Rosacea

Rosacea is a chronic facial skin condition of unknown cause. It is characterized by marked involvement of the central face with transient or persistent erythema, telangiectasia, inflammatory papules and pustules, or hyperplasia of the connective tissue. Transient erythema, or flushing, is often accompanied by a feeling of warmth. It usually lasts for less than five minutes and may spread to the neck and chest. Less common findings include erythematous plaques, scaling, edema, phymatous changes (thickening of skin due to hyperplasia of sebaceous glands), and ocular symptoms. 

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  • Microneedling

CLASSIFICATION & CHARACTERISTICS

Subtype

 

Erythematotelangiectatic

Flushing and persistent central facial erythema with or without telangiectasia

 

Papulopustular

Persistent central facial erythema with transient, central facial papules or pustules or both

 

Phymatous

Thickening skin, irregular surface nodularities and enlargement; may occur on the nose, chin, forehead, cheeks, or ears

 

Ocular

Foreign body sensation in the eye, burning or stinging, dryness, itching, ocular photosensitivity, blurred vision, telangiectasia of the sclera or other parts of the eye, or periorbital oedema (should consult eye specialist).

Treatment

Because rosacea can be triggered by a variety of stimuli, avoidance of known triggers is recommended. To identify potential triggers, patients should be encouraged to keep a journal documenting exposures, diet, and activities that cause flare-ups.

Treatment for rosacea focuses on controlling signs and symptoms. Most often this requires a combination of good skin care and prescription drugs.

The duration of your treatment depends on the type and severity of your signs and symptoms. Recurrence is common.

The type of medication your doctor prescribes depends on which signs and symptoms you're experiencing. You may need to try different options or a combination of drugs to find a treatment that works for you.

 

Drugs for rosacea include:

  • Topical drugs that reduce redness. For mild to moderate rosacea, your doctor may prescribe a cream or gel that you apply to the affected skin which reduce redness by constricting blood vessels. You may see results within 12 hours after use. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to maintain improvements.

    Other topical products have less effect on the redness but help control the pimples of mild rosacea. These drugs include azelaic acid (Azelex, Finacea), metronidazole (Metrogel, Noritate, others) and ivermectin (Soolantra). With azelaic acid and metronidazole, noticeable improvements generally don't appear for two to six weeks. Ivermectin may take even longer to improve skin, but it results in a longer remission than does metronidazole.

  • Oral antibiotics. Your doctor may prescribe an oral antibiotic such as doxycycline for moderate to severe rosacea with bumps and pimples.

  • Oral acne drug. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acnelike lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects.

 

Properly selected skin care products improve and maintain the integrity of the stratum corneum permeability barrier and reduce skin sensitivity. Mild cleansing and moisturizing regimens improve patient satisfaction. Cleansers should be fragrance- and abrasive-free with a mildly acidic to neutral pH. Recommended skin cleansers include lipid-free, nonalkaline cleansers and sensitive skin synthetic detergent bars. Patients should cleanse gently with their fingertips, avoid use of abrasive materials, and pat dry for better absorption of moisturizers. Moisturizers should contain emollients and occlusives.

Although no individual skin care product has been well studied, some products found to improve dryness. Patients should avoid astringents, toners, sensory stimulants, and potentially irritating ingredients. Photoprotection is universally recommended, including the use of wide-brimmed hats and broad-spectrum sunscreens (minimum sun protection factor [SPF] of 30). Dimethicone- and simethicone-based products containing titanium dioxide and zinc oxide may be better tolerated. 

Therapies

Laser therapy and other light-based therapies help reduce the redness of enlarged blood vessels. Repeat treatments may be needed periodically to maintain the improved appearance of your skin.