Rosacea

Rosacea is a chronic, relapsing, inflammatory skin condition that can seriously the impair quality of life of those affected. It primarily 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 characterized by persistent redness with episodes of flushing and redness, visible blood vessels, and sometimes pimples or pustules. About half of the people with rosacea also experience eye problems such as dryness, irritation, and swollen, reddened eyelids.

Men with rosacea may have severe symptoms that include 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.

Ocular rosacea symptoms include 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.

The exact cause is unknown but involves a genetic predisposition, immune system dysfunction, and environmental components that typically affect people with sun-sensitive fair skin. Flushing is believed to be the result of inflammation of the blood vessels on the cheeks, chin and nose causing them to dilate easily. Microbes that are part of the normal skin flora called Demodex mites play a role in developing rosacea. There is no cure, but the condition is manageable.

Common triggers to avoid include sun exposure, drinking alcohol, eating spicy foods, chocolate, caffeine, cinnamon, tomatoes and citrus (tomatoes, fruit juice), and drinking hot beverages. Obesity, H Pylori infection, smoking and inflammatory bowel disease increase the risk of developing rosacea.

The diagnosis of rosacea is based on the patient’s history and clinical features.  While many patients show eye and skin signs, some may only show eye symptoms. You may have tests to rule out other health conditions.

While there is no cure for rosacea, several treatments can help manage and reduce the symptoms. Research and clinical experience have shown that medications used in combination have a synergistic effect that is more effective than the use of any single therapy alone. At Ironwood Dermatology we tailor your treatment regimen to your individual needs.

• Topical Treatments: Prescription medications such as metronidazole, azelaic acid, and ivermectin are commonly used to reduce inflammation and redness, and to treat red bumps and pimples. Brimonidine (Mirvasoâ) and Oxymetazoline (Rhofadeâ) can temporarily constrict blood vessels and reduce redness.
• Oral Antibiotics: Doxycycline and minocycline help control inflammation and can be effective in controlling moderate to severe rosacea, particularly for pimples and pustules.
• Pulse-dye laser (PDL) therapy is a popular and effective treatment for managing rosacea, particularly to reduce the appearance of redness and visible blood vessels. This therapy uses a concentrated beam of light that targets blood vessels in the skin without damaging the surrounding tissue. It is non-invasive and require no significant down time. Multiple sessions may be necessary to achieve optimal results.
• Intense Pulsed Light (IPL) therapy is another effective treatment option for managing rosacea, particularly for reducing redness, flushing, and visible blood vessels. Unlike lasers, which use a single wavelength of light, IPL uses a broad spectrum of light wavelengths to target multiple layers of the skin. It is non-invasive and require no significant down time. Multiple sessions may be necessary to achieve optimal results.
• Electrotherapy: This involves the use of a thin needle that applies a weak electric current to target large blood vessel causing them to shrink.
• Lifestyle Modifications: Identifying and avoiding triggers, using sunscreen daily, and adopting a gentle skincare routine.
• Eye Care: For those with ocular rosacea, topical antibiotics and cyclosporin as well as oral antibiotics may be prescribed. Other options include eyelid hygiene and artificial tears.
• Isotretinoin: In severe cases, oral isotretinoin may be prescribed, though this is usually a last resort due to its potential side effects.

The amount of time required for these treatments to take effect depends on the type of medication. Most patients see improvements within a matter of weeks. But because rosacea is a chronic, progressive condition most medications are meant to be used for extended periods of time.