Rosacea: A common and treatable disease
By Eric N. Tabor, MD, Nortshore Dermatology, Northshore & New Orleans LIVING WELL Magazine
Many people either know someone or they themselves suffer with a very common skin disease known as rosacea. The most common symptom of rosacea is the classic “red-face” that you may have seen or heard of, although many more subtypes and symptoms are common.
Rosacea is a common but poorly understood disorder of the facial skin that is estimated to affect well over 16 million Americans and most of them don’t even know it. But because of its red-face, acne-like effect on personal appearance, it can cause significant psychological, social and occupational problems. In fact, in a survey by the National Rosacea Society, more than 76% of rosacea patients said their condition had lowered their self-esteem and 41% reported that it had caused them to avoid public contact or cancel social situations. Further, 51% said they had even missed work because of their condition.
What is rosacea and what causes it? Is there a cure? Unfortunately, the answers to these questions aren’t the most encouraging. The medical definition of rosacea usually says something close to, “Rosacea is a common, chronic inflammatory condition of unknown etiology, usually occurring on the face, nose and eyes.” This basically says we do not fully understand why people get this disease and, to make matters worse, this disease is not curable. However, we do understand and have many, many studies detailing which medications and treatments can put rosacea in remission, or decrease the severity of symptoms for the majority of people.
Although rosacea is not curable, it is very manageable depending on the type and severity of the disease progression. Individuals who suspect they may have rosacea are urged to see a dermatology provider for diagnosis and treatment. Patients should look for flushing, persistent redness, bumps and pimples, or visible blood vessels almost always occurring on the face. Other symptoms to notice are eye irritation, burning or stinging of the face, raised red patches, skin thickening or swelling of the face.
There are four main subtypes of rosacea. Erythematotelangiectatic patients present with flushing, prolonged facial redness and small blood vessels on the face. Papulopustular patients present with acne-like bumps and pustules with associated redness and swelling. Phymatous patients present with long-term inflammation and swelling causing marked thickening of the skin, and enlarging of the sebaceous glands, leading to “rhinophyma” or swelling of the nose. Ocular patients present with conjunctivitis, inflamed eyelids, and often complain of dry, irritated, itchy eyes. Depending on the type of rosacea you are suffering from will determine the type and modality of treatment that will be offered to you.
The first thing one should do to treat rosacea is to avoid certain known triggers that have classically exacerbated rosacea flares for most patients. The most common are temperature extremes, heat from sunlight, severe sunburn, stress, anxiety, cold wind, alcohol, caffeine, spicy food, red wine, beer, yogurt, and aged cheeses to name a few. Also patients with rosacea are urged to wash their face with a gentle skin cleanser and apply sunscreen with both UVA and UVB protection every morning.
Various topical and oral medications are generally the first line treatment for most forms of rosacea. Topical metronidazole and azelaic acid have FDA indications for the treatment of rosacea, work well and are generally tolerated well. Oral antibiotics such as the tetracyclines (tetracycline, minocycline and doxycycline) work as an anti-inflammatory agent in the treatment of rosacea. An extended release, low milligram oral version of doxycycline with less risk of microbial resistance has also been developed specifically for rosacea and has been shown to be safe for long-term use. Ocular rosacea is also treated with oral antibiotics with the addition of oral antihistamines if it is beneficial to control the patient’s itching.
When appropriate, treatment with lasers, intense pulse light sources or other medical and surgical devices may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. In fact, laser treatment has been shown to be the most effective treatment for permanent facial redness.
There are several different forms of rosacea with many different treatment modalities available. It is important to seek medical advice from an experienced professional who can gear treatment for rosacea patients depending on the symptoms the patient is experiencing. And although rosacea is not curable, the majority of people with rosacea control their symptoms with easy to use medications and lifestyle changes.
Dr. Tabor is available at the Northshore Dermatology in Slidell & Madisonville. He can be reached at 985-641-5198 in Slidell or 985-792-5959 in Madisonville.