Rosacea is a common chronic skin condition that presents with persistent central facial redness. Rosacea is often confused with temporary flushing one can experience after emotional episodes or strenuous physical activity. It can be accompanied by acne like pimples, pustules, broken facial capillaries, and in severe cases, nodules, cysts, and even scarring. Rhinophyma, or bulbous growth and enlargement of nose that causes irregularity in nose shape, is also seen in some patients with rosacea. Ocular rosacea occurs in more than 50% of patients with rosacea, and can also occur in patients that do not experience skin rosacea. Ocular rosacea presents with eyelid margin redness, crusting on eyelids, eyelid margin irregularity, and eye irritation. Patients often experience symptoms of burning, stinging, sensitivity to light, or sensation of a foreign body.
What are the risk factors for rosacea?
Rosacea is more common in females than males, and in adults over the age of 30, especially those with a history of sun damage. Rosacea is frequently observed in individuals with light skin tones, a family history of rosacea, and Celtic or Northern European descent. Other risk factors include obesity, smoking, consumption of alcohol, hot drinks and foods, spicy foods, wind, exercise, extreme temperature fluctuations, extreme emotions, and certain skin care products. There are also several medications that can cause the flushing of rosacea such as nicotinic acid and vasodilators. Co-infection of the oil glands in facial skin by demodex mites is also known to cause of worsening symptoms of rosacea.
Can rosacea be cured?
While there are no cure, rosacea can be successfully managed with combination treatments.
- 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 and without harsh loofa brushes or mechanical scrubbing is recommended. Toners, astringents (witch hazel), and chemical exfoliating agents should be avoided. The preferred formulation for skin care and cosmetic products are creams, foams, and powders. Avoid using lotions as they are alcohol based and might worsen the irritation.
- Sun protection: Daily application of a broad-spectrum sunscreen with SPF of at least 30, avoidance of mid-day sun, and use of sun-protective clothing is highly recommended to treat and prevent flares of rosacea.
- Camouflage: Green-tinted liquid foundation or mineral powder before application of skin-matching powder can help camouflage the facial redness. This is primarily a cosmetic measure to reduce the appearance of flushing from rosacea.
- Lasers: When behavioral changes and avoidance of known triggers do not help, lasers such as pulsed dye lasers, KTP lasers, or intense pulsed light (IPL) can be used treat facial redness. Results vary based on severity of symptoms and multiple treatments will be needed to achieve desired results.
- Topical medications: Topical brimonidine gel and oxymetazoline creams can be prescribed to control facial flushing associated with rosacea. However, rebound redness 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 ivermectin. These topicals are considered first line treatment. Sulfacetamide-sulfur is another common topical treatment which is available as a topical suspension, lotion, cleanser, cream, foam, and cleansing pad. However, sulfacetamide-sulfur topicals should be avoided in patients with sulfonamide (“sulfa”) allergies. While widely used and highly effective, some patients find the odor of sulfacetamide-sulfur topicals unpleasant. 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 these retinoids can sometimes worsen skin irritation and redness.
- Systemic medications: Inflammatory rosacea that is not responding to topical treatment options can be treated with systemic antibiotics such as tetracycline, minocycline, and doxycycline. These antibiotics can make the skin sun-sensitive so patients must take care to use proper sun protection while on these medications. These oral antibiotics must not be used by pregnant or nursing females. Severe and recurring rosacea can be treated with isotretinoin, but this medication can only be dispensed after enrolling and satisfying the FDA-regulated iPledge program.
- Rhinophyma: The overgrowth of the nose in rhinophyma can be treated with laser ablation and surgical techniques to debulk and recontour the nose.
Talk to our dermatologists if you experience any of these symptoms so a treatment plan that is best suited for your condition and symptoms can be developed for you.
