Rosacea

What is rosacea?

Rosacea is a chronic inflammatory skin condition whose presentation can vary depending on type. It typically affects Caucasians who are more prone to the damaging affects of the sun. The cause for rosacea still remains unknown, however, the following factors have been found to contribute to the condition: overactive inflammatory mechanism in the skin, ultraviolet light exposure, hyperactive vasodilatation of blood vessels, and a dysfunctional skin barrier that increases the tendency for skin irritation and dryness.

What are the different types of rosacea?

The presentation of rosacea depends on the type one is affected by.

  • Erythematotelangiectatic: flushing, persistent redness, broken blood vessels, sensitive skin
  • Papulopustular: acne-like red bumps and pustules, persistent redness
  • Phymatous: bulbous enlargement of the nose or other areas on the face resembling an orange skin; men are most affected by this condition
  • Ocular: 50% of patient with rosacea can have eye problems including dryness, irritation, and inflammation of eyelids or eye (blepharitis, conjunctivitis, keratitis, stye, chalazion)

What are the triggers for rosacea?

Although not always readily apparent, triggers for rosacea include sun exposure, alcohol, spicy foods, hot beverages, extremes of temperatures (hot and cold weather), heavy exercise, and stress. Avoidance of triggers is important.

How is rosacea treated?

The combination of a gentle skin care regimen, sun protection, medicated therapies, and avoidance of triggers are key in treating rosacea and minimizing flares.

  • Daily Skin Care
    • Use soap-free cleansers such as Cetaphil or NeoCleanse Gentle Cleanser.
    • Use a broad-spectrum sunscreen daily with a minimum SPF of 30 containing physical blockers (zinc oxide or titanium dioxide), such as EltaMD® UV Clear for rosacea-prone skin.
    • Use fragrance-free moisturizing creams, preferably glycerin or petrolatum-based (Cetaphil or Cerave).
    • Avoid astringents, toners, and exfoliants along with cosmetics containing alcohol, menthols, camphor, witch hazel, fragrance, peppermint, eucalyptus, and other irritating ingredients.
    • Apply water-soluble facial powders or creams with a green tint (Clinique Redness Solutions) if needed to neutralize the appearance of redness.
  • Medications
    • Topical medications such as metronidazole, azeleic acid, sodium sulfacetamide with sulfur, and topical ivermectin (Soolantra) are used for the treatment of papulopustular rosacea.
    • Mirvaso (brimonidine) is a new topical for the temporary reduction of redness that lasts 8-12 hours. Worsening redness can occur in 10-20% of patients, and usually develops within the first 2 weeks.
    • Oral antibiotics are often indicated for those with papulopustular or ocular rosacea.
  • Surgical Procedures
    • Laser treatment offers a more permanent solution for those with persistent redness and broken blood vessels, however, repeated sessions are needed for optimal results. For those with an enlarged nose, surgical excision, electrocautery, or resurfacing lasers are recommended for re-sculpting.
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