Clearing the Confusion: Understanding and Treating Rosacea

April is Rosacea Awareness Month, and while many people have heard of this chronic inflammatory skin condition, there is still a lot of confusion surrounding its diagnosis and treatment. As a dermatologist, I often see patients who have been told they have rosacea by someone who is not a medical professional, which can lead to a lot of misinformation and ineffective treatment. In this blog post, I will explain what rosacea is, its symptoms, and how to effectively treat and prevent it. 

What is Rosacea? 

Rosacea is a chronic inflammatory skin condition that affects millions of people worldwide. The word “rosacea” comes from the Latin “rosa” meaning made of roses and “aceus” which means resembling or belonging to. Those suffering from this disorder have a pervasive redness to the face, which most commonly affects the central areas of the face. Rosacea is more common in those between the ages of 30-60 but can occur at any age. It affects men and women equally, and it occurs more often in ethnic groups that tend to flush readily, such as those with fair skin (often of Celtic or North European descent). While patients of color can have rosacea, it is less common and often underrecognized. Rosacea can have a relapsing and remitting course which is often precipitated by lifestyle, skincare choices, and the environment.  

Rosacea Symptoms 

To have a true clinical diagnosis of rosacea, there are specific diagnostic criteria. Essentially, having persistent (all the time) central facial redness that gets worse with triggers or having two of the following:  

• Facial flushing 
• Red papules and pustules 
• Visible blood vessels (known as telangiectasia)  
• Eye dryness and discomfort. 
• Having minor facial redness that is not persistent does not constitute a diagnosis of rosacea. Those who tend to be redder may get worse with age and may develop more symptoms of rosacea. 

Rosacea Treatment, What Works? 

The treatment of rosacea is highly dependent on its symptoms, and there is no one-size-fits-all solution. Most patients who come to see me with a presumptive diagnosis of rosacea are using drugstore anti-redness creams and a topical metronidazole prescription, both of which do little if anything to help facial redness. 

1. Persistent Facial Redness: a. IPL (Intense pulsed light) and other laser treatments are the best treatment. As I often say to patients: you cannot remove a blood vessel with a cream.  
2. There is also a prescription topical medication containing brimonidine or oxymetazoline that causes blood vessels to shrink or constrict. However, I do not prescribe this medication anymore as it often leads to rebound or more facial redness. 

3. Inflammatory Papules and Pustules: 
   • Topical metronidazole
   • Topical ivermectin 
   • Topical azelaic acid 
   • Oral antibiotics doxycycline/minocycline and isotretinoin

4. Flushing: There is no effective topical treatment to decrease or stop flushing. In extreme cases, dermatologists will prescribe oral medications like beta-blockers and anti-cholinergic drugs to decrease flushing, but the systemic side effects outweigh their benefits.

Dr. Sandy’s Tips

We flush because our body thinks we are hot and in easy flushers because our nervous system gets it wrong. Flushing is a technique that lowers the body’s temperature. 

• You can try sipping on ice water or chewing ice chips to help prevent or reduce your symptoms.  
• Sipping on ice water or chewing ice chips can trick our brain into thinking our core body temperature is cooler, which can help bring down a flush. This simple and effective technique can be especially helpful during exercise or when in hot environments.  

Give it a try and see if it works for you! 

Preventing Rosacea 

Prevention is as key as treatment. Lifestyle, skincare, and environmental factors can trigger and worsen rosacea symptoms, so it is important to take steps to prevent flares. 

A patient of mine who had significant rosacea and would often visit me during big flares, complaining that the medication I had prescribed was not working. My response was the same every time, “If you insist on eating cayenne peppers no amount of medicine will work, I am not a magician.”  It became apparent that his diet was a major trigger for his symptoms. Despite my best efforts to explain this to him, he continued to eat spicy foods like cayenne peppers, which only exacerbated his condition. I often reminded him that no medication would be effective if he continued to consume trigger foods.  

Lifestyle: 

• Avoid spicy foods or realize when you do indulge you might flare. Everything in moderation. 
• Avoid extreme or long durations of sun exposure. 
• Some forms of alcohol will lead to flaring and trigger the inflammatory 

Environment 

• Extreme cold, wind and heat trigger facial redness 
• Cover up and stay cool 

Skincare  

When comes to taking care of your skin, there are some important steps to keep in mind, especially if you suffer from rosacea or sensitive skin. They are: 

• Avoid using true soap bars as they can strip the skin of its natural oils and disrupt the skin barrier. Instead, opt for pH balanced cleansers that are gentle on the skin. 
• Use moisturizers that help repair the skin barrier, which is often disrupted in patients with rosacea. 
•  Look for fragrance-free products, including those labeled as “botanicals” as these can still cause irritation. 
• Avoid using harsh exfoliants like physical beads, glycolic acids, and retinol/retin A. 
• Use cosmetics with a green tint to help camouflage redness. 

Dr. Sandy’s Tip

Follow the products on my Product Elimination Diet or look for the PED approved logo on my webstore. These products have been vetted by me and are fragrance and botanical-free, making them ideal for patients with sensitive skin, rosacea, and eczema/dermatitis. 

By following these simple skincare tips, you can help manage your rosacea symptoms and keep your skin looking and feeling its best. 

Rosacea is a complex and nuanced skin condition that requires individualized treatment and prevention strategies. By understanding its symptoms and triggers, patients can take control of their symptoms and improve their quality of life. If you suspect you have rosacea, it is important to see a dermatologist for a proper diagnosis and treatment plan. With the right treatment and lifestyle modifications, those suffering from rosacea can live full and healthy lives, free from the burdens of this chronic skin condition.