Everything you need to know about Rosacea

What is Rosacea?

Rosacea is a common skin disease that often begins with a tendency to blush or flush more easily than other people. If left untreated, Rosacea can get worse. The redness can slowly spread beyond the nose and cheeks to the forehead, chin, ears and even chest and back. Due to its potential complexity, Rosacea has been classified into four subtypes based on signs and symptoms that often occur together. It is also important to note that it is possible to have the characteristics of more than one subtype at the same time.

  • Erythematotelangiectatic:  Redness, flushing, visible blood vessels.
  • Papulopustular:  Redness, swelling, and acne-like breakouts.
  • Phymatous:  Skin thickens and has a bumpy texture.
  • Ocular: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty.

What causes Rosacea?

A genetic propensity, particularly being of Northern European heritage, can increase your chances of developing Rosacea and Rosacea-like symptoms. Triggers also play a very important role in understanding what causes “flare-ups”, those moments of flushing and redness that the sufferer can feel coming on. These triggers can be many things, most often alcohol, spicy or hot foods, stress, caffeine, chronic sun exposure, cold weather and overly dry climates.

Learn what triggers your Rosacea

Many everyday things can cause Rosacea to flare. These include sunlight, stress, and many foods and beverages. What causes one person’s Rosacea to flare may not trigger a flare-up for another person. This is why dermatologists recommend that patients with Rosacea learn what factors trigger their flare-ups, and try to avoid them. It is also important to follow a Rosacea skin-care plan. Skin care plays a key role in keeping Rosacea under control. Beware that some skin care products may be too harsh and make the condition worse.

Factors That May Trigger Rosacea Flare-Ups

The following list was compiled from patient histories by Dr. Jonathan Wilkin and produced by the National Rosacea Society.

Foods

  • Liver
  • Yogurt, Milk
  • Sour cream
  • Cheese (except cottage cheese)
  • Chocolate, Sugar
  • Vanilla
  • Soy sauce
  • Yeast extract (bread is OK)
  • Vinegar
  • Eggplant
  • Avocados
  • Spinach
  • Broad-leaf beans and pods,
  • including lima, navy or pea
  • Citrus fruits, tomatoes, bananas,
  • red plums, raisins or figs
  • Spicy and thermally hot foods
  • Foods high in histamine
  • Meat

Temperature Related

  • Saunas
  • Hot baths
  • Simple overheating
  • Excessively warm environments

Weather

  • Sun
  • Strong winds
  • Cold
  • Humidity

Drugs

  • Vasodilators
  • Topical steroids

Beverages

  • Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne
  • Hot drinks, including hot cider, hot chocolate, coffee or tea
  • Soda

Medical conditions

  • Frequent flushing
  • Menopause
  • Chronic cough
  • Caffeine withdrawal syndrome

Emotional influences

  • Stress
  • Anxiety

Physical exertion

  • Exercise
  • “Lift and load” jobs

Skin care products

  • Some cosmetics and hair sprays, especially those containing alcohol, witch hazel or fragrances
  • Hydro-alcoholic or acetone substances
  • Any substance that causes redness or stinging

How to control Rosacea

In addition to medical therapy, rosacea patients can improve their chances of maintaining remission by identifying and avoiding lifestyle and environmental factors that may trigger flare-ups or aggravate their individual conditions. Identifying these factors is an individual process, however, because what causes a flare-up for one person may have no effect on another.

What is the treatment for rosacea?

There are many treatment choices for rosacea depending on the severity and extent of symptoms. Available medical treatments include antibacterial washes, topical creams, antibiotic pills, lasers, pulsed-light therapies, photodynamic therapy, and isotretinoin.

Mild rosacea may not necessarily require treatment if the individual is not bothered by the condition. More resistant situations may require a combination approach, using several of the treatments at the same time. A combination approach may include home care of washing with a prescription sulfa wash twice a day, applying an antibacterial cream morning and night, and taking an oral antibiotic for flares. A series of in-office laser, intense pulsed light, or photodynamic therapies may also be used in combination with the home regimen.

Topical medications

With the proper treatment, rosacea symptoms can be fairly well controlled. Popular methods of treatment include topical (skin) medications applied by the patient once or twice a day. Metronidazole (Flagyl) and  Azelaic acid (Finacea gel 15%) are examples of such medications that work to control redness and bumps.

Some patients elect combination therapies and notice an improvement by alternating metronidazole and azelaic acid: using one in the morning and one at night. Sodium sulfacetamide (Klaron lotion) is also known to help reduce inflammation. Other topical antibiotic creams include erythromycin and clindamycin (Cleocin).

Recently a new topical prescription gel has become available designed to relieve the redness so characteristic of rosacea.  Brimonidine gel (Mirvaso) applied once a day can produce a prolonged period of blanching of previously red skin in rosacea patients.

Oral antibiotics

Oral antibiotics are also commonly prescribed to patients with moderate rosacea. Tetracycline (Sumycin), doxycycline (Vibramycin, Oracea, Adoxa, Atridox), minocycline (Dynacin, Minocin), and amoxicillin (Amoxil, Dispermox, Trimox) are among the many oral antibiotics commonly prescribed and they actually help reduce inflammation and pimples in rosacea. A newer low-dose doxycycline preparation called Oracea (40 mg once a day) has been used in rosacea. The dose may be initially high and then be tapered to maintenance levels. Common side effects and potential risks should be considered before taking oral antibiotics.

Miscellaneous medications

Short-term topical cortisone (steroid) preparations of minimal strength may in occasional cases also be used to reduce local inflammation. Some mild steroids include desonide lotion or hydrocortisone 0.5% or 1% cream applied sparingly once or twice a day just to the irritated areas. There is a risk of causing a rosacea flare by using topical steroids. Prolonged use of topical steroids on the face can also cause irritated skin around the mouth (perioral dermatitis).

Some doctors may also prescribe tretinoin (Retin-A), tazarotene (Tazorac), or adapalene (Differin), which are prescription medications also used for acne. Rarely, permethrin (Elimite) cream is prescribed for rosacea cases that are associated with skin mites. Permethrin is also used for follicular Demodexmites if warranted.

Isotretinoin (Accutane)

Isotretinoin is infrequently prescribed for severe and resistant rosacea. Often it is used after multiple other therapies have been tried for some time and have failed. It is used as a daily capsule for four to six months. Isotretinoin is not typically used in rosacea, and it is most commonly used in the treatment of severe, common acne called acne vulgaris. Close physician monitoring and blood testing are necessary while on isotretinoin. Generally, at least two forms of birth control are required for females using this medication, as pregnancy is absolutely contraindicated while on isotretinoin.

Cleansers

In addition, prescription or over-the-counter sensitive skin cleansers may also provide symptom relief and control. Harsh soaps and lotions should be avoided, whereas simple and pure products such as Cetaphil or Purpose gentle skin cleanser may be less irritating. Patients should avoid excessive rubbing or scrubbing the face.

Other recommended cleansers include:

  • sulfa-based washes (for example, Rosanil),
  • benzoyl peroxide washes (for example, Clearasil).

Laser and Intense Pulsed Light (IPL)

Many patients are now turning to laser and intense light treatments to treat the continual redness and noticeable blood vessels on the face, neck, and chest. Often considered a safe alternative, laser and intense pulse-light therapy may help to visibly improve the skin and complexion.

Laser treatment may cause some discomfort. While most patients are able to endure the procedure, ice packs and topical anesthetic cream can help alleviate the discomfort. Multiple treatments are typically necessary, and the procedure is not covered by most insurances. Treatments are recommended in three- to six-week intervals; during this time, sun avoidance is necessary. Risk, benefits, and alternatives should be reviewed with your physician prior to treatment. Laser treatments may be combined with photodynamic therapy (light-activated chemical using Levulan) for more noticeable results.

Photodynamic therapy

Photodynamic therapy (PDT) is one of the newly available treatments. PDT uses a topical photosensitizer liquid that is applied to the skin and a light to activate the sensitizer. Levulan (aminolevulonic acid) and blue light, commonly used to treat pre-cancers (actinic keratosis) and acne vulgaris, can also be used to treat some rosacea patients. The use of PDT in rosacea is considered off-label, since it is primarily designed for regular acne. PDT is thought to work at reducing the inflammation, PDT is performed in your physician’s office. The treatment takes anywhere from one to one and a half hours to complete. Strict sun avoidance for approximately one to three days is required after the treatment. Mild discomfort during the treatment and a mild to moderate sunburn appearance after the treatment is common. Some patients have experienced remissions (disease-free periods) of several months to years from these types of treatments. Other patients may not notice significant improvement.

Glycolic peels

Glycolic-acid peels may additionally help improve and control rosacea in some people. The chemical peels can professionally be applied for approximately two to five minutes every two to four weeks. Mild stinging, itching, or burning may occur and some patients experience peeling for several days after the peel. Any peel can irritate very sensitive skin and cause flares for some people. Peels should be used with caution in rosacea as not everyone is able to tolerate these treatments.

Sun protection

Sun exposure is a well-known flare for many rosacea sufferers. Sun protection using a wide-brimmed hat (at least 6 inches) and physical sunscreens (like zinc or titanium) are generally encouraged. Because rosacea tends to occur in mostly fair-skinned adults, the use of an appropriate daily sunscreen lotion and overall sun avoidance is recommended.

Some tips for sufferers from Rosacea

  • More of the reasons, which are causing Rosacea are related to the digestive system.
  • To keep the Colon clean is very important to maintain remission.
  • Colon Hydrotherapy or Glycerine Suppositories at night are recommended.
  • Taking 1tea spoon of Linseed Oil in the morning is good for healthy colon environment.
  • Vit. A- 600mg/day for women and 700mg/day for men is helpful for the skin tone and color.
  • Vit. B2 and Vit. B6 are necessary to prevent  “red face”.
  • Using Organic Apple Vinegar to cleanse the face at night  balance the pH of the skin, which is equivalent to the pH of Apple Cider.
  • A cup of Green Tea with 2 t.sp. of Apple Vinegar and 1 t.sp. Org. Honey before going to sleep is also helpful.
  • Eating more vegetarian diet, fresh fish, green salads and drinking plenty of mineral water are the highlights in Rosacea treatment.

In conclusion, we cannot eliminate the genetic propensity of developing Rosacea, but by following an individual care plan to control the factors that trigger it we can at least keep it under control!