Rosacea is a common chronic, acne-like condition of the facial skin that affects as many as 13 million Americans. It typically first appears when people reach their 30s and 40s as flushing or redness on the cheeks, nose, chin, or forehead that comes and goes. If left untreated, rosacea tends to worsen over time. As the condition progresses, the redness becomes more persistent, bumps and pimples called papules and pustules appear and small dilated blood vessels may become visible. The condition can gradually spread to involve the full face, and sometimes even ears, chest and back.

Who Gets Rosacea?

Rosacea is usually seen in adults. It seems to affect fair-skinned people more often, though it can affect any skin type. Most people who get rosacea have a history of flushing or blushing more easily and more often than the average person.

What are the common symptoms?

Many rosacea patients have only 1 or 2 symptoms. Here is a complete list of the most common ones:

Redness: Initally patients will report intermittent flushing (a blush or sunburn like look to their face), which are often triggered by many factors including emotions and foods. The redness gradually becomes more noticeable and will not go away.

Blood Vessels / Telangiectasias: When people with rosacea flush, the small blood vessels of the face get larger– eventually showing through the skin. These enlarged blood vessels look like thin red lines on the face, usually on the cheeks. These lines may be hidden at first by flushing, blushing or redness, but they usually reappear when the redness is cleared up.

Pimples: Some patients may get small, red and solid (papules) or pus-filled (pustules) like teenage acne. Because they look alike, rosacea has been called “adult acne” or “acne rosacea.” Skin Thickening, especially on the nose. When rosacea is not treated, some people — especially men — may eventually get small knobby bumps on the nose, called rhinophyma. Caused by enlarged oil glands in the skin, rhinoplyma makes the nose larger and the cheeks puffy.

Eye involvement: About 50% of patients with rosacea can have eye involvement called ocular rosacea. This often causes dryness, burning, and grittiness of the eyes. If you have these symptoms, a referral to an ophthalmologist should be considered. Left untreated, ocular rosacea can lean to serious eye complications.

How Does Rosacea Progress?

In most people, the first sign of rosacea is rosy cheeks; the face gets red in patches and stays red — eventually redness doesn’t go away at all. Rosacea is a chronic condition. In most people symptoms come and go in cycles. These flare-ups are common. Although the condition may improve (go into remission) for a while without treatment, it is often followed by a worsening of symptoms (redness, pimples, red lines or nasal bumps) that progresses over time.

Can Anything Make Rosacea Worse?

Triggers that causes flushing can make symptoms worse and cause flare-ups in patients whose rosacea was under control with medications. Flushing can be triggered by many things including strenuous exercise, menopause, and even some medicines. The most common triggers are: sunlight, extreme heat or cold, stress, wind, alcohol, spicy foods, hot drinks, and caffeine. You should avoid anything that causes flushing. You will need to find out what things affect you and decide if you want to change your habits to avoid them. Just remember — flushing may affect your success in controlling rosacea.

What can I do to improve my rosacea?

Following a regular cleansing and medication routine will make treatment easier and more successful. In general, it helps to choose facial products that will not clog pores; look for “non-comedogenic” on the package. Most patients with rosacea have sensitive skin, so avoid products that contain alcohol (check hair spray and toner labels), acetone or oil. Avoid excessive rubbing, scrubbing or massaging the face.

Soaps/cleansers: Only very mild products should be used on the face such as Cetaphil cleanser and Dove soap. Your doctor may prescribe a sulfa-based cleanser. Avoid products that contain alcohol or irritants.

Moisturizers: Apply a quality moisturizer as needed. When using with a topical medication, you can usually apply the moisturizer after the medication has dried. My favorites are green-tinted makeup and moisturizers that help to mask the redness. (Eucerin Redness Relief Daily Perfecting Lotion SPF 15, Clinique Redness Solutions Daily Protective Base SPF 15).

Sunscreens: Since sunlight can exacerbate rosacea, you should use a broad spectrum sunscreen (protection from UVA and UVB) with SPF 30 or higher every day. If you plan to be in the sun for an extended period of time, choose a stronger sunscreen and wear a hat.

What Medications Are Used for Rosacea?

Several medications are available by prescription. They control redness and reduce the number of papules and pustules. Remember, without regular treatment, redness and pimples can return. Studies of patients who stopped treatment after their symptoms were successfully cleared show that rosacea came back in many of the patients within a week to 6 months.

  • Topical Antibiotics such as metronidazole and sulfa/sulfacetamide products may be used in mild forms of rosacea to decrease skin bacteria. These topical medications work best when used on a regular basis to prevent flares rather than to spot treat.
  • Topical comedogenics such as azelaic acid, benzoyl peroxide, or retinoids help to unclog pores.
  • Oral Antibiotics such as minocycline and doxycycline are sometimes used in more severe cases to treat the papules and pustules. As rosacea is not caused by an infection, the effectiveness of antibiotics is due to their anti-inflammatory properties rather than their bacteria-fighting capabilities.

Do treatments help redness and blood vessels?

While topical medications can stop the progression of redness and blood vessels, they are only minimally effective for existing background redness. Blood vessels or telangiectases are most effectively treated with a Pulsed-Dye Laser (V Beam) and Intense Pulsed Light (IPL). Laser treatment causes selective injury to the blood vessels, which makes them disappear. Most patients will notice some swelling, redness, and even bruising after laser treatments which lasts 2-5 days. A series of treatments (3-5) are usually required for optimal results. As patients with rosacea have a tendency to form new blood vessels, maintenance treatments may be needed.

Are there effective treatments for Rhinophyma?

Rhinophyma is the term for the skin thickening on the nose from enlarged oil glands. Surgery is the most effective treatment for this. The excess tissue can be carefully sculpted and removed with laser and electrosurgery.

If you have any questions, please contact us at (615) 266-3376 (DERM).