What is Rosacea?
Facial redness is a common complaint among many people and I often hear patients refer to any form of redness as rosacea. A chronic disorder that affects facial skin, rosacea is a disorder that can be characterized by acne-like red bumps, facial redness and flushing, and increased skin sensitivity.
Rosacea affects an estimated 16 million Americans, although only a small fraction of these people are being treated. Those with fair skin who tend to flush or blush easily are most likely affected by rosacea. Women tend to be more frequently diagnosed with the condition. However, when rosacea is diagnosed in men it is usually more severe.
The Cause of Rosacea
While many people assume that lifestyle and environmental factors are the cause of rosacea, this is not true. There are many factors that can trigger rosacea flare-ups, most commonly: hot & spicy foods, alcohol, hot temperatures, and sun exposure. There is no known cause for rosacea. However, many individuals with rosacea report having a family member with the condition.
The Sub-Types of Rosacea
Facial Redness (Telangiectatic Rosacea): This type of rosacea leaves you with a red face and flushing. Redness and visible blood vessels are more prominent on the cheeks and around the nose.
Bumps and Pimples (Papulopustular Rosacea): Mimics acne (without the appearance of white heads or black heads) with prominent redness and swelling.
Skin Thickening (Rhinophymatous Rosacea): Characterized by a large, bulbous ruddy nose.
Eye Irritation (Occular Rosacea): This type of rosacea affects the eyes primarily, and is associated with red eyes, and burning, sensitivity to light.
Each sub-type of rosacea requires a specific treatment plan that is tailored to the individual. Rosacea can be treated orally or topically (and in some cases, both oral and topical treatments will be used). To start, the goal is to bring the condition under immediate control and this often requires a combination of oral and topical medications.
Treatment of mild rosacea can begin with over-the-counter products that target redness. HydroPeptide Soothing Serum, La Roche-Posay Rosalica AR Intense Hydration Facial Serum, and Olay Regenerist Microscuplting Cream with niacinamide are a few creams that I recommended for treating symptoms of mild rosacea.
There are a number of prescription creams that can be used. The most common topical treatments are azelaic acid (Finacea), sodium sulfacetamide (Klaron), and topical metronidazole (MetroCream or MetroGel). If swelling, inflammation and acne are severe, oral antibiotics such as doxycycline are prescribed.
It is important to be aware that, in most cases, rosacea medications will not improve facial redness. Currently, there is one prescription medication on the market for the redness caused by rosacea. Brimonidine (Mirvaso) is a vasoconstricting medication that temporarily decreases the appearance of facial redness by closing down blood vessels. The effects can last for up to 12 hours. This medication is expensive and not well covered by insurance.
When facial redness and blood vessels are the primary concern, I usually recommend that lasers or intense pulse light sources be used to provide a more permanent improvement in the appearance of the skin. It is also important to become aware of one’s rosacea triggers as these triggers can cause a temporary worsening of facial redness.
Rosacea can sometimes mimic acne but over-the-counter acne treatments will not be beneficial to a rosacea patient and may actually make rosacea worse. If you suffer from rosacea, it is best to consult with your dermatologist for a treatment plan. There is no cure for rosacea but long term treatment combined with gentle skin care will help minimize irritation and redness, allowing clear and beautiful skin to shine through.
Joyce Imahiyerobo-Ip, MD, MPhil serves as the director of cosmetic dermatology at South Shore Medical Center in Boston, MA and shares skin tips along with health and wellness knowledge through her blog at www.vibrantdermatology.com. She graduated cum laude from Harvard University with a bachelor’s degree in health policy and then traveled to the United Kingdom to pursue a master’s degree in international development at Cambridge University. She received her medical degree from Cornell University’s Weill Medical College and completed specialized training in dermatology at Dartmouth-Hitchcock Medical Center where she served as a chief resident in her final year. She is married with two children and loves spending time with her extended family.