Rosacea: What It Is and What to Do About It
Rosacea is a progressive skin issue that affects tens of millions of people in the United States alone. It occurs in both genders—more often in fair-skinned women—in patients ranging from the ages of 30 to 50 years.
As a dermatologist, I see plenty of patients who suffer from persistent facial redness and flushing. Because of its complex etiology and wide spectrum of clinical manifestations, rosacea remains a challenging condition for both dermatologists and patients. For many people, the symptoms often go undiagnosed and untreated.
Symptoms of Rosacea
Symptoms of rosacea typically include one or more of the following:
- Persistent facial redness
- Red flushing of the face and neck
- Acne-like lesions
- Burning, stinging, soreness and irritation
- Thin, reddish-purple veins especially around the nose and cheeks
- Red swollen eyelids
It is worth it to note rosacea commonly begins with red facial flushing, but without treatment, it can cause enlargement of blood vessels and thickening of the skin and an enlarged nose.
Are There Different Types of Rosacea?
More than 12 years ago, the National Rosacea Society Expert Committee published an article in the Journal of American Academy of Dermatology, in which diagnostic criteria were discussed. This article classified rosacea into four subtypes and one variant. Patients may have more than one subtype. The four subtypes of rosacea are as follows:
- Subtype 1: Erythematotelangiectatic rosacea. Characterized by erythema (redness) of the central face in addition to telangiectasias and flushing. Many patients in this subtype do not realize that they have rosacea and therefore are not using the proper skincare to avoid progression.
- Subtype 2: Papulopustular rosacea. This “classic rosacea” presents with papules, pustules and erythema on central face. This type may be misdiagnosed as acne.
- Subtype 3: Phymatous rosacea. Well recognized by thickened and uneven skin on the nose with an irregular surface and nodularities, this type is seen more commonly in men and most patients have been affected for many years.
- Subtype 4: Ocular rosacea. Most patients complain of burning, stinging, itching and watering of their eyes. Many of them go undiagnosed and untreated for many years, since they believe they are allergic to different substances.
- Variant of rosacea: Granulomatous form. Characterized by yellow-brown firm papules and nodules usually on the periorificial and malar areas of the face, this presentation can lead to possible scarring.
What Triggers Rosacea?
The redness associated with rosacea is caused by dilation of the blood vessels. The other symptoms of rosacea, such as the acne-like papules and pustules, are poorly understood. There are many hypotheses, but we don’t really know the root cause of rosacea. As with many conditions, there is probably a strong genetic component. Those descended from Scandinavian or other Northern European stock are much more susceptible, though it can affect people of all ethnicities.
Certain environmental conditions and lifestyle factors can cause rosacea to flare up. By paying close attention to your rosacea and when it worsens, you can identify which of these factors affect your skin. Not all of the factors affect everyone so learn what your triggers are.
- Sun exposure
- Exercise (keeping cool helps prevent flushing)
- Spicy foods, hot drinks, caffeine and alcohol
- Extreme hot and cold temperatures and seasonal change
- Friction (avoid frequent use of microdermabrasion, chemical peels, facial scrubs and skincare brushes)
- Skincare products (certain sunscreens, hydroxy acids and products that contain alcohol are some of the known rosacea triggers)
- Glittery eye shadow and other color cosmetics that contain rough ingredients can irritate the skin
- Perfumed laundry detergents
Identifying triggers is important because they will vary from patient to patient. Although coffee, wine and spicy foods are frequent culprits, these do not cause rosacea in everyone. Patients will be more compliant if they don’t have to “give up everything” and can only avoid the triggers that affect their skin.
I believe that sun exposure increases the risk of rosacea. Many chemical sunscreens can irritate sensitive rosacea-prone skin, so recommend a physical sunscreen that your patient will be willing to use daily. Anti-inflammatory diets high in omega-3 fatty acids (such as salmon and flaxseed oil) may help calm the inflammation of rosacea. Although there are no studies to back this up, stress-reduction activities such as medication and getting enough sleep may help reduce inflammation as well.
How is Rosacea Treated?
It is important to diagnose and treat rosacea early to avoid progression of the disorder. There is no single, universal approach for treating everyone affected by this condition, but if caught early, patients can be placed on treatment regimens that are individualized and tailored to address their concerns.
The first step for treatment of rosacea is to determine your skin’s subtype. All subtypes have one thing in common: Inflammation. Therefore, anti-inflammatory supplements and skincare products can help this condition. Rosacea is a progressive disease, but treating it early and with a customized regimen may help slow or prevent progression.
After spending 15 years researching cosmeceutical ingredients. I’ve learned that many ingredients can worsen rosacea, but a few can actually help decrease the inflammation. A cleanser and moisturizer that includes anti-inflammatory ingredients such as chamomile, argan oil, feverfew, licorice extract, azelaic acid, mushroom extract, caffeine or green tea is important. Caffeine, for example, may help control inflammation by constricting the blood vessels, making them shrink down thereby reducing redness. New prescription products are coming to market that help shrink blood vessels, but these should be used in combination with soothing skincare products.
Avoiding rosacea-causing ingredients is as important as choosing the proper ingredients for rosacea-prone skin. Proper use of these products is also important. Most rosacea patients complain that their face is red and stinging after washing or applying a topical moisturizer, no matter what they use. I believe that the friction of washing or applying moisturizer is a trigger. I discourage them from using microdermabrasion, cleansing brushes, scrubs or other products that use friction in the skin. Chemical peels are not a good option for rosacea patients either. In fact, I am not a fan of facials for rosacea patients unless they utilize products specifically designed for rosacea prone skin.
Topical steroids should be avoided as well. I always warn my patients not to use over the counter “anti-redness” creams that contain hydrocortisone or other steroids to temporarily shrink dilated blood vessels. The vessels eventually rebound and may even become larger, creating a vicious cycle of redness.
ALWAYS Consult a Dermatologist
There is no question that a rosacea patient should be under the care of a dermatologist to prevent progression of the disease. Based on the severity and type of rosacea, several topical and oral antibiotics and anti-inflammatory medications can be used to treat rosacea.
Much research is being performed in the area of rosacea, and new, innovative treatments are coming down the pike. In the meantime, remain in the care of a dermatologist, avoid any friction or inflammation in the skin, and use the Skin Type Solutions Questionnaire to determine more best over-the-counter treatment options for you and your skin. Your Skin Type Solutions Questionnaire can be used to ensure you get the proper treatment, improve symptoms and possibly prevent this skin condition from progressing. Find a physician to help you find a skincare routine to help with your rosacea.
Dr. Leslie Baumann, M.D. and her team at Baumann Cosmetic Dermatology believe in proof, not promises. World-recognized for both cosmetic and general dermatology, our treatment strategies rely exclusively on evidence-based, scientifically verified products and procedures that promote skin health and a natural appearance. We combine effective medical procedures with individualized instruction on proper skincare, nutrition, supplementation and lifestyle in order to maximize the health of the skin and body as a whole while minimizing the effects of aging. For more, visit Dr. Baumann’s blog for daily updates Monday through Friday, or inquire about an appointment through Derm.net.