When rosy red cheeks are a sign of serious problems

Rosacea, or 'the curse of the Celts', is something that often affects the skins of westerners living in the Middle East.

It's known as the "curse of the Celts", and in many cases the description is well justified. Living in the Middle East, it is not unusual to see westerners with bright-red faces, presumably flushed with over-exposure to the sun. The reality of that burning glow, however, could be more serious. Rosacea is a chronic and potentially life-disrupting disorder which primarily affects facial skin. It is estimated that 10 per cent of the population in Britain and Sweden, five per cent of the American and Canadian population, and more than 14 per cent of the Irish population suffer from rosacea, with only a fraction being treated. Doctors in the UAE have little experience with rosacea as Emiratis, more accustomed to the desert climate, are not prone to the condition. But with the rise in western workers in the UAE, doctors are treating more cases. The Scots and Irish, in particular, are more vulnerable to the ailment. Think Braveheart, or any other movie image of a stereotypical Celt, and you will probably be visualising a ruddy complexion and a gruff demeanour. While some may have thought that those red cheeks reflected robust health from a good diet and an outdoor life running through the heather in the Scottish highlands, the opposite may be more accurate. The dermatologist Dr Aisha al Bloushi explains that rosacea is a more common in white-skinned Caucasians who are unaccustomed to the climate and lifestyle in the UAE. "I don't think you will find it in UAE nationals. I've been working in dermatology for many years and I have never seen rosacea in UAE nationals. I have seen it in some people from Egypt or Syria, who are also white, but very few." While treatment of the condition is varied, she says the cause is still unknown. "There have been so many theories and so many studies," she says. "Some think it is the vessels of the facial skin, the small ones; they are higher and more sensitive. They are not sure what it is; it is all theory-based." While rosacea is not a life-threatening condition, if left untreated it can develop into rhinophyma, which gave the comedian WC Fields his trademark red bulbous nose. Other famous sufferers include the former US president Bill Clinton, the financier JP Morgan and Rembrandt. In the most serious cases, sufferers can also experience ocular rosacea, where the eyes become bloodshot and patients can experience eye irritation, stinging, dryness, itching or light sensitivity. As this condition progresses, common problems include dry eyes, swollen eyelids, visible blood vessels on the eyelids, and styes. In severe cases, complications can result in loss of visual acuity or vision. Beyond its physical effects, rosacea often inflicts significant emotional and social damage because of its conspicuous impact on personal appearance. In recent surveys by the National Rosacea Society (NRS) in the US, nearly 70 per cent of rosacea patients said this unsightly disorder had lowered their self-confidence and self-esteem, and 41 per cent reported it had caused them to avoid public contact. Al Bloushi says that the sooner rosacea is identified and treated the sooner its progress can be halted, as treatment depends on the severity of the condition. She adds that there are a number of "triggers" that can aggravate rosacea. "When you get these triggers, at the beginning you get the redness which goes and comes, but after many years the vessels get dilated and it becomes permanent redness," she says. While each patient has individual "triggers" causing inflammation, a recent study of 400 patients by the NRS found that sun exposure (81 per cent) was the worst culprit, while emotional stress (79 per cent), hot weather (75 per cent), wind (57 per cent), exercise (56 per cent) and alcohol consumption (52 per cent) were not far behind. Other factors included hot baths, spicy foods, skin care products, hot beverages and some medications. While a combination of the top "triggers" would appear to reflect life in Abu Dhabi, Dr al Bloushi says that minor lifestyle adjustments and awareness can reduce the risk of rosacea. "You have to put on a proper sunblock, and make sure it is a type that does not irritate you," she says. "There are different kinds of sunblocks. People who work outdoors during the day and are exposed to sunlight have to apply it more than once during the day and make sure you have good coverage. "The SPF number doesn't really matter. SPF100, for example, doesn't mean 100 percent coverage from the sunlight - there is no 100 per cent protection from the sun. Even in cold weather there is sunlight that can be harmful, but obviously in the summer it is extreme." She explains that UVB rays cause burning, while the UVA rays cause dryness and accelerated ageing of skin. She recommends a minimum SFP35 for protection. "You need the sun for vitamin D, but the time you go out is important. You can go out early morning and late afternoon, but don't go out, especially here, between about 10am and 4pm. These are extremely hot times; you should avoid these times." Exercise should also be limited to cooler times of the day and reduced to shorter, more frequent periods to offset the increase in body temperature that can inflame rosacea. Sufferers should try to stay as cool as possible when exercising by draping a damp towel around the neck, drinking cold fluids or chewing on ice chips. Spraying your face with cool water will also help. Alcohol consumption, another major "trigger" for some, should also be controlled and limited. A common myth is that rosacea sufferers are reacting to over consumption. In fact, while alcohol can aggravate rosacea, the symptoms can be just as severe in a teetotaller whose skin is reacting to another personal "trigger". Rosacea is usually treated initially with oral antibiotics and topical therapy to bring the condition under immediate control, followed by long-term use of topical therapy. Laser treatment or other medical and surgical devices can also be used to remove visible blood vessels, reduce extensive redness and halt progression of the ailment. So, is there an overall solution, to the ailment? "Moving to a cold climate might not help, because it depends on the trigger that affects you. It could be coffee or something else that is your particular trigger," says Dr al Bloushi. "You have to find out what are the triggers for you. You cannot stop living. You have to look at what is happening in your life and fin d out [what is creating] the problem."