The red patches of acne rosacea, which most often occur on cheeks and nose, can be a misery for women, causing emotional distress. Thirty-plus women ( and sometimes men) are most likely to be affected. There are four different phases in rosacea, according to leading cosmetic dermatologist Prof Nicholas Lowe**: the first is flushing and/or blushing; the second acne-like pustules and papules (small, raised red lumps); thirdly, permanently enlarged blood vessels (spider veins); finally, red, lumpy, bulbous enlargement of the noses (medically called rhinophyma). In rosacea keratitis, pustules and acne-like rashes can affect eyes and eyelids.

Rosacea -Symptoms, Causes, Treatment And Home Remedies

Causes of Rosacea

The underlying cause is a mystery, although different factors, including hormonal changes, can make it worse. Various triggers, particularly sunlight or heat, seem to stimulate chemicals in the body which cause the blood vessels to enlarge. Some foods, particularly coffee, chocolate, oranges, spices, and alcohol may also act as triggers. Cosmetics including AHA-based creams may also make rosacea worse.

Camouflage make-up can work wonders. Several Hollywood stars rely on Laura Mercier’s brilliant cover-up Secret Camouflage*.

Treatment for Rosacea

Drug Therapy

It includes antibiotics (usually tetracycline, which is safe for most people, even over long periods) or Rozex gel, it is the preferred treatment. In the last extreme, patients (though never women of childbearing age) are put on a very low dose of the drug Accutane.

Any redness, flushing and spider veins left after treatment can be removed by laser. It is also suggested that taking vitamins B1 and B2 also works wonders on the skin.

If the patient suffers from any digestive problems then she/he should consult a nutritionist.

Qualified Chinese herbal medicine practitioners also have a very good track record with skin conditions in general.

Home Remedies for Rosacea

1. Chamomile cold compress is a great remedy for rosacea because it has got an anti-inflammatory property which helps in reducing inflammation and redness. It has also got active ingredients like terpenoids and flavonoids which soothe inflamed skin.
2. Green tea has got antioxidant, anticarcinogen, anti-inflammatory properties which help in treating rosacea effectively. It helps in preventing papules and pustules from developing on the affected area.
3. Oatmeal helps in reducing itching, redness, and inflammation. Rub it on the affected and wash with cold water after 20 minutes.

Lifestyle Modifications For Rosacea

If you want to control the flare-ups of rosacea make sure to make this lifestyle Modifications in your day to day life. These self-care tips help to prevent future flare-ups of rosacea:

1. Avoid triggers:- Find your triggers for rosacea and avoid those triggers.
2. Avoid Direct Sunlight:- Use sunscreen on a daily basis. Try to incorporate broad-spectrum sunscreen in your skincare routine. The broad-spectrum sunscreen help to block both types of harmful UV radiation which UV-A as well as UV-B. You can select SPF based on your skin tone. Minimum SPF should be 30 and you can increase it according to your need. Apply sunscreen after use of topical medications and application of sunscreen should be the last step of your skincare routine.
3. Use Gentle Skin-care products:- Don’t use harsh scrubs on your face because it can further increase the flare-ups of rosacea. Instead, opt for chemical exfoliants which are not as harsh as compared to physical exfoliants. Use a soap-free cleanser and use a sensitive skin moisturiser. Use alcohol-free toners and avoid other skin irritants as well.
4. Use makeup to reduce redness:- If you want to hide those red cheeks then use some makeup products which can vanish your redness due to rosacea.

References:

1. https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353815
2. https://www.medicalnewstoday.com/articles/160281
3. https://www.webmd.com/skin-problems-and-treatments/understanding-rosacea-basics#1

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Cardiac arrhythmias occur because of abnormalities of impulse formation or propagation. Abnormal impulse formation

Abnormal Automaticity

Automaticity is another term for pacemaker activity, a characteristic possessed by all cells of the specialised cardiac conduction system during health and, potentially, by other cardiac myocytes during certain disease states. The rate of firing of a pacemaker cell is largely determined by the duration of the phase 4 diastolic interval This in turn is determined by (i) the maximum diastolic potential following depolarization of the preceding action potential, (ii) the slope of diastolic depolarisation due to pacemaker currents and (iii) the threshold potential for generation of a new action potential. In the healthy state, there is a hierarchy of firing rates within the specialised conduction system with the highest rate in the sinus node followed by the AV node and then the His–Purkinje system.

Arrhythmias

Abnormal Impulse Propagation

Re-entry

Many clinically important arrhythmias are due to reentry, in which an activation wavefront rotates continuously around a circuit. Re-entry depends upon a trigger in the form of a premature beat, and a substrate, that is, the reentry circuit itself.

Signs And Symptoms of Arrhythmias

Patients with a cardiac arrhythmia may present with a number of symptoms:

The most common symptom is palpitation, an awareness of an abnormal heartbeat, although some patients with clearly documented arrhythmia have no palpitation. Arrhythmias start suddenly and, therefore, if the patient clearly describes palpitation of sudden onset (‘like flicking a switch’), this is a useful pointer to an arrhythmia rather than heightened awareness of sinus tachycardia, which has a less sudden onset.

The heart is designed to work most efficiently in sinus rhythm. Any arrhythmia compromises cardiac function. Classical symptoms that arise due to reduced cardiac output include reduced exercise capacity, breathlessness and fatigue.

Angina may accompany tachycardia, even in the absence of coronary artery disease. Tachycardia increases the metabolic rate of cardiac muscle and hence its demand for blood flow. Myocardial perfusion occurs predominantly during diastole and during tachycardia proportionately less time is spent in diastole and so myocardial demand for blood can exceed supply, resulting in angina.

A sudden drop in cardiac output may accompany either bradycardia or tachycardia, causing episodes of dizziness (presyncope), loss of consciousness (syncope) or, in extreme cases, sudden death from cardiac arrest.

Atrial tachyarrhythmias such as atrial flutter and atrial fibrillation may be complicated by the development of intracardiac thrombus, usually within the left atrial appendage. This thrombus may embolize to any part of the body but the most common clinical presentation is with a transient ischaemic attack or stroke. Arrhythmias may aggravate heart failure in two ways: (i) the haemodynamic effect of the arrhythmia may precipitate heart failure or aggravate existing heart failure and (ii) prolonged tachycardia of any type may lead to tachycardia-induced cardiomyopathy

Diagnosis of Arrhythmias

It includes a 12-lead ECG and an echocardiogram to detect structural heart disease. Other investigations for structural and ischaemic heart disease may be indicated at this stage with the aim of detecting any underlying structural heart disease. If the history does not include sinister features such as syncope or a family history of sudden unexpected death at a young age, and the resting 12-lead ECG and echocardiogram are normal, then the patient can be reassured that they are extremely unlikely to have a serious heart rhythm disturbance. The extent of further investigation will be dictated by how troublesome the symptoms are.

Treatment for Arrhythmias

Management

Cardiac arrhythmias associated with unstable angina, heart failure or hypotension requires emergency treatment. In most cases, the treatment of choice is d.c. cardioversion.

Concerns about thromboembolism as the heart returns to sinus rhythm are valid but should not delay emergency treatment. Immediate d.c. cardioversion is appropriate when the onset of arrhythmias is clearly identified as within 48 h of presentation or when the patient is already taking warfarin and has had a therapeutic INR for at least 4 weeks.

If facilities permit, a transesophageal echocardiogram may be performed in patients not already on warfarin in order to exclude intracardiac thrombus. Heparin should then be given immediately and continued until the INR is within the therapeutic range.

Anticoagulant therapy should be continued for at least 3 months following cardioversion. Long-term stroke prophylaxis is guided thereafter by the CHADS2 score.

If d.c. cardioversion is deemed inappropriate, rapid ventricular rate control may be achieved with intravenous ß-blockers, verapamil or digoxin.

Drug Therapy for Arrhythmias

Antiarrhythmic drug therapy is used to control the frequency and severity of arrhythmias, with the aim of maintaining sinus rhythm where possible. Although antiarrhythmic drug treatment has been the mainstay of arrhythmia treatment, many of these drugs have limited efficacy and important toxicity. Many arrhythmias are now curable by catheter ablation. Implantable devices such as permanent pacemakers and ICDs have assumed an increasingly important role in the treatment of arrhythmias and, in many cases, antiarrhythmic drugs have an adjunctive role.

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