczema and what can you do about it?</a>
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<p>Those with a sensitive or dry skin type, an underlying inflammatory skin condition or history of contact allergy should try to avoid irritants and potential allergens. Foaming agents, astringent products (such as toners that remove oils), scrubs and acids (such as alpha hydroxy acids used in acne and anti-ageing) tend to be irritating. Hypoallergenic formulations and those targeting sensitive skin are a good choice. </p>
<h2>What should I do if I think I might have a reaction?</h2>
<p>If you develop a new rash or skin irritation, the first thing to do is to try to confirm the diagnosis. If you suspect you are reacting to one of your cosmetics but not sure which, then ideally you need to stop using all your current products in the problem area. You should try to simplify your daily routine, choosing products that have been specifically formulated for sensitive and allergic skin. </p>
<p>If the problem settles, you can reintroduce your cosmetics one at a time to see whether you can identify the culprit. It’s a good idea to test each one in a small localised area on the neck or face for a week or two before using it all over the face. This process is known as a “repeat open application test”. </p>
<p>If you can’t get to the bottom of it or find cosmetics that don’t irritate your skin, you may need to seek professional help to rule out other skin conditions and formally test for allergies if warranted.</p><img src="https://counter.theconversation.com/content/82820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cara McDonald consults to La Roche Posay. </span></em></p>Many of us cover our faces with foundation and other beauty products every day. Here’s what we know about whether they are doing us damage.Cara McDonald, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/538862016-05-08T20:05:18Z2016-05-08T20:05:18ZWhy do some old men have big red noses? No, it’s not alcohol<figure><img src="https://images.theconversation.com/files/111746/original/image-20160217-19260-1e3e5pn.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Thought by many to be caused by alcohol, a skin condition is actually to blame for bulbous red noses seen on elderly men.</span> <span class="attribution"><span class="source">Painting by Domenico Ghirlandio, Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This is part of our series on hidden or stigmatised health conditions in men. Read the other articles in the series <a href="https://theconversation.com/au/topics/mens-hidden-health-conditions">here</a>.</em></p>
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<p>Many people will have seen a middle-aged or elderly man with an abnormally big red nose, whether it’s in real life or in classical paintings. Most think of it as synonymous with alcoholism, however it’s a real condition not caused by alcohol.</p>
<p>It’s caused by a common skin condition called rosacea. If the rosacea is not properly treated or controlled, within a few years the nose can grow and become bulbous. This is the condition rhinophyma.</p>
<p>Rosacea is a chronic skin condition that causes a red rash on the face. In rhinophyma, inflammation from rosacea and sometimes pressure from glasses pushing heavily on the bridge of the nose can cause proteins in the skin to stagnate and water to accumulate between the cells of the skin. This excess of fluid in the skin (lymph) is called lymphoedema.</p>
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<a href="https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111748/original/image-20160217-19245-1yrefl4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Rhinophyma causes the skin to thicken and appear bulbous and swollen.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>This protein-rich fluid causes further inflammation in the skin that transforms the initially soft swollen tissue into a harder tissue with stiffer, thicker skin in cases that have progressed for a long time. The sebaceous glands (which produce oil in the skin) dilate greatly, which is why the pores on the nose appear so large. If squeezed the pores will leak a white paste full of dead skin.</p>
<p>The nose appears deformed, with thickening and bulbous lumps distorting the shape. The surface is often red and has more obvious blood vessels. The skin often looks like orange peel because of the enlarged pores. The process affects mainly the lower two-thirds of the nose.</p>
<p>We’re not certain about why it mostly affects men, but think likely causes include that they are more likely to work outside, and less likely to seek treatment for rosacea.</p>
<h2>Origins</h2>
<p>Rosacea has a genetic and an ethnic predisposition – it runs in families, typically those of fair-skinned heritage such as English, Irish, Scottish, Scandinavian and similar descents.</p>
<p>There is <a href="http://www.rosacea.org/rr/2010/fall/article_4.php">evidence</a> alcohol, especially red wine, is among the scores of different triggers that can prompt or aggravate rosacea flare-ups in patients. This is why rhinophyma is often wrongly associated with alcohol abuse. The biggest three influences of flare-ups are usually sunlight, heat and environmental stress (like working in dusty or dirty environments).</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111874/original/image-20160218-1252-hqmjx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Prolific Dutch renaissance artist Rembrandt van Rijn suffered from rhinophyma.</span>
<span class="attribution"><span class="source">Rembrandt self-portrait. Wikimedia commons.</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>However in this type of rosacea, Demodex mites are an important potential trigger. Demodex are tiny mites with eight legs that live in the hair follicle and oil glands of the face. </p>
<p>They are less than half a millimetre in length meaning they are invisible to the naked eye but under the microscope their structure is clearly visible. Most cases have a prominent colonisation (more than five times normal) of Demodex.</p>
<p>The rosacea may begin first anywhere in the central face however in this form the nose is always the worst affected area. In rhinophymatous rosacea the inflammation is usually more aggressive, with tender red lumps on the nose and pimple-like pustules occurring frequently.</p>
<p>If rosacea can be controlled at an early stage then it is unlikely to progress to rhinophyma. The dermatologist will be able to recommend the most appropriate treatment of the rosacea to prevent rhinophyma if started early enough. </p>
<p>There are a number of creams and tablets available to treat rosacea. Ivermectin cream (a cream for mites) specifically targets the demodex and is often very useful in this type of Rosacea. Antibiotics from the local doctor can help and in resistant cases there are dermatologist restricted retinoids (like Vitamin A) available. Cortisone creams are best avoided as these can worsen the condition and even in some people cause a rosacea-type of rash.</p>
<h2>Treatment</h2>
<p>Once the nose has significantly enlarged, there are a few ways to normalise the appearance. Excess skin can be removed with surgical excision, electrocautery (electrically heated needle), or laser.</p>
<p>New forms of laser used by dermatologists (called “Erbium YAG” laser) are giving the best results. With treatment, parts of the nose can scar when the operator is trying to restore the shape of the nose and there are not enough skin cells to cover the area because of the large gaping pores.</p>
<p>Some will also lose the normal tan in the nose after the procedure. The main problem with some of the surgical sculpturing techniques is that it is difficult to get as smooth a contour. Bleeding leads to poor visibility, making tissue removal much less precise and is most problematic in the surgical approach.</p>
<p>The Erbium YAG laser procedure starts with anaesthetising the nose. If the nerves that supply the nose can be injected away from the nose initially, the discomfort of the local anaesthetic can be reduced. General anaesthetic is possible but adds an unnecessary risk. </p>
<p>Once the nose is completely numb the laser is employed to vaporise the unwanted tissue. The nose then takes two weeks or so to grow the surface skin back in place and heal. The condition will only come back if the rosacea is not controlled.</p>
<hr>
<p><em>Further reading:</em></p>
<p><em><a href="http://theconversation.com/dads-get-postnatal-depression-too-55829">Dads get postnatal depression too</a></em></p>
<p><em><a href="http://theconversation.com/men-more-reluctant-to-go-to-the-doctor-and-its-putting-them-at-risk-57420">Men more reluctant to go to the doctor - and it’s putting them at risk</a></em></p>
<p><a href="https://theconversation.com/breast-cancer-campaigns-might-be-pink-but-men-get-it-too-56663"><em>Breast cancer campaigns might be pink, but men get it too</em></a></p>
<p><a href="https://theconversation.com/hows-your-walnut-mate-why-men-dont-like-to-talk-about-their-enlarged-prostate-58209"><em>How’s your walnut, mate? Why men don’t like to talk about their enlarged prostate</em></a></p>
<p><a href="https://theconversation.com/klinefelters-syndrome-being-unable-to-produce-testosterone-has-serious-implications-for-men-57488"><em>Klinefelter’s syndrome: being unable to produce testosterone has serious implications for men</em></a></p>
<p><em><a href="https://theconversation.com/hypospadias-the-cause-of-penis-malformation-is-still-a-matter-of-debate-56507">Hypospadias: the cause of penis malformation is still a matter of debate</a></em></p><img src="https://counter.theconversation.com/content/53886/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Freeman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many people will have seen a middle-aged or elderly man with an abnormally big red nose. Most think of it as synonymous with alcoholism, however it’s a real condition that is not caused by alcohol.Michael Freeman, Dermatologist, Associate Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.