Rosacea is a common disorder which affects around 1 in every 100 women. It causes inflammation of the skin and it may cause pain, redness, swelling and itching. Rosacea is caused by changes in the immune system. These changes affect how our body fights off infection or foreign substances. When these substances enter the blood stream they are known as antigens (foreign substance). Antigens trigger the immune system to produce antibodies against them. These antibodies then attack other parts of the body where they have been detected. The result is a rash or small blisters appearing all over your face, neck and chest.
The main symptom of rosacea is facial flushing, which occurs when there is too much production of the hormone erythropoietin (EPO) in the adrenal glands. Erythropoietin stimulates white blood cells to make more antibodies against invading germs. This results in redness and swelling.
However, if EPO levels are high enough, they can lead to a condition called “exacerbation”. Exacerbation is a condition in which the body cannot get rid of the excess EPO fast enough. This can cause an increase in facial flushing.
If you are suffering from rosacea, there are certain lifestyle changes that you can make to help prevent or reduce your symptoms. These include:
Eat a diet low in fat – many people who suffer from rosacea also seem to suffer from high fat diets. By eating a low fat diet, this may help to improve your symptoms.
Get plenty of rest – not getting enough rest can cause stress to your body. This lowers the amount of white blood cells in your body and prevents your body from fighting off infection as effectively. It is recommended that you try to get at least 8 hours of sleep each night.
Avoid alcohol – many people who suffer from rosacea also suffer from flushing. Alcohol in general may make your symptoms worse, so you should avoid it as much as you can. Red wine is known to have properties that can make your condition worse, so you may want to avoid drinking it.
Apply ice packs – redness, swelling and itching are all common side effects of rosacea. Applying an ice pack to the area may help to relieve some of your symptoms.
Relax – stress seems to play a major role in the worsening of most individuals’ symptoms. If you think that stress is worsening your condition, you should try to relax as much as you can. This can be as simple as listening to music or taking a warm bath.
Try topical medicines – there are many topical medicines that you can buy from your local pharmacy to help control your rosacea. These include creams, lotions and gels that are applied directly to the skin. Many of these medications can help improve your symptoms within one to two weeks of starting the treatment.
Your doctor or dermatologist will be able to recommend the best medicine for you.
While all of these factors are important, the root cause of rosacea is still not known. This means that it is difficult to predict how your condition may change in the future. However, there are some treatments that may help to control your symptoms at different times.
Tetracycline antibiotics – most doctors will start by prescribing tetracycline antibiotics. These are the standard medications used to treat rosacea and will help to reduce your facial redness and swelling. The effectiveness of these antibiotics vary from person to person, but most people will respond well to them.
I commonly prescribe Oracea (generic: doxycycline) for many of my rosacea patients. It is an extended release tablet that dissolves in your mouth and contains low doses of doxycycline, an old tetracycline antibiotic. New studies show that it can be an effective treatment for rosacea.
Azelaic Acid – another medication called azelaic acid has also been shown to be effective in the treatment of rosacea. This is a topical cream that you rub directly on the areas affected by rosacea. It is normally applied once or twice a day depending on the severity of your condition.
When starting treatment with a new medication, you should start off using it at a low strength. This will allow your doctor to increase the dose until your symptoms have reduced as much as they are going to. Once this has occurred, you can either continue applying the same strength of medicine to prevent your symptoms from recurring or stop applying the cream completely if your symptoms have gone away completely.
Combination therapy – many people don’t respond well to these medications when taken separately. This is why combination therapy has been developed. This involves you taking a lower dose of tetracycline and azelaic acid tablets along with a topical cream that contains a low dose of fluorinated steroids.
This combination has been proven to be very effective in the treatment of rosacea and usually leads to marked improvement in most patients.
Isotretinoin – also known under it’s brand name of Accutane, this is a very powerful drug that is only given to patients that don’t respond to any other forms of treatment. It is extremely effective but due to it’s potential dangerous side effects, it is reserved as a last resort for patients with severe rosacea.
The decision whether or not to take isotretinoin should be made by you in conjunction with your doctor. It can cause birth defects so you will be required to take pregnancy tests every month before starting the treatment. You will also have to complete monthly blood work and visit the doctor every 2 – 4 weeks to make sure the drug is not having a damaging effect on your body or organs.
Isotretinoin works by decreasing oil production in the skin and killing enlarged oil glands. This reduces redness and inflammation associated with rosacea. Some people taking this medication have also experienced an improvement of symptoms such as flushing or small blood vessels.
Isotretinoin is not a cure. It will reduce the symptoms of your rosacea but if you stop taking the medication, your symptoms are likely to return. You will most likely have to take the medication for at least five months before you see any improvement in your symptoms.
With all the potential side effects and having to commit to taking this drug for at least five months, this really should be considered as a last resort treatment. If you are interested in this treatment option, consult with your doctor. They can go over the potential risks and benefits with you.
How Can You Prevent The Symptoms From Flaring Up?
Once you have started treating your rosacea, your symptoms should start to get better. If you practice good skin care by avoiding anything that might irritate your skin and take appropriate medication when needed, your symptoms should remain under control. There are also certain things that you can do in your everyday life to minimize any flare-ups.
Avoid Direct Sunlight – Some patients find that exposure to sunlight seems to make their rosacea symptoms worse. If you have noticed a connection, avoid spending too much time in the sun. If you need to go out, ensure that you apply a strong sunscreen and wear a hat or sun-covering clothing to protect your face.
Don’t Pick Or Scratch Your Skin – Some people with rosacea find that rubbing, scratching or picking spots makes their skin condition worse. It is very important that you resist the temptation to do this. If you have persistent redness or spots, it is best to interact with a dermatologist to see what medication options are available for you.
Treat Emotional Factors – Although there is no proven connection between rosacea and emotions, some doctors believe that emotional factors can play a part in worsening the condition. Anything that causes you to be under stress can potentially make your rosacea worse. If you feel your flare-ups are connected to emotional factors, there are doctors who can help you.
A psychologist or psychiatrist can help you to find ways of dealing with these issues.
As with most skin conditions, the best treatment for rosacea is good skin care. This starts with keeping your facial skin clean to prevent any blockages that might lead to redness and pimples. Cleaning your face also helps to get rid of any bacteria or dirt that might be exacerbating your condition.
Many patients with rosacea find that their skin is more likely to react to different soaps and cleansers. The best approach with rosacea is to use products that are specially formulated for sensitive or problem skin. These are available from pharmacies and drugstores, or you might want to consult a dermatologist about which products would be best for you.
We all shed dead skin cells every day, but it is important not to overdo it. Exfoliating your skin is fine, but don’t overdo it. Use a washcloth with warm water to cleanse your face and get rid of any dead cells, but take care not to rub or scrub too hard as this can irritate your facial skin.
Moisturizing your skin is very important as it helps to keep it flexible and reduces the likelihood of dryness, peeling or flaking. Apply moisturizer after cleansing and drying your face. Look for a moisturizer that is light, non-greasy and doesn’t contain any ingredients that might irritate your rosacea.
You can also use a non-medicated moisturizing lotion designed for babies if you have dry or sensitive skin.
If you find that your skin is over-sensitive, try using an unscented moisturizer or one that is designed for sensitive skin. If your skin is more oily, you might prefer a cream-based moisturizer. It is a good idea to keep your moisturizer in the fridge as cool products help to calm warm skin.
It is a good idea to use a moisturizer twice a day. Use an oil-free sunscreen if you are going to be going out in the sun as your skin is more sensitive and prone to sunburn and photo-damage. Take a wide-brimmed hat and sunglasses whenever you can to protect your face.
You can moisturize your skin throughout the day if you need to. Just use a quick patting motion rather than rubbing to prevent aggravating your facial skin. If you need to, you can even moisturize several times during the day.
Make sure you wash your hands before touching your face to prevent transferring any dirt or oil from your hands to your face.
Although many people believe that rosacea sufferers shouldn’t go in the sun, this isn’t true. Sun exposure can make your rosacea worse and cause skin damage, so it’s important to protect your skin from the sun’s harmful UV rays. Use a sunscreen that has an SPF of at least 15 whenever you are going to be out in the sun for more than a few minutes.
Look for a specially designed sunscreen for sensitive or problem skin.
You can use a non-medicated moisturizer with a built-in SPF if your skin is sensitive.
You can also use a non-medicated after sun lotion if your skin feels tender or sunburnt.
It is a good idea to apply a layer of sunscreen first and then a layer of moisturizer on top.
When you are outdoors, make sure you wear a wide-brimmed hat and a long-sleeved shirt to protect your skin.
If you want to protect your face in particular, you could wear a sunscreen with an SPF of at least 30 or higher that is made for the face. You can also use a non-medicated self-tanning lotion to give your skin a tanned appearance. Look for one that has a dark tint to it so you know you are getting even coverage.
Make sure you wear your sunscreen and self-tanner whenever you are going to be going out in the sun as your skin is more sensitive and prone to sunburn and photo-damage. Take a wide-brimmed hat and a long-sleeved shirt to protect your skin.
There are various types of medication that can be used to treat rosacea. The most common types are topical and include metronidazole (such as Metrogel) and azelaic acid (such as Azelex). These medications work by reducing the blood flow in the skin, which reduces redness and inflammation.
They are applied directly to the skin, usually once or twice daily.
Metronidazole has been shown to be effective in the treatment of papules and pustules. Azelaic acid is more effective in the treatment of papules and erythema. If you suffer from both types of rosacea (i.e.
inflammatory and vascular), your physician may prescribe a combination of the two medications.
Dosing of either medication is usually once or twice daily. If you apply metronidazole or azelaic acid in the morning, it is best to apply it at night as well, since both of these medications are known to cause photosensitivity.
These topical medications work best when used in conjunction with another medication called tretinoin (such as Atralin). Tretinoin is a retinoid, which is a derivative of vitamin A. It works by reducing the buildup of skin cells.
Your physician may prescribe 0.05% or 0.1% tretinoin to be applied once daily at night or in the morning.
Other topical medications that may be used include sodium sulfacetamide (such as Sulfacet-R) or topical steroids (such as clobetasol). These are usually used in conjunction with either tretinoin or azelaic acid.
As rosacea can also lead to eye problems, your physician may also prescribe an eye drop medication such as timolol (such as Blocadren), which helps prevent inflammation of the blood vessels in the eye.
When topical medications are not enough to treat your condition, or if your rosacea is persistent, you and your physician may decide to use a systemic medication. The two most common systemic medications used to treat rosacea are metronidazole (such as MetroGel) and azithromycin (such as Zithromax).
Metronidazole works by decreasing the inflammation in the skin. It also has an antimicrobial effect on the skin, which helps in the treatment of rosacea caused by bacteria or parasites.
Azithromycin works by decreasing inflammation and reducing the buildup of skin cells. It also treats rosacea caused by a type of bacteria known as mycoplasma, which does not respond to tetracycline-class antibiotics.
Metronidazole is usually taken in pill form one to two times daily for at least three months. It is also applied topically once daily at bedtime.
Azithromycin is taken as a pill daily for at least three months. It may also be applied topically twice daily at night.
These medications are both effective in the treatment of rosacea. They do, however, have some common side effects that you should be aware of.
Common side effects may include nausea, vomiting, stomach pain, loss of appetite, diarrhea, headache, skin rash and vaginal itching or a discharge.
Metronidazole has been known to cause severe birth defects and should not be taken if you are pregnant. If you are planning on becoming pregnant within the next three months, you should talk to your physician before taking this medication.
Common side effects may include nausea, vomiting, stomach pain, loss of appetite, diarrhea, headache and dizziness.
In addition, it has been known to cause severe allergic reactions. If you experience swelling of the face, lips or throat, difficulty breathing, hives or a rapid heartbeat you should seek immediate medical attention.
The Next Step As always, we recommend meeting with a physician to discuss your options and find a treatment that’s right for you.
If you’d like to find a Rosacea Support Group near you, please visit our Find A Support Group Page.
We also have a list of approved skincare products that have been recommended by the Rosacea Support Group community. Find that here.
Sources & references used in this article: