Rosacea

Definition
Rosacea is a common chronic disorder of the skin that causes redness in the face. The redness is often accompanied by small, red, pus-filled papules, characterized by flares and remissions. It usually begins after age 30, as redness on the cheeks, nose, chin or forehead, which waxes and wanes. In some cases, rosacea may also occur on the neck, chest, scalp, or ears. Over time, the redness becomes more persistent, and ruddier. Visible blood vessels may appear. If left untreated, bumps and pimples often develop. In some severe cases, the nose may grow swollen and bumpy from excess tissue. This condition is called rhinophyma. In many patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

Rosacea can affect anyone, but individuals who are fair-skinned and tend to flush and blush easily are at greatest risk. It affects women more than men, but the most severe signs and symptoms are found in men, possibly because they delay treatment until the disease is advanced.

There is no cure for rosacea and the cause is unknown, but medical therapy can control or reverse the signs and symptoms. Individuals who suspect they may have rosacea are urged to see a dermatologist or other knowledgeable physician for diagnosis and appropriate treatment.

 Signs And Symptoms

Signs and symptoms of rosacea may include:

• Facial redness: Rosacea usually causes a persistent redness in the central portion of the face. Small blood vessels on the nose and cheeks often swell and become visible
• Swollen red bumps: Many people with rosacea develop bumps on their face that resemble acne. They sometimes contain pus. The skin may feel tender and hot. 
• Eye problems: About half of the people who have rosacea also experience eye dryness, irritation, and swollen, reddened eyelids. In some people, eye symptoms precede the skin symptoms.
• Enlarged nose: Rarely, rosacea can thicken the skin on the nose, causing the nose to appear bulbous (rhinophyma). That occurs more often in men than in women.

Causes And Triggers

The cause of rosacea is unknown, but it is thought to be a combination of hereditary and environmental factors.

There are some factors that can trigger or aggravate rosacea by increasing blood flow to the surface of your skin. Some of the factors include: 

• Hot foods or beverages
• Spicy foods
• Alcohol
• Temperature extremes
• Sunlight
• Stress, anger or embarrassment
• Strenuous exercise
• Hot baths or saunas
• Corticosteroids, such as prednisone
• Drugs that dilate blood vessels, including some blood pressure medicines

Diagnosis
Diagnosis is made by examination of the skin, with consideration given to symptoms and fluctuation of signs and symptoms over time. There is no specific test for rosacea.

Treatment

Although there’s no cure for rosacea, treatments can control and reduce the signs and symptoms. The best result possible usually requires a combination of prescription treatments and lifestyle changes. Surgical and other procedures, as well as prescription drugs used for rosacea, may include:

• Antibiotics. The antibiotics used for rosacea have anti-inflammatory effects. There are various methods of delivery including creams, gels, or lotions to apply topically, and oral pills. Antibiotic pills are usually more effective for short-term consumption, but may have more side effects.
• Acne drugs. If antibiotics are not effective, isotretinoin (Accutane, Claravis, others) may give a better result. It’s a powerful drug usually reserved for severe cystic acne. It’s tightly regulated, especially for treatment of women in their child-bearing years. It is known to cause severe birth defects. These drugs may have major risks; be sure to speak with your health care professional about potential dangers and side effects.
• Laser surgery and electrosurgery. These may reduce the visibility of blood vessels, and remove tissue buildup around the nose, improving the appearance.

The best step to healthier skin starts with avoiding potentially harmful chemicals and using 100% pure ingredients instead. 

Alternative And Natural Treatment

These are the most frequently used alternative treatments:

• Chrysanthellum Indicum Cream: uses an extract of the herb by the same name. Research evidence is limited, but adverse reactions are described as mild, and no greater than reactions to placebos. One study showed that the drug is significantly more effective than placebos.
• Niacinamide cream, a form of vitamin B3, has been found to be an effective moisturizer, but data is scanty.
• Azelaic acid cream, derived from wheat, rye and barley, is thought to alleviate redness and reduce papules and pustules.

Prevention And Lifestyle Management

Rosacea Skin Treatment

Once treatment achieves remission, it can be maintained by identifying and avoiding lifestyle and environmental factors that trigger flare-ups or aggravate an individual’s condition. Refer to the section listing triggers for what you may need to avoid. Suggestions to prevent flare-ups include:

• Wear broad-spectrum sunscreen with an SPF of 30 or higher.
• Protect your face in cold weather – use a scarf or ski mask.
• Avoid irritating your facial skin by rubbing or touching it too much.
• Wash problem areas with a gentle cleanser (Dove, Cetaphil).
• Avoid facial products that contain alcohol or other skin irritants. In addition, many skincare products contain potentially harmful ingredients.
• Use clean and simple ingredients to moisturize and revitalize your skin daily.

Your Questions Answered

1. Can I wear makeup? 
   It’s safe to wear makeup when you have rosacea. Consider using green-tinted foundations and powders because they are designed to counter redness.
2. Will vitamins help?
   Vitamins K and A, taken by mouth, are said to improve symptoms. There is no conclusive evidence to support that, and taking excessive doses of any vitamins can be dangerous.
3. Are there any dietary supplements that help? 
   Discuss possible supplements with your doctor before you use them. Many false claims are made by manufacturers.
4. Can I go to the beach? 
   Yes, with precautions. Use a natural sunscreen (with no parabens or petrochemicals) generously and reapply at least every 2 hours. Wear a wide-brimmed hat and a use a sun umbrella.
5. My rosacea depresses me. What can I do? 
   See your doctor about the depression. There are ways to treat depression.
6. I feel so alone with this. What can I do? 
   A rosacea support group can connect you with others facing the same problems. You can contact the National Rosacea Society for groups in your area or go online to find groups. (Contact info below.)
7. I had terrible acne as a teenager. Does that mean I’ll develop rosacea? 
   There is no evidence supporting the idea that teen acne indicates future rosacea.
8. Do foods affect rosacea?
   Spicy foods can trigger a flare-up. Learn what foods trigger you and avoid them. Because rosacea is an inflammatory process, anti-inflammatory foods may be of benefit. Contact the National Rosacea Society or your doctor for information on foods which may be of benefit to you.
9. I’m embarrassed and don’t want to leave the house. What I do?
   Ask your doctor for a referral to a counselor, to help you learn how to live with rosacea. You can have a fulfilling life.

Article Written By Sheila M. Krishna M.D., FAAD

Dr. Krishna is a board certified dermatologist. She received her undergraduate degree at the Massachusetts Institute of Technology where she double majored in biology and foreign languages and graduated with Phi Beta Kappa honors. She is fluent in both English and Spanish. Dr. Krishna received her medical degree at the David Geffen School of Medicine at the University of California, Los Angeles, where she was a member of the Alpha Omega Alpha Medical Honor Society. She completed her dermatology residency at the Virginia Commonwealth University in Richmond, Virginia, and she served as Chief Resident in the Department of Dermatology. She completed an additional research year at UCLA with Dr. Lloyd Miller, where she gained expertise in research methods and protocol design and execution. Dr. Krishna is a Fellow of both the American Academy of Dermatology (AAD) and the American Society for Mohs Surgery (ASMS). Dr. Krishna practices in San Diego, California where she treats adults and children for skin conditions. Dr. Krishna was selected as a Top Doctor by her peers in San Diego in 2017. Website - https://www.sheilakrishnamd.com/

Article Reviewed By Natalia Kerr, Licensed Esthetician/Facial Specialist

Natalia Kerr is a licensed esthetician/facial specialist. She graduated from Orange Technical College in 2019 with her diploma in Facial Specialty. She is passionate about skincare and skin health, and has continued her education since graduation by attending various seminars, trainings, and trade shows. She struggled with acne for many years throughout her middle and high school years, and knows the damage to self-confidence that comes with it. This inspired her journey into the world of skincare, and she currently owns and practices at Skin by Natalia in Orlando, Florida. Website - https://skin-by-natalia.square.site/

More information

National Rosacea Society, 196 James Street, Barrington, IL 60010, rosaceas@aol.com, 888-NO-BLUSH

References

1. American Academy of Family Physicians: http://familydoctor.org/familydoctor/en/diseases-conditions/rosacea.html
2. National Rosacea Society: http://www.rosacea.org
3. U.S. Department of Health and Human Services, Office on Women’s Health: http://www.womenshealth.gov/news/healthday/en/2013/jul/17/677977.html
4. Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/rosacea/basics
5. National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004971
6. National Institutes of Health: http://www.nlm.nih.gov/medlineplus/rosacea.html