Rosacea poses a vexing problem for estheticians and physicians. It is a fairly common skin condition since it affects around 16 million people a year yet a poll found that 78% of Americans have no knowledge of this condition and do not know how to recognize or treat it. Perhaps what is most frustrating about rosacea is that there is both no known cause* or cure (though there is ongoing research to determine the cause of this disorder). Correct diagnosis can be difficult since there is no test for rosacea and symptoms can sometimes mimic those of acne or other skin problems and diseases. Be sure that you trust the source of your rosacea diagnosis. I should point out here that we estheticians cannot legally diagnosis health problems and rosacea is classified as a skin disorder. So while an esthetician may be sure you have rosacea because of her experience be sure to get a physician’s opinion as well. Plus as you will read below there are treatment options for rosacea that can only be dispensed by physician.
What is Rosacea?
Rosacea is a genetic inflammatory skin disorder that usually affects the face but can also affect other parts of the body as well such as areas as the chest and ears. It is particularly common in people with fair skin and light-colored eyes. Normally the symptoms of rosacea appear after the age of 30, and rosacea is more commonly found in women than men. But interestingly rosacea is usually worse in men than in women. Rosacea shows a range of symptoms from mild to severe (see the illustration below).
According to The National Rosacea Society:
Rosacea (pronounced “roh-ZAY-sha”) is a chronic and potentially life-disruptive disorder primarily of the facial skin, often characterized by flare-ups and remissions. Many have observed that it typically begins any time after age 30 as a redness on the cheeks, nose, chin or forehead that may come and go. In some cases, rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness tends to become ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue. This is the condition, called rhinophyma (pronounced “rhi-no-FY-muh”), that gave the late comedian W.C. Fields his trademark bulbous nose. In many rosacea patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.
Sun exposure and other rosacea triggers, more on triggers in a moment, cause blood vessels near the surface of the skin to dilate. As this occurs the complexion appears red. This causes the body to send inflammatory cells to the area of the dilated blood vessels and even triggers the growth of more blood vessels in the area. The body tries to stop this process by creating more veins so that the inflammatory cells can fix the problem but all this does is create more of a problem.
If you have been diagnosed with rosacea you need to take the time to figure out your triggers. Managing your triggers will help keep your symptoms under control as much as possible. UV (aka sun) exposure is one of the biggest rosacea triggers. Using sunscreen and staying out of the sun (wearing a hat as well) are key to controlling rosacea. Heat, stress, hormones, hot tubs, fragrance, allergies, spicy food, alcohol, exercise, and topical products can all trigger rosacea flare-up or make symptoms worse.
Rosacea Treatment Options
First and foremost use your sunscreen everyday if you have rosacea. Do not forget to reapply throughout the day even if the only time you are “outdoors” is when you are only driving to and from work. Figure out your personal rosacea triggers and avoid them. Use gentle skincare products (recommendations below) that contain anti-inflammatory ingredients.
A doctor can prescribe Metrogel (metronidazole) which is a powerful anti-inflammatory. Some doctors prefer to prescribe Finacea which is azaleic acid, another strong anti-inflammatory ingredient. Lotions and creams with sulfur, yet another anti-inflammatory ingredient, may also be prescribed. If those steps are not enough than oral antibiotics such as Oracea may be prescribed. Hydrocortisone is only sporadically prescribed today to patients, but a low dose of a beta-blocker like propranolol may be prescribed to prevent vasodilation and redness.
In terms of in-office treatments for rosacea IPL (intense pulse light) and laser treatments are available. IPL is a very effective way to get rid of extra blood vessels and to calm redness. In the case of severe rosacea a doctor may opt to treat with a laser such as the Vbeam instead of using IPL.
Rosacea patients need to be patient since it usually takes 12 to 16 weeks to see improvement when treating rosacea. Additionally, as with acne you must be diligent and persistent in treating rosacea since, as of yet, there is no cure for this disorder.
Sources and Further Reading
- Taming the Tempest MedEsthetics July/August 2010
- Recognizing Rosacea – Skin Inc. August, 2011
- Simple Skin Beauty by Ellen Marmur, MD – pages 234-236
- The National Rosacea Society is a great source of information
- RosaceaNet part of The American Academy of Dermatology website
- Rosacea: The Cause of Red Skin New Beauty Magazine Spring-Summer 2010 – pages 89-92
* There is a theory that rosacea is caused by microscopic skin mites but as with all theories about the causes of rosacea this has not been conclusively proved.