Rosacea is a long term inflammatory dermatologic condition that affects 16 million people in the US. It occurs more often in people between the ages of 30 and 60 years of age and affects primarily women and individuals with fair skin, particularly of Irish, Scottish or English descent. However, this skin condition can affect anyone at any age and if left untreated, will worsen over time. Catching this skin condition early is key! While women are more likely to get rosacea, men are likely to get more severe cases. Some famous people that have rosacea are the old comedian, W.C Fields and former US president, Bill Clinton. Rosacea is not contagious or infectious and cannot be spread through contact with the skin, sharing towels, etc.
Signs and Symptoms
These can vary in type and degree of severity from person to person. Rosacea causes redness or flushing of the skin around the cheeks, nose, chin, forehead, and even eyelids. Individuals can present with raised red bumps that resemble acne and may present with a bulbous red swollen nose. During the course of rosacea, patients experience flare-ups and periods of remission. More than 50% of Rosacea patients have eye issues such as dryness, burning, excess tearing, sensitivity to light and swollen eyelids.
What Causes Rosacea?
The exact cause is unknown, but it does involve the swelling of the blood vessels just under the skin. Research suggests it may be hereditary or related to one's immune system. It may be linked to the bacterium, Helicobacter pylori, which is responsible for peptic ulcer disease. Triggers that may make rosacea worse are sun exposure, stress, hot weather, hot baths, intense exercise, cold temperatures or wind, alcohol, and hot or spicy foods. Diagnosing most cases of rosacea is straightforward. There are some look-alike conditions that need to be ruled out such as acne, impetigo which is a staph skin infection, lupus, a medication reaction (like the flushing caused by Niacin), dermatitis, and eczema before a diagnosis of rosacea can be made. Medications that are vasodilators can also flare rosacea. These include certain blood pressure meds like nitrates, calcium channel blockers (verapamil or amlodipine) and thiazide diuretics (HCTZ).
While there is no cure for rosacea, it can be treated and managed by a dermatologist. Primary treatment involves avoidance of know triggers. To prevent flare-ups, it is important to wear sunscreen daily to protect the skin all year round. Zinc-based sunscreens (SPF 30 or higher) provide adequate protection. Treatment options include use of oral antibiotics such as tetracycline, doxycycline, minocycline and amoxicillin, as well as, treatment with topical antibiotic therapy such as metronidazole (Flagyl), clindamycin. These therapies alone or in combination with azelaic acid (Finacea Gel) can also be effective. Both of these meds work to control the redness and bumps.
There are some forms of rosacea that may be significantly cleared for long periods of time using laser, intense pulse light, photodynamic therapy, or isotretinoin (Accutane). Isotretinoin is not first line therapy and is used only after multiple other therapies have been tried and failed. Close physician monitoring and blood testing are necessary while on isotretinoin. Many patients are now turning to laser and intense light treatments to treat the continual redness and noticeable blood vessels on the face, neck, and chest to visibly improve the complexion. Laser treatment may cause discomfort and is costly since it is not covered by insurance. Photodynamic therapy (PDT) is a newly available treatment. PDT uses a topical photosensitizer liquid that is applied to the skin and a light to activate the sensitizer. The treatment takes 1 to 1 and 1/2 hours to complete. The chemical Levulan and blue light used to treat certain pre cancerous conditions and Glycolic acid peels can be used to treat some rosacea patients. Not everyone is able to tolerate these procedures so options should be weighed by your physician to determine the best course of therapy for you.
Short-term topical steroids may also be used to reduce local inflammation. Some of these mild steroids include desonide lotion or hydrocortisone 0.5 or 1% cream applied once or twice a day to only the irritated areas. There is a risk of causing a rosacea flare by using topical steroids so risk versus benefit must be weighed. Other treatments include prescription topical acne meds such a tretinoin (Retin-A), tazarotene (Tazorac), or adapalene (Differin).
How Should I Care for My Skin?
Prescription sulfa skin cleansers and lotions such as sodium sulfacetamide (Klaron lotion) or OTC sensitive skin cleansers are recommended such as Cetaphil or Purpose (OTC). Using non-irritating and hypoallergenic facial products and lotions can help avoid skin irritation. Cleansers should be free of alcohol, witch hazel, menthol, peppermint, eucalyptus oil, and other irritating ingredients.
Where Can I Get More Information?
Resources on managing and treating rosacea include:
National Rosacea Society Website: http://www.rosacea.org/patients/index.php
American Academy of Dermatology RosaceaNet website: http://www.skincarephysicians.com/rosaceanet/whatis.html
You can also contact the National Rosacea Society (NRS) at 888-no-blush
Treating Rosacea is a collaborative approach incorporating both pharmacologic and non-pharmacologic measures. The best defense in managing rosacea is having a clear understanding of this condition and the factors that trigger flare- ups, and adhering to your treatment regimen. Overall, promptly diagnosed and properly treated, rosacea should not prevent people with the condition from enjoying productive lives.