According to the National Rosacea Society, more than 16 million Americans suffer from the chronic skin condition known as rosacea. Typified by redness and inflammation across the nose, cheeks and forehead, rosacea can lower self-esteem, inhibit social interactions and even affect professional success. While not curable, with proper treatment the disease can often be effectively managed.
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Reviewed by Dr Roy Kedem, MD
Information last reviewed 10/28/19
Rosacea (rose-AY-sha) is a chronic condition causing redness and irritation of the skin, usually on the nose, cheeks and forehead. It may present with pimples and can affect the chest, back and ears in addition to the face. Over time, skin thickening and eye problems may develop.
Because rosacea may cause a variety of symptoms, the American Academy of Dermatology has established four subtypes:
Although rosacea is usually associated with fair skin, those of any skin color may develop it. It is found more often in women than men, particularly during menopause, and mostly affects middle age and older adults.
The exact causes of rosacea are still not known. Some evidence suggests the redness and flushing may be caused by blood vessels with a tendency to dilate too easily. Recent research has also revealed additional potential contributors:
While the underlying causes of rosacea remain something of a mystery, many known factors can trigger and/or intensify a rosacea flare-up. These include:
Rosacea is typified by frequent redness and flushing of the face, usually in the areas of the cheeks, nose, chin and forehead. Skin may also have a burning sensation, become extremely sensitive to cosmetics and feel swollen.
The symptoms of rosacea can also go well beyond reddening of the face. Because the disease can present in numerous ways, four subtypes have been established. Many people exhibit symptoms of multiple subtypes, and not all symptoms in a subtype need be present to establish a diagnosis. It should be noted that each subtype requires a different treatment protocol.
Subtype 1: Flushing, redness, visible blood vessels:
Subtype 2: Acne-type breakouts:
Subtype 3: Skin thickening
Subtype 4: Eye involvement
It is important to note that rosacea can progress from one subtype to others. If you have rosacea, closely monitor your skin for any signs of progression. Any signs of skin thickening or eye involvement should be addressed with your physician immediately as early treatment is imperative.
There are no definitive medical tests to confirm rosacea. Rather, your doctor will examine your skin and eyes, in addition to asking many questions related to the typical presentation and symptoms of rosacea. Your doctor may recommend medical tests to rule out other conditions which can look similar to rosacea, such as lupus and allergic reactions.
Recent studies have shown rosacea to be associated with an increased risk for developing a number of serious conditions, including autoimmune diseases, gastrointestinal disease, neurological disorders, cardiovascular disease and even some cancers. While a causal relationship to rosacea has not been shown, the association is thought to be indicative of underlying systemic inflammation, a known contributor to all these conditions . As such, it may be prudent to discuss a rosacea diagnosis with your primary care physician as a potential risk factor for these types of diseases.
While there is no cure for rosacea, a variety of treatment options can improve your skin’s appearance and comfort.
As a baseline, most doctors will recommend:
Beyond this basic approach, the recommended course of treatment will depend on the subtype(s) of your rosacea and other considerations. Together, you and your doctor will devise a customized plan, which may include multiple medications to treat the varying symptoms of each subtype of which you suffer.
Because it has many subtypes and the exact causes are not known, there is no one best treatment for rosacea. For reducing redness, many find a Brimonidine gel (such as Mirvaso) to work in as little as 30 minutes. In more severe cases, Azelaic Acid treatments (such as Azelaic Acid 15% Gel or Finacea Foam) have been shown to noticeably reduce rosacea’s acne-like breakouts in 70–80% of patients.
Yes. In December, 2014, the FDA approved the use of Ivermectin creams (such as Soolantra) for the treatment of rosacea. Although ivermectin has been widely used for medical purposes since 1981, its use in rosacea treatment provides a new treatment option for those living with the disease. Although the exact mechanism by which it works is not known, it is thought to provide anti-inflammatory and anti-parasitic properties, and therefore may reduce the presence of demodex mites inhabiting the affected area.
Many people find certain foods can trigger or intensify a rosacea flare-up. You may want to consider changing your diet to eliminate the most common food triggers, which include: alcohol, spicy foods, heated beverages, certain fruits (avocado, tomatoes, bananas, red plums, raisins, figs and citrus fruits), certain meats (liver and marinated meats), certain vegetables (spinach, eggplant, lima beans, navy beans, peas), and dairy products (yogurt, sour cream, cheese) as well as chocolate, vanilla, soy sauce, vinegar and foods high in histamine.
As the exact causes of rosacea are not known, there is no specific method of prevention. You may help reduce the frequency and intensity of flare-ups, however, by minimizing certain known triggers. These include: certain foods and beverages, emotional influences like stress and anxiety, harsh cosmetics and skincare products, heat-inducing environments, and weather conditions such as direct sunlight, strong winds, cold and humidity.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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