Sixteen million Americans have rosacea, but only a small number are receiving treatment. Most people with this condition, known for causing facial redness, do not know they have it. The cause is not yet determined, however certain risk factors have been identified.
Who gets rosacea?
- Age 30 to 50
- Fair skinned with blond hair and blue eyes
- Have a family member with rosacea
- Likely to have a past history of acne
What causes rosacea?
- Genetics likely plays a role
- A bacteria found in the intestines, H.pylori, may play a role. It can be found in people with rosacea more often that in people who do not have rosacea
- Demodex, a mite found on the skin, is found in higher concentrations in rosacea patients
- Cathelicidin, a protein involved with inflammation is also found in higher levels in people with rosacea.
What are the signs and symptoms of rosacea?
There are 4 subcategories of rosacea, each with a slightly different picture:
- Type I rosacea consists of facial redness with associated flushing.
- Type 2 rosacea has acne like breakouts in the central face in addition to redness.
- Type 3 or rhinophyma is rare. The main finding is thickening or deformity of the skin of the nose in addition to the signs of Type 1 and 2.
- Type 4 or ocular rosacea is characterized by watery or bloodshot eyes. The eyes may burn or feel dry and gritty
How is rosacea treated?
Topical and oral antibiotics are the mainstay of treatment. Antibiotics are thought to work against rosacea by reducing inflammation. Typically oral antibiotics are used for 1-3 months in patients with a large number of inflamed acne lesions. Topical metronidazole, azaleic acid and oral Doxycycline all work in treating rosacea. Ocular rosacea is treated with antibiotic eye drops often combined with a steroid to reduce inflammation. Rosacea is a chronic condition with intermittent flare-ups so it is important to stay on treatment long term.
A newer treatment, topical Ivermectin (AKA Soolantra) targets inflammation, bacteria and also parasites such as the Demodex mite. In clinical studies, patients improved in 2 weeks vs 4-6 weeks with standard topical antibiotic therapy.
Flushing, a common complaint of rosacea patients can be best treated by avoiding or minimizing triggers. The most common triggers include sun exposure, stress, hot or cold weather, wind, heavy exercise, alcohol, hot baths and spicy foods. Keeping a diary of triggers can help patients manage flare ups. A new topical medication, Brimodine tartrate, or Mirvaso, improves flushing. The active ingredient reduces blood flow to the small vessels of the face thus decreasing the redness.
Facial redness can be reduced long term by treatment with lasers that target blood vessels. The Vbeam pulsed dye laser can decrease facial redness by 80% in a series of four treatments. The acne lesions of rosacea are usually improved as well. For rhinophyma, the thickening or deformity of the nose seen in severe rosacea, resurfacing lasers such as the fractional CO2 laser may be effective.
Following a skin care plan can also reduce flareups. Many skin care products are too harsh and can worsen this condition. Dr Goodlerner will recommend a specific product line that works with the topical medication to calm and hydrate the skin as well as reduce redness. Daily use of sunscreen, SPF #30 or more is a very important part of rosacea care.
If you think you have rosacea, schedule an appointment today. Prompt treatment can prevent worsening of the condition.
The National Rosacea Society is an excellent source of up to date information and patient support.