Rosacea

What is rosacea?

Rosacea is a chronic inflammatory skin condition that most often affects the central face. It can cause persistent redness, easy flushing, visible blood vessels, acne-like bumps, burning or stinging, facial swelling, and in some patients eye irritation. Some people have one dominant subtype, while others have a mix of features.

Rosacea commonly appears in adulthood and often tends to come and go in flares. Without treatment, symptoms may gradually become more persistent over time.

What causes rosacea?

The exact etiology of rosacea remains elusive. However, a combination of factors, such as sun exposure, genetics, environment, vascular changes, and inflammation, are believed to contribute. There's also speculation about the role of hair follicle mites, though it's not conclusive. Several triggers can exacerbate rosacea, including:

• Prolonged use of topical or oral steroids like prednisone

• Extended exposure to sunlight

• Consumption of hot or spicy foods

• Alcohol consumption

• Exposure to extreme temperatures

• Emotional stress

• Intense physical activity

• Some medications

What are the symptoms of rosacea?

Rosacea presents as reddened areas on the face, often accompanied by pus-filled bumps. Unlike acne, it doesn't feature blackheads, whiteheads, or deep nodules. Common symptoms encompass:

• Regular blushing or flushing

• Visible redness and noticeable blood vessels

• Red, raised spots on facial areas such as the nose, forehead, cheeks, and chin

• Dry, flaky skin on the face

• Sensitivity to products, accompanied by burning or stinging sensations

• Eye irritation, manifesting as red or swollen eyelids, bump formation, or styes

• A swollen, bulbous nose with pronounced pores

• Persistent facial swelling

How is rosacea treated?

Treatment depends on the main subtype and symptoms present.

Common treatment approaches include:

• Gentle skin care and daily sun protection

• Topical metronidazole, azelaic acid, or ivermectin for inflammatory disease

• Brimonidine or oxymetazoline for persistent redness in selected patients

• Oral doxycycline or other oral anti-inflammatory therapy for more inflamed flares

• Newer prescription options for papulopustular rosacea, including specialized benzoyl peroxide (like Epsolay) or minocycline (like Emrosi) formulations in selected patients

• Laser or light-based treatments for visible blood vessels and background redness

• Isotretinoin in difficult or severe cases

The best treatment plan depends on whether the main problem is redness, bumps and pustules, visible blood vessels, eye involvement, thickened skin, or a combination of these.

How do I prevent rosacea flares?

Helpful steps can include:

• Using sunscreen regularly

• Avoiding topical steroids on the face unless specifically directed

• Choosing gentle skin-care products

• Limiting known personal triggers

• Protecting the skin from temperature extremes

• Treating symptoms early when flares begin