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Rosacea

What is rosacea?

Rosacea is a chronic, acne-like condition of the facial skin that may affect as many as 13 million Americans. It typically first appears when people reach their 30s and 40s as a flushing or subtle redness on the cheeks, nose, chin or forehead that comes and goes. If left untreated, rosacea tends to worsen over time. As the condition progresses, the redness becomes more persistent, bumps and pimples called papules and pustules appear and small dilated blood vessels may become visible.

Who Gets Rosacea?

Rosacea is usually seen in adults. It seems to affect fair-skinned people more often, though it can affect any skin type. Most people who get rosacea have a history of flushing or blushing more easily and more often than the average person.

What Causes Rosacea?

There are many theories but none have been proven. Researchers now believe that there is some link between rosacea and how often (and how strongly) people flush or blush.

What are the common symptoms?

Many rosacea patients have only one or two symptoms; here is a complete list of the most common ones:

  • Redness: This looks like a blush or sunburn and it is caused by flushing. The redness gradually becomes more noticeable and will not go away. Facial skin may get very dry.
  • Pimples: Later, pimples may appear on the face. These pimples may be inflamed — small, red and solid (papules) or pus-filled (pustules) like teenage acne. Because they look alike, rosacea has been called “adult acne” or “acne rosacea.” But people with rosacea do not normally have the blackhead or whitehead type of pimples (called comedones) that are usually seen in teenage acne.
  • Red lines: When people with rosacea flush, the small blood vessels of the face get larger — eventually showing through the skin. These enlarged blood vessels look like thin red lines on the face, usually on the cheeks. These lines may be hidden at first by flushing, blushing or redness, but they usually reappear when the redness is cleared up. These lines are called telangiectasias.
  • Nasal bumps: When rosacea is not treated, some people — especially men — may eventually get small knobby bumps on the nose. As more bumps appear, the nose looks swollen. This condition is called rhinophyma.

How Does Rosacea Progress?

In most people, the first sign of rosacea is rosy cheeks; the face gets red in patches and stays red — eventually redness doesn’t go away at all.

Rosacea is a chronic condition. In most people symptoms come and go in cycles. These flare-ups are common. Although the condition may improve (go into remission) for a while without treatment, it is often followed by a worsening of symptoms (redness, pimples, red lines or nasal bumps) that progresses over time.

Can Anything Make Rosacea Worse?

Facial flushing can make symptoms worse. It can even cause flare-ups in patients whose rosacea was under control with medications. Flushing can be triggered by many things including hard exercise, menopause, and even some medicines. The most common triggers are: hot drinks, alcohol, spicy foods, stress, sunlight, extreme heat or cold.

You should avoid anything that causes flushing. You will need to find out what things affect you and decide if you want to change your habits to avoid them. Just remember — flushing may affect your success in controlling rosacea.

What can I do to improve my rosacea?

Following a regular cleansing and medication routine will make treatment easier and more successful. You should be careful about what products you use with rosacea medications. • Soaps/cleansers: Only very mild products should be used on the face. Avoid products that contain alcohol or irritants. Cetaphil® daily facial cleanser or bar soaps, GlyDerm® Gentle Cleanser, Dove® soap, or Lever 2000 antibacterial soap are examples. • Moisturizers: Apply a quality moisturizer as needed. When using with a topical medication, you can usually apply the moisturizer after the medication has dried. • Sunscreens: Use an SPF 30 or higher whenever you think you will be in the sun for more than 10 or 15 minutes.

In general, it helps to choose facial products that will not clog pores; they will have the word “noncomedogenic” on the package. Avoid products that contain alcohol (check hair spray and astringent labels), acetone or oil.

What Medications Are Used for Rosacea?

Several medications are available by doctor’s prescription. They control redness and reduce the number of papules and pustules.
Topical Antibiotics such as metronidazole and erythromycin may be used in mild forms of rosacea.

  • Oral Antibiotics such as tetracycline, minocycline, and doxycycline are sometimes used in more severe cases or when topical antibiotics fail.
  • Isotretinoin is sometimes used for severe rosacea that has not responded to other forms of treatment. If this medication is used, blood draws may be necessary to monitor possible side effects.
  • Remember, without regular treatment, redness and pimples can return. Studies of patients who stopped treatment after their symptoms were successfully cleared show that rosacea came back in many of the patients within a week to 6 months.