Rosacea…redness, bumps, and vessels, OH MY! “I’m too old to have acne.” “Why is my face always red?” 16 million Americans are affected by rosacea, experiencing redness of the mid face, vessel prominence/telangiectasias, and papules and pustules resembling acne. Rosacea primarily affects middle-aged women with fair skin and light eye color, but can be seen in teens as well as men. It is considered chronic and can remit and relapse over time. There is also a hereditary component to the condition.
Although the exact cause of rosacea is unknown, the theory is that it is an overgrowth of the Demodex mite, Demodex folliculorum. Increased quantity of this mite on the skin can cause inflammation of the blood vessels just under the surface of the skin. It is also theorized that sun damage to these areas cause capillary fragility and leakage as well.
Subtype 1 – Erythematotelangiectatic – redness, flushing, and broken capillary appearance to the skin.
Subtype 2 – Papulopustular – acne-like papules and pustules of the nose and cheeks, can also appear on chin and central forehead.
Subtype 3 – Rhinophymatous – thickening of skin on nose with enlarging pores and cysts affecting men more than women. Often is a progression of untreated papulopustular rosacea.
Subtype 4 – Ocular – redness of eye areas including conjunctiva. May appear on its own or with facial rosacea.
Some flares of rosacea can be attributed to triggers which increase blood flow to the skin. These include sun, stress, heat, spicy foods, hot beverages, or alcohol consumption. Recently, a correlation between H. Pylori infection of the stomach and rosacea has been found.
The mainstay of treatment is using a gentle cleanser and moisturizer containing SPF 50. Mineral sunscreens appear to be gentler and less irritating than their chemical counterparts. Ceramides and niacinamide are ingredients to look for which also seem to soothe the skin. Prescription treatment usually starts with topical metronidazole or Ivermectin applied daily after washing face. Azelaic acid or topical minocycline foam are options for a leave-on topical treatment. Sulfacetamide/sulfur washes can help with flaking and deeper papules.
In some cases, oral doxycycline is prescribed if papules, pustules, and cysts are predominant. GI upset and photosensitivity are common side effects of the tetracycline family of medications. If redness is particularly bothersome to the patient, there are topical agents that temporarily decrease the redness and vascularity by constricting the inflamed capillaries. Some patients may also opt to undergo laser treatments to decrease redness/telangiectasias, but the rosacea still will require some topical regimen to keep new vessels from inflaming.
Although rosacea is not curable, it is manageable with a customized regimen. Everyone is different, and it may take trying a few things to find the right combination of treatments. Avoiding triggers and a good maintenance treatment are essential to preventing flares.
Written by Amy Horner, PA