The Many "Faces" of Rosacea

What is Rosacea?

Rosacea is a chronic, but often treatable skin condition. Rosacea is a common concern for many of my patients, but nationally rosacea affects an estimated 14 million Americans!

Believe it or not: Rosacea not only affects the skin, but may impact one’s overall well-being and interpersonal interactions. In fact, according to the national rosacea society, 90% of rosacea expressed a lowered self esteem and self confidence and 41% reported that their rosacea had caused them to avoid public contact and social engagements.

Major signs of rosacea & types (“Faces of Rosacea”):

  1. Persistent facial redness is the most common individual sign of rosacea. We call this the erythematotelangiectatic type of 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.

  2. The burning sensation is not just be limited to the face. Some patients may experience a burning sensation in their eyes. The eyes may be irritated and appear watery or even bloodshot. This is actually it’s own subtype of rosacea called ocular rosacea. If you experience any of these symptoms, it is important to contact your dermatologist and/or ophthalmologist.

  3. Some people with rosacea may experience the dreaded acne bumps and pimples that accompany the facial redness. This subtype is called Acne Rosacea or Inflammatory Rosacea. This type of acne is different in that blackheads and white heads are absent. Because this differs from a normal acne breakout, the treatment itself for acne rosacea may differ.

  4. One last subtype that is the least common, but potentially more disfiguring is phymatous rosacea. Phymatous rosacea can occur anywhere on the face, but is often seen on the nose and called Rhinophyma. This occurs when someone has long-standing rosacea that has never been treated, or progressive disease that worsens overtime causing skin thickening and enlargement of the glands. Although this is a benign skin condition, it can become particularly disfiguring people can develop large sometimes bulbous nodules on the nose. And as you can imagine, this can really impact one’s self esteem and so prompt treatment is highly recommended.

Rosacea Triggers

  1. Sun exposure

  2. Emotional stress

  3. Hot weather

  4. Heavy exercise

  5. Alcohol consumption (most commonly, red wine, beer, bourbon and champagne…)

  6. Hot baths

  7. Spicy foods

  8. Hot drinks

  9. Caffeine withdrawal

  10. Topical steroid use

  11. Cold weather

  12. Strong winds

  13. Certain foods (i.e. chocolate, broad-leaf beans, cirus fruits, tomatoes, figs, avocados, eggplant and spinach)

What causes rosacea?

Unfortunately, the exact cause of rosacea is not really known, but there is a lot of research looking into what are potential causes.

  1. 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.

  2. 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.

  3. Some dermatologists and researchers believe that there is a genetic link in rosacea, and that is one of the reasons that I find myself often asking my patients if they have an immediate family member with rosacea. Despite the uncertainty in the exact cause, there are some successful treatments out there for rosacea depending on the type of rosacea.

How can I treat my rosacea?

  1. The first thing I recommend is avoiding known triggers, although some are unavoidable like stress and red wine for me. In addition to that, using a gentle facial cleanser, daily broadband sunscreen and of course an oil-free facial moisturizer.

  2. I encourage my patients who wear make-up to avoid any products that may burn, sting or irritate the skin.

  3. 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. In terms of make-ups, look for either a powder-based or an oil-free water-based foundation or concealer. In terms of sunscreens, mineral sunscreen is often a good choice for those with rosacea as it typically doesn't contain irritating ingredients that can be seen in some of the chemical sunscreens.

  4. For males: using an electric razor is helpful to avoid the irritation of a dull razor blade. Also, 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.

  5. Azealic acid: This is an ingredient that has antibacterial properties, and can help fade the background redness. My top pick is the Ordinary Azelaic Acid Suspension 10%.

  6. Niacinamide: Although the mechanism is not fully understood, it’s believed that niacinamide can improve the skin barrier and hydrate the skin, which potentially can reduce exposures to irritants in the environment which may trigger rosacea.

  7. In terms of prescription topicals, there are so many options out there and they work in different ways. Some topicals have anti-inflammatory and anti-mite properties while others help to constrict the dilated blood vessels. It is important to talk to your dermatologist about what options would be good for your skin, particularly because some of these products may cause rebound redness and swelling which is more intense when not used. Low doses of oral antibiotics can also be helpful to decrease the inflammation in the skin especially for those with acne rosacea, ocular rosacea and severe persistent facial redness.

For more information: Check out the following helpful link on the signs, symptoms and treatment of rosacea BELOW!


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