From: gnas_@_.edu
Date: Thu Mar 11, 1999 2:55 am
Hello Carol,
How do you get relief from burning? This is a difficult question to answer
without seeing you. Let me give you some information and suggestions and
we will go from there.
First of all, why do many rosacea sufferers feel the sensation of burning?
In the case of facial burning, there are nerves that come in contact with
your facial skin called sensory neurons. They 'sense' different things
like heat, pain and touch. If there is any inflammation in the skin, these
nerves sense this and send a signal back to your brain. The brain then
registers this sensation of pain or burning. You do not have to see the
inflammation in the mirror -- it can be happening deep within the layers
of the skin (what you see in the mirror is usually only the tip of the
iceberg). Now with rosacea skin, there can be chronic low-grade
inflammation that activates these nerves -- brain senses burning.
Furthermore, studies show that when you have increased blood flow to the
face, the temperature of your facial skin rises (warm or hot to the
touch). This not only increases local inflammation, but it also makes
those sensory neurons more excitable -- more pain or burning signal. The
ironic thing is that in most cases, when the brain gets the message of
pain or burning from the sensory neurons, it activates other neurons that
cause facial blood vessels to dilate even further to bring in more blood
-- in our case, this is not good. You see, when the body senses pain or
inflammation, it wants to deliver nutrients, oxygen and cells from the
immune system to that area under siege. The only way to do that is to
increase blood flow! YIKES! We can't win can we.
In addition, to generalized inflammation and blood flow due to rosacea,
some patients can also have inflammation from seborrheic dermatitis,
atopic dermatitis, allergies, ecxema etc.... These cause even more
inflammation and more activation of sensory nerves.
The bottom line is that you must decrease inflammation. A first step is to
make sure that you do not irritate your face with facial cleansers,
moisturizers. A second step is to find a good topical anti-inflammatory
cream. Some have quite a bit of success with Noritate. Many notice
decrease in burning and stinging. However, this does not work for
everyone. A third step is to try cool soaks by placing a cool (not cold)
wash cloth over your face (do not rub). By cooling the temperature of the
facial skin, the sensory nerves are much less likely to send impulses back
to the brain. Some people also notice some improvement with the safflower
and jojoba oils -- place a drop in the noritate cream and mix -- then
apply to face. The oil will help if the cause of irritation or
inflammation is from chronic dry skin. Furthermore, some find 2 baby
aspirin (one in am and one in pm) are beneficial. Aspirin blocks the
synthesis of substances that are intimately involved in inflammation
(prostaglandins). Others notice relief with antihistamines such as zyrtec
to block histamine. Clinical studies demonstrate that histamine can bind
to sensory (and 'itch') nerves and increase the sensation of pain to the
brain. Photoderm is perhaps one of the best methods to decrease
inflammation (see recent post).
Pharmaceutical companies are in the process of making topical drugs that
block the sensation of pain. The key is to block substance P (main
mediator of pain) release from the sensory neuron. They need to place it
into liposomes (delivery agents) first to decrease irritation. This looks
promising.
This should get you started,
Geoffrey
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Dr. Geoffrey Nase