Rosacea

Rosacea is a common chronic skin condition that presents with persistent central facial redness, in contrast to temporary flushing one experiences after emotional episodes and strenuous physical activities and exercises. It can be accompanied by acne like pimples, pus heads, broken facial capillaries, and in severe cases, by nodules, cysts and even scarring. Rhinophyma, the bulbous growth and enlargement of nose, causing irregularity in contour of nose, is also seen in some patients with rosacea. Ocular rosacea occurs in more than 50 percent of patients with rosacea, and can also occur without skin rosacea. It presents with lid margin redness, crusting on lids, lid margin irregularity or eye irritation.  Patients often complain of foreign body sensation, burning, stinging and sensitivity to light.

What are the risk factors for rosacea?

Frequently observed in individuals with very light skin, rosacea is more common in females than males, and in adults over 30, especially with history of sun damage. Smokers, those with a family history of rosacea, and people of Celtic or Northern European descent are at increased risk for developing rosacea. Other risk factors include obesity, consumption of alcohol, hot and steamy drinks and foods, spicy foods, wind, exercise, extreme temperature fluctuations, extreme emotional feelings of anger, rage, and embarrassment, certain skin care products, as well as some medications that cause flushing of rosacea, like nicotinic acid and vasodilators for control of blood pressure. Co-infection of oil glands of facial skin by demodex mite is also known to cause or worsen symptoms of rosacea.

Can rosacea be cured?

While there are is no cure, rosacea can be successfully managed with combination treatment.

  • Skin care: mild rosacea that presents with rough, red, dry, irritated skin can be managed with gentle skin care measures. Frequent skin moisturization can help restore and maintain normal skin barrier and decrease symptoms of burning, stinging, skin sensitivity and flushing. Daily cleansing with non-soap gentle cleansers, without harsh loofa brushes or mechanical scrubbing is recommended. Toners, astringents (witch hazel), and chemical exfoliating agents as in peels, and mechanical exfoliating sponges should be avoided. The preferred formulation for skin care and cosmetic products should be creams, foams and powders, not lotions, which are alcohol based and may likely worsen the irritation. 

  • Sun protection: daily application of a broad-spectrum sunscreen with SPF of at least 30, avoidance of mid-day sun avoidance and use of sun-protective clothing is highly recommended to treat and manage rosacea and flushing associated with rosacea. 

  • Camouflage: green-tinted liquid foundation or mineral powder before application of skin-matching powder can help camouflage the facial redness.

  • Lasers: when behavioral changes and avoidance of known triggers do not help, lasers like pulsed dye lasers, KTP lasers, or intense pulsed light (IPL) can be used to help with facial redness.  Results vary based on severity of symptoms and multiple or repeat treatments may be needed to achieve desired results. 

  • Topical medications: topical brimonidine gel and oxymetazoline creams can be prescribed for control of facial flushing associated with rosacea. However, rebound redness, which can persist even after discontinuation of the drug.  Inflammatory rosacea that presents with pimples and pus heads can be treated with topical therapies such as metronidazole, azelaic acid, and topical ivermectin, which are considered first line treatment, as well as sulfacetamide-sulfur which is available as topical suspensions, lotions, cleansers, creams, foams, and cleansing pads. It should be avoided in patients with sulfonamide ("sulfa") allergies. While widely used and highly effective, some patients find the odor of sulfacetamide-sulfur topicals offensive. Topical antibiotics like clindamycin, erythromycin and benzoyl peroxide have also been successfully used for inflammatory rosacea.

  • Retinoids: topical adapalene, tretinoin and tazarotene can be used for acne like pimples, but can sometimes worsen skin irritation and redness. 

  • Systemic medications: inflammatory rosacea that is not responding to conservative treatment options can be treated with systemic antibiotics like tetracycline, monocycline and doxycycline.  Care must be taken when taking anitbiotics that make skin sun-sensitive such as these.  They must not be used by pregnant or nursing females. Refractory rosacea can be treated with isotretinoin, which can only be dispensed after enrolling and satisfying program requirement of the FDA-regulated ipledge program.

  • Rhinophyma: overgrown nose can be treated with laser ablation and surgical technique to debulk and recontour the  nose.

 

Talk to your dermatologist if you experience any of these symptoms so a treatment plan that is best suited for your condition and symptoms can be prescribed for you.