If you blush easily, you might already have a skin disease that is likely to get worse without the appropriate treatment. About 16 million Americans suffer from rosacea (pronounced “rose-ay-shah”), an inflammatory skin disorder that causes intermittent flare-ups of redness on the nose and cheeks. The mildest form, known as prerosacea, could start as nothing more than the tendency to flush easily.
Without treatment, patients may then develop vascular rosacea, the swelling of small blood vessels in the face… inflammatory rosacea, which can resemble acne… and/or ocular rosacea, an irritating sensation in the eyes.
Only a small percentage of patients with rosacea are diagnosed or treated, largely because they don’t realize that they have a “real” disease.
Researchers still don’t know what causes rosacea, although it has been linked to genetic factors. What is known is that environmental factors, or triggers, can cause flare-ups. Common triggers include sun exposure, heat, stress, alcohol and spicy foods.
The symptoms of rosacea often are intermittent. A patient might have clear skin for months or even years. Then he/she will develop redness and/or pimples that can last from a few weeks to several months.
Many people with rosacea never see a doctor because they assume that they have a form of adult acne.
Not true. With acne, bacteria living in the hair follicles cause redness and swelling. Bacteria aren’t involved in patients with rosacea. Patients with acne almost always have blackheads and whiteheads along with pimples… these don’t occur in patients with rosacea. Rosacea mainly affects the central one-third of the face, while acne usually covers a larger area. Other differences…
Rosacea patients often develop telangiectasias, tiny red lines caused by the swelling of blood vessels in the nose and cheeks.
Without treatment, some will go on to develop knobby bumps and waxy-looking skin in the nose area, a condition known as rhinophyma.
More than 50% of patients with rosacea have some degree of eye involvement. This might include mild tearing or a burning sensation. Some patients also have eyelid swelling.
If you have any of the symptoms noted above, see a dermatologist. He/she can make a diagnosis by looking at the skin and considering factors such as age (it tends to occur after age 30), a family history of the condition and the waxing and waning of symptoms.
Important: Rosacea’s rash pattern is similar to the “butterfly rash” that occurs in some patients with lupus, an autoimmune disease. A dermatologist may recommend a blood test for lupus.
There is no way to eliminate rosacea. The main treatments are used to reduce inflammation and prolong the time between flare-ups. Some patients will need to continue treatment for months or even years. Treatments…
Antibiotics. Topical antibiotics, such as metronidazole (MetroCream, Metrogel), used once daily, are the main treatment. Available by prescription, they’re used for their anti-inflammatory properties rather than to fight infection.
A patient might be treated with both topical and oral antibiotics to reduce or eliminate flare-ups. Oral antibiotics include doxycycline, minocycline and tetracycline and are mainly used for patients with moderate-to-severe symptoms. These drugs have anti-inflammatory effects even at low doses.
Azelaic acid. This naturally occurring substance is available as a prescription gel and is about as effective as metronidazole. In some patients, however, it’s slightly more irritating to the skin.
Sulfacetamide sodium and sulfur, combined in a cream (such as Plexion SCT, Novacet). This is available over-the-counter and by prescription. The combination treatment can help reduce skin eruptions in patients with inflammatory rosacea. It’s usually used along with other topical treatments.
Laser therapy to remove swollen blood vessels. The treatment usually is effective but expensive (from hundreds to thousands of dollars) and isn’t covered by insurance. It is the best way to eliminate telangiectasias. The results of the treatment (or course of treatments—some patients require more than one) can last for years but are unlikely to be permanent.
The most important strategy is to identify triggers that cause flare-ups. One survey found that 81% of patients get worse after sun exposure…79% react to stress…75% react to hot weather…52% to alcohol…and 45% are sensitive to spicy foods.
Avoid excessive sun. Wear a broad-brimmed hat…and use sunscreen with an SPF of 15 or higher.
Keep your face cool. Avoid lengthy hot showers or baths…and apply a moist, cool towel to your face when you feel flushed.
Drink in moderation or not at all. Alcohol dilates blood vessels and can make your face look redder. Helpful: If you enjoy a glass of wine, you may do better with white wine. Red wine contains histamines, compounds that can cause vasodilation and inflammation.
Use gentle soaps, such as Cetaphil or Dove. Apply a moisturizer daily, preferably one without added scents. When using makeup or other skin-care products, choose brands that are designed for sensitive skin.
