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Rosacea is a chronic, relapsing, inflammatory skin condition that mainly affects the cheeks, nose, chin and forehead. It is characterized by recurrent episodes of flushing, persistent redness, visible blood vessels and small, pus-filled bumps or pustules similar to acne. It can also cause skin burning or stinging, dryness and sensitivity. It can lead to embarrassment, low self-esteem, depression, anxiety, and potentially negatively impact quality of life. Rosacea is also associated with multiple systemic diseases including hypertension and dyslipidemia.

More than 50% of individuals with rosacea have eye symptoms including irritation, dry eye, light sensitivity and blepharitis (inflammation of the eyelids).  In some cases, it can cause disfigurement over time as the skin on the nose thickens and enlarges. This is called rhinophyma, and it is more common in men.

Who is at risk?

Patients typically receive a diagnosis between the ages of 30 and 60. It is more common in people of Celtic and northern European descent with fair skin, blond hair and blue eyes. However, it also affects people of color. Women are two to three times more often affected than men. Women of menopausal age are at even greater risk, as are those with a family history of rosacea.

What causes rosacea?

The exact cause of rosacea is not fully understood. It’s important to emphasize that rosacea is a multifactorial condition, and the exact mechanisms behind its development are still a subject of research. While immune system factors may contribute to the condition, they are just one piece of the puzzle. Other factors, such as genetic predisposition, vascular abnormalities, and environmental triggers, all play a role. 

What are the main triggers for Rosacea?

Rosacea is a complex condition. Diet and certain foods are known triggers that can cause a flare-up or make it worse. The main triggers include alcohol, spicy food, cinnamaldehyde-containing foods (e.g., tomatoes, citrus fruits, chocolate), hot drinks, and histamine-rich foods (e.g., aged cheese, wine, processed meats). Other flare-up triggers include exposure to sunlight, and certain skincare products.

What triggers or exacerbates it can vary significantly from person to person. Additionally, while these factors are associated with rosacea, they may not be the sole cause, and more research is needed to fully understand the condition’s underlying mechanisms.

How is Rosacea diagnosed?

Rosacea is typically diagnosed based on clinical signs and symptoms, as there is no specific laboratory test for it. Dr. Michael Rains will review your medical history and ask about your symptoms and their duration. He will ask about any triggers that worsen the disease and lifestyle factors that exacerbate symptoms. Then he will perform a thorough skin examination and rule out other causes of your symptoms such as acne. If Ocular Rosacea is diagnosed, he may refer you to an ophthalmologist. 

Rosacea has different subtypes, and Dr. Rains will determine which subtype best describes your condition, though many people have more than one subtype. With all of this information, he will develop an individualized treatment plan.

How is Rosacea treated?

The treatment of rosacea depends on the severity of symptoms and the specific subtype of rosacea a person has. Treatment typically involves a combination of medical therapies, lifestyle modifications, and skincare routines. Here are the primary treatment options for rosacea:

Skincare and Lifestyle Modifications:

  • Gentle Cleansing: Use a mild, non-abrasive cleanser to wash the face. Avoid harsh scrubbing or using hot water.
  • Sun Protection: Apply a broad-spectrum sunscreen with at least SPF 30 daily and wear protective clothing, including a wide-brimmed hat, to shield the face from sunlight.
  • Avoid Triggers: Identify and avoid triggers that worsen rosacea symptoms. Common triggers include spicy foods, alcohol, hot beverages, and extreme temperatures.
  • Skincare Products: Choose skincare products that are non-comedogenic (won’t clog pores) and fragrance-free.

Topical Medications:

  • Topical Antibiotics: Creams or gels containing antibiotics like metronidazole, azelaic acid, or clindamycin may help reduce redness and inflammation.
  • Topical Retinoids: In some cases, topical retinoids like tretinoin may be prescribed to address skin texture and reduce papules and pustules.

Oral Medications:

  • Oral Antibiotics: For moderate to severe cases, oral antibiotics like doxycycline, tetracycline, or minocycline may be prescribed to reduce inflammation and control symptoms. These are typically used for shorter periods to avoid antibiotic resistance.
  • Isotretinoin: In rare cases, when other treatments are ineffective, isotretinoin (commonly used for severe acne) may be considered under close medical supervision.

Laser and Light Therapies:

  • Intense Pulsed Light (IPL): IPL therapy can reduce redness and visible blood vessels associated with rosacea.
  • Laser Therapy: Certain lasers, such as pulsed dye lasers, can target blood vessels and reduce redness.
  • Photodynamic Therapy (PDT): PDT involves applying a photosensitizing agent to the skin and then exposing it to a specific light source to target abnormal blood vessels.

Dr. Rains creates individualized treatment plans based on the patient’s specific symptoms and needs. It may take several weeks to months to see significant improvement, and long-term management is often necessary to control rosacea effectively. Contact Dr. Michael Rains at Beacon Dermatology in Asheville, North Carolina to schedule a consultation to receive an accurate diagnosis and all your treatment options. You will always be treated with respect and kindness.

At a Glance

Michael Rains, MD, FAAD

  • Board certified in dermatology
  • Specializing in medical, surgical and cosmetic dermatology
  • Author of multiple peer-reviewed publications and previous adjunct faculty at Dell Medical School at the University of Texas at Austin
  • Learn more

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