Have you noticed you have a flushed appearance? Is the redness on your face getting worse? Does it come and stay much longer than before or are you experiencing more severe episodes? Millions of Americans suffer from rosacea, so don’t worry you are not alone. Rosacea typically affects light-skinned, blue-eyed adults of Celtic or Scandanavian heritage starting around 30 years of age. The cause is unknown but may involve genetics, blood vessel changes, microbes, ultraviolet light, and the immune system. Demodex mites live on the skin normally although they are found in greater numbers in those with rosacea. This surplus of Demodex might activate the immune system and cause inflammation. Many people shudder at the thought of having little creatures live on their skin, but don’t worry we have bacteria, fungi, and mites that normally live on our skin. Just like our gut has flora so does our skin. Sometimes a person may have an excess of a certain species or react differently than the next person. It also involves the person’s genetic makeup and immune system- no two people are alike.
About 16 million people have rosacea but most do not seek treatment (National Rosacea Society). Women are affected more than men. It manifests in different forms:
Redness, flushing, and visible “broken” vessels
This form of rosacea is best treated by avoiding triggers (see below). These triggers are factors that increase visible redness and flushing. The flushing and redness become more prominent over time. Make-up and concealer is a first step to hide the redness. Certain medication may alleviate the redness temporarily but the mainstay of treatment are lasers and intense pulsed light which will give a more lasting result. Multiple treatments are needed and consultation with a board-certified dermatologist is highly encouraged before starting these treatments.
Acne-like with bumps, pimples, and redness
This type may co-exist with the first type. However, this type has more bumps and pimples which can be successfully managed by medication. However, these medications may need to be used on a consistent basis to yield lasting results. In other words, as soon as the medications are stopped, the patient is at risk for a flare-up. Both topical and oral medication may be utilized. Anti-inflammatory and antibiotic treatment is the mainstay here. Your dermatologist will develop a treatment plan. Laser and intense pulsed light may be required to treat any underlying redness.
Enlargement of the nose
Skin thickening of the nose along with bulbous enlargement of the nose may occur. This is gradual and only noticed over time. The pores appear enlarged as well. This type is treated surgically to remove the excess glandular tissue and recontour the nose.
Rosacea may also affect the eyes. Irritation along with a gritty and uncomfortable sensation may happen affecting quality of life. More severe cases can affect vision and cause blurring or damage to the outer layer of the eye. Treatment by a dermatologist or ophthalmologist (eye doctor) is recommended. Oral and eye medications may be required to treat this type.
Rosacea does not have a permanent cure but can be controlled. The first step is to avoid triggering flare-ups. This includes the following:
Avoid Dietary Triggers
Certain beverages and foods are known to trigger rosacea. While there are common triggers, each person reacts differently to different factors.
In addition to the above, stress or stressful situations can also exacerbate rosacea. Certain medications or skin care products can cause rosacea to become worse. For a full listing please visit https://www.rosacea.org/patients/materials/triggers.php
Rosacea can be managed through lifestyle modification and help from your local dermatologist. Rosacea can be a combination of the above-mentioned subtypes and everyone is different. What might work for one patient may not necessarily work for another patient. Other skin diseases may also mimic rosacea so it is important to be diagnosed and treated accurately.