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Medical Dermatology


What is rosacea?

Rosacea is a common chronic recurring inflammatory skin condition that can seriously impair quality of life. Depression and anxiety are common among people with rosacea. It usually affects the middle of the face creating sensitive skin, redness and acne-like flareups across the nose and cheeks and may involve the chin and forehead. It is more common in fair skinned men and women with light eyes and hair, but the majority of cases are in women older than age 30.  It affects more than 16 million Americans, especially those with a Celtic heritage.

What causes rosacea?

The exact cause of rosacea is unknown but involves a complicated combination of a genetic component, dysregulation of the immune system, the gut microbiome, and environmental components. Microbes called Demodex mites are part of the normal skin flora but play a role in developing rosacea. There is no cure for rosacea, but it is manageable.

Many triggers exacerbate rosacea including include sun exposure, drinking alcohol, eating spicy foods, chocolate, caffeine, cinnamon, tomatoes and citrus (tomatoes, fruit juice), heat, cold, wind, stress, and drinking hot beverages. Of greater concern is that rosacea can develop as a manifestation of systemic diseases including GERD, celiac disease, irritable bowel diseases, small intestine bacterial overgrowth, and inflammatory bowel disease. Obesity, H.Pylori bacterial infection and smoking increase the risk of developing rosacea.

What are the symptoms of rosacea?

  • flushing
  • short-lived or persistent redness
  • papules and pustules (pimples)
  • broken blood vessels (telangiectasis) on the skin and eyelids
  • stinging, burning skin
  • dry skin
  • swelling
  • skin thickening
  • ocular manifestations include gritty eyes and blepharitis

There are four types of rosacea

Many people progress from one type to another.

  1. Erythematotelangiectatic rosacea (ETR) Symptoms: redness and flushing with visible broken blood vessels; swollen and sensitive skin; dry, rough, and scaly skin, and skin that stings and burns.
  2. Papulopustular (acne) rosacea. Symptoms: redness, swelling and small, red acne-like lesions that look like pimples; breakouts that flare and remit; sensitive skin, oily skin, skin that burns and stings; visible broken spider veins and raised areas of skin called plaques.
  3. Rhinophyma is rare and usually affects men. Symptoms: Thickened skin on the nose, forehead, cheeks, chin, and ears that has a bumpy texture, and enlarged pores; visible broken blood vessels, and oily skin.
  4. Ocular Rosacea affects the eyes. Symptoms: watery and bloodshot eyes; dry eyes that burn, sting, and feel gritty; sensitivity to light; blurry vision; visible broken blood vessels on the eyelids, swollen eyelids, eyelid cysts and impaired vision.

How is rosacea diagnosed?

Diagnosis is based on your medical and skin history, a family history and clinical features. The dermatologists at Lucent Dermatology will examine your skin and eyes and help you to identify your specific triggers. If you already know some things that cause flareups please record those and bring them to your appointment. Identifying your triggers is important to controlling your symptoms and alleviating or preventing a breakout. Creating a simple skin routine, and lifestyle changes can help you gain control and prevent flareups.

What are the skin diseases that may be mistaken for rosacea?

Acne, seborrheic dermatitis, dermatitis, and folliculitis.

How is rosacea treated?

In addition to identifying and avoiding triggers, treatment is individualized based on each patient’s signs and symptoms. Often a treatment plan will likely include the use of topical and oral antibiotics. Research reports that achieving the best results typically involves a combination of treatments.

Acne-like breakouts are often treated with topical medications that treat inflammation. Perpetual redness and broken blood vessels can be improved with laser surgery, and intense pulsed laser (IPL).

A drug used to treat acne called sarecycline may be effective for long-term use to treat rosacea. Combination therapy is necessary to treat the different types of skin lesions.

U.S. Food and Drug Administration (FDA) – approved therapies for treating the inflammatory papules of rosacea, the papules and pustules, including ivermectin (IVM), metronidazole, azelaic acid and sodium sulfacetamide, and sulfur and modified release doxycycline. Brimonidine (BR) is indicated for persistent facial erythema or background erythema.

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