Rosacea

Who is at risk?

Rosacea usually develops in adults between ages 30 and 50. It affects both men and women, although it seems to affect more women. It tends to affect people with fair skin, such as those of northern and eastern European descent (e.g. Irish, English, Scottish), although rosacea can develop in any skin type.

Signs and symptoms

• frequent flushing or blushing on cheeks, nose, chin, forehead
• persistent redness
• red lines, due to enlarged blood vessels becoming visible
• dry skin
• burning, stinging or itching
• pimplelike bumps without blackheads or whiteheads

What causes it?

Experts are not sure about specific causes of rosacea but they believe it is due to both genetic and environmental factors.

There are four forms of rosacea, defined by the following:

Erythemato-telangiectatic — Main symptoms are facial flushing and redness, which may not always be present. There may also be some swelling, burning and stinging, roughness and visible red blood vessels.

Papulo-pustular — This form of rosacea is marked by persistent redness and pimplelike bumps (often mistaken for acne).

Phymatous — In some individuals rosacea may affect oil glands and connective tissue causing the skin tissue to thicken (appearing enlarged) and become bumpy. Phymatous rosacea most commonly affects nose (rhynophyma) and can rarely affect forehead and chin.

Ocular rosacea — In addition to skin symptoms, rosacea may affect the eyes and eyelids. It can cause redness to the surrounding skin tissue but also burning or stinging, dryness, light sensitivity, blurred vision and watery, bloodshot eyes.

Rosacea can feel worse than it looks. Like other chronic diseases, it is psychologically hard to deal with a condition that persists for many years. Many patients with rosacea feel self-conscious and embarrassed about the redness and bumps that mar the face, making it difficult to hide. They also may be negatively affected by common misconceptions about the condition, such as the belief that it is a sign of alcohol abuse or poor hygiene.

Nearly three-quarters of rosacea patients have reported low self-esteem. Similar numbers have reported that they feel the rosacea adversely affects their career opportunities. Because of the social and psychological impact, it is imperative to be diagnosed and treated for this chronic skin condition. Successfully controlling symptoms through treatment has been shown to improve the mental and emotional well-being of patients.

Several lifestyle factors can cause rosacea to flare up. Some known triggers include hot/cold weather extremes, sun exposure, mental stress, and hot or spicy food and drinks. These triggers vary from person to person, so it is both important and helpful to find out which ones make your own symptoms flare up. This knowledge can help you better manage your condition, because you’re able to avoid things that may aggravate the skin.

Food and beverages

What you eat and drink can affect rosacea symptoms — especially spicy foods or hot soup and drinks. Watch for the following, and track when you eat these trigger foods/drinks to determine which ones affect you:

• thermally hot drinks such as soup, hot chocolate
• caffeinated beverages such as tea, coffee
• spicy seasonings such as white or black pepper, paprika, red pepper, cayenne
• alcohol, especially red wine

Sun exposure

Exposure to UV seems to make rosacea worse, so rosacea sufferers are advised to use sunscreen with an SPF value of 30 or more daily. Try to avoid the sun at peak times, primarily between 11 am and 3 pm.

Temperature extremes

Extremely hot or cold weather conditions, very dry or humid air, wind and indoor heat exposure can be triggers. The key is to stay cool in hot weather, cover skin and moisturize when it is cold outdoors, and avoid hot baths, saunas or other environmental factors that raise your body temperature.

Intense exercise

High-intensity workouts overheat the body, which can trigger flushing. Avoiding vigorous exercise or divide it into shorter sessions. You can also find ways to stay cool while working out, such as exercising outdoors during cooler weather, or working out indoors in an air-conditioned space when it’s hot outside.

Stress

Stress is one of the most common triggers associated with rosacea flare-ups. If this is a trigger for you, seek out ways to manage emotional upset — such as getting enough sleep, deep breathing and stretching, exercising regularly and eating a healthy diet. Remember that too much caffeine and sugar, dehydration or skipping meals can also raise stress levels.

Medications

Extended use of prescription-strength cortisone creams on the face can precipitate rosacea flares and worsen rosacea symptoms. Topical acne treatments may also increase dryness and exacerbate rosacea.

Certain medications that cause vasodilation (enlarged blood vessels) and flushing can also prompt flare-ups. Consult your physician if you think your medication plays a role in rosacea flares.

Cosmetic products

Products with fragrance, alcohol, abrasives or other irritating ingredients can aggravate rosacea symptoms. Remember that rosacea-prone skin is sensitive and dry, so choose only mild products.

Good skin health tips 

The key to caring for skin affected by rosacea is to treat it gently.

• Choose products that are non-drying, and free of alcohol or astringents.
• Use a mild cleanser; don’t rub or scrub skin.
• Make a habit of using sunscreen (SPF 30 or higher) every day.
• Moisturize your skin, especially during colder months when the air is dry.

Five myths about rosacea

It’s a form of acne — Don’t try acne creams to treat confirmed rosacea; they may dry out and irritate your skin even more.

It’s because of a drinking problem — Excess alcohol consumption does not cause rosacea. Alcohol is a known trigger, so it can worsen symptoms in individuals with rosacea.

It’s due to high blood pressure — It’s a common misconception that high blood pressure produces facial flushing.

It’s due to poor hygiene — Rosacea isn’t caused by not washing enough. In fact, because rosacea skin tends to be dry and sensitive over-washing it can make symptoms worse.

It’s actually a bad sunburn or a frost bite— Because of the redness that characterizes rosacea, people may assume that you have sun or cold burned skin.

Rosacea does not resolve on its own, and untreated rosacea can worsen over time. Unlike acne, self-treating with over-the-counter products may not help, and may even irritate skin more — causing more redness and bumps. Your family doctor or dermatologist can prescribe various treatments and recommend appropriate skin care products and cosmetics.

Sticking with your recommended treatment will improve symptoms within a few weeks.

Topical

Metronidazole

This topical agent, which has anti-inflammatory and antimicrobial effects, is considered a gold-standard treatment for rosacea. It can be used long-term and is available in gel, cream or lotion form.

Azelaic Acid

Azelaic acid is a naturally occurring dicarboxylic acid possessing antibacterial activity. It is as effective as metronidazole. While some studies have shown azelaic acid to be slightly superior to metronidazole, it may not be as well tolerated.

Brimonidine Tartrate

Used once daily as a cream, brimonidine tartrate can reduce the redness (erythema) associated with rosacea by shrinking blood vessels.

Ivermectin

Topical ivermectin is a prescription cream for treating the inflammatory lesions associated with rosacea in adults. The drug is thought to have anti-inflammatory activity.

Tretinoin cream

This topical agent may be prescribed for mild rosacea. It can irritate skin and should be used with caution.

Sodium sulfacetamide and sulphur

Sodium sulfacetamide and sulphur are occasionally used to treat redness and inflammation.

Oral (systemic)

Antibiotics

Rosacea is often treated with antibiotics, either in a topical formulation or taken orally as a pill. They work mainly as anti-inflammatories. Oral antibiotics include tetracycline, doxycycline, minocycline and others. Topical antibiotics are used for milder forms of rosacea, while oral medication is reserved for moderate or severe rosacea.

Isotretinoin

This oral agent may be prescribed if rosacea is severe, or if symptoms do not respond to antibiotics.

Laser Therapy and other Cosmetic Surgery

Laser treatment involves using light energy to treat visible red blood vessels and redness in rosacea that does not respond to other types of therapy. Laser resurfacing, dermabrasion or cosmetic surgery may be used to reduce the tissue overgrowth associated with rhinophyma.

Makeup

In addition to treating rosacea symptoms, many patients feel better about their condition if they are able to cover the visible redness and bumps. Corrective camouflage makeup is available to help conceal rosacea symptoms; it is a special kind of makeup with a green tint.