Rosacea: No ifs, ands or BLUSH about it!
Experiencing occasional flushing and blushing on the cheeks? Does the flushing worsen with an occasional glass of red wine, drinking caffeinated beverages or after completing a vigorous work-out? What we are hinting at is a chronic, but often treatable skin condition called Rosacea.
Rosacea is an important topic to discuss not only because it is a common concern for many of my patients, but nationally Rosacea affects an estimated 14 million Americans! According to the National Rosacea Society, 90% of rosacea patients expressed a lowered self esteem and self confidence and 41% reported that their rosacea had caused them to avoid public contact and social engagements. This is important because rosacea not only affects the skin, but impacts your overall well-being and interpersonal interactions.
What are common signs and symptoms and "faces" of rosacea?
Persistent facial redness is the most common individual sign of rosacea. This is also referred to as erythematotelangiectatic rosacea. This may resemble a blush or sunburn that just doesn’t go away. Many people with rosacea also experience frequent flushing, which is redness that comes and goes, and this may actually be one of the first signs of Rosacea. This facial redness may be accompanied by a sense of heat, warmth or burning.
The burning sensation may not just be limited to the face. Some may experience a burning sensation in the eyes. The eyes may be irritated and appear watery or even bloodshot. This is actually it’s own subtype of rosacea called ocular rosacea.
Rosacea may not only present with facial redness, but also acne-like eruption that accompanies the facial redness. This subtype is referred to as acne rosacea or inflammatory rosacea. This type of acne differs from traditional acne as blackheads and white heads are absent.
A subtype of rosacea that is less frequently encountered; however, may result in more serious skin textural changes is phymatous rosacea. Phymatous rosacea may occur anywhere on the face, but is most often seen involving the nose resulting in a bulbous appearance of the nose, also referred to as rhinophyma. This typically occurs as a result of long-standing, untreated rosacea that progresses overtime resulting in skin thickening and enlargement of the oil-producing (sebaceous) glands of the nose.
What are the common triggers for rosacea?
Sun exposure, emotional stress, hot weather, heavy or strenuous exercise, alcohol consumption (most commonly, red wine, beer, bourbon and champagne...), hot baths, spicy foods are among the most common.
Other triggers include: Hot drinks, caffeine withdrawal, topical steroid use, cold weather, strong winds and certain foods, such as chocolate, broad-leaf beans, citrus fruits, tomatoes, figs, avocados, eggplant and spinach.
What causes rosacea? Is it hereditary?
Unfortunately, the exact cause of rosacea is not really known, but there is a lot of research regarding potential causes of rosacea.
One proposed cause is the overgrowth of the demodex mite on the face. Just like you have bacteria that lives in your gut, there are mites that live on the skin. This mite normally lives in the sebaceous glands (also known as our oil producing glands) on the skin and is thought that an over abundance of this mite triggers a exaggerated response from our immune system. This exaggerated response leads to inflammation in the skin and as a result, the pink acne-like bumps and redness.
Other potential causes include a malfunction in our body’s innate immune system, which is our body’s first line of defense against infection; an overproduction of a substance that is linked to the overgrowth of visible blood vessels on the face. Some dermatologists and researchers believe that there is a genetic link in rosacea.
What are treatments for rosacea and how can I avoid rosacea flares?
One of the first steps to managing rosacea is avoiding known triggers. For those who find themselves flaring after certain foods or activities, keeping a "Rosacea Diary" is a helpful tool to help identify and avoid lifestyle and environmental factors that may trigger rosacea flare-ups.
Sun exposure is a known trigger for rosacea flares. Wearing a broadband sunscreen protecting against both UVA and UVB rays (SPF 30+, zinc-oxide and/or titanium dioxide-containing sunscreens are recommended).
Washing your face with a gentle cleanser and using oil-free facial moisturizers are important to maintaining protective skin barrier. Avoid any make-up and/or skincare products that may burn, sting and/or irritate the skin. A sheer green-tinted primer is also a good choice for a make-up base and it may help visually correct the redness and even out skin tone. Make-up that is powder-based and/or an oil-free water-based foundation or concealer are less likely to result in skin irritation.
For males, using an electric razor is recommended to avoid the irritation of a dull razor blade. Avoid any shaving creams or lotions that burn or sting and instead opt for a gentle post-shave balm or moisturizer to help soothe the skin and prevent rosacea flares.
Over-the-counter topicals containing an ingredient called azelaic acid may help fade the background redness and have some antibacterial properties. Although the mechanism is not fully understood, it’s believed an ingredient called niacinamide may improve the skin barrier and hydrate the skin, which potentially can reduce exposures to irritants in the environment which may trigger rosacea.
There are prescription topical and oral treatments for rosacea that have been shown to be beneficial in both treatment and prevention of rosacea flares. Some have anti-inflammatory and anti-mite properties while others help to contract the dilated blood vessels. Laser and light treatments are also helpful in the treatment of rosacea and are performed by a dermatologist. On average, about 3-4 treatments are recommended for the treatment of facial redness.
For more information and guidance, it is recommended to schedule an appointment with one of our board-certified dermatologists to create a personalized treatment plan. Schedule online or call (610) 265-1166.