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Rosacea

Posted July 28, 2013 in Blog & News, Newsletter

Rosacea (ro-ZA-she-uh) is a chronic, inflammatory skin condition that affects adults. It causes redness in your face and produces small, red, pus-filled bumps or pustules.

Left untreated, rosacea tends to be progressive, which means it gets worse over time. However, in most people rosacea is cyclic. Rosacea signs and symptoms may flare up for a period of weeks to months, and then diminish before flaring up again. Besides acne, rosacea can be mistaken for other skin problems, such as a skin allergy or eczema.

Though rosacea doesn’t have a cure, treatments can control and reduce the signs and symptoms. If you experience persistent redness of your face, see your doctor for a diagnosis and proper treatment.

Symptoms

Signs and symptoms of rosacea include:

  • Red areas on your face
  • Small, red bumps or pustules on your nose, cheeks, forehead and chin (but not the same as whiteheads or blackheads)
  • Red, bulbous nose (rhinophyma)
  • Visible small blood vessels on your nose and cheeks (telangiectasia)
  • Burning or gritty sensation in your eyes (ocular rosacea)
  • Tendency to flush or blush easily

Rosacea usually appears in phases:

  • Pre-rosacea. Rosacea may begin as a simple tendency to flush or blush easily, and then progress to a persistent redness in the central portion of your face, particularly your nose. This redness results from the dilation of blood vessels close to your skin’s surface. This phase may sometimes be referred to as pre-rosacea.
  • Vascular rosacea. As signs and symptoms worsen, vascular rosacea may develop — small blood vessels on your nose and cheeks swell and become visible (telangiectasia). Your skin may become overly sensitive. Vascular rosacea may also be accompanied by oily skin and dandruff.
  • Inflammatory rosacea. Small, red bumps or pustules may appear and persist, spreading across your nose, cheeks, forehead and chin. This is sometimes known as inflammatory rosacea.

In addition, about 1 in 2 people with rosacea also experience ocular rosacea — a burning and gritty sensation in the eyes. Rosacea may cause the inner skin of the eyelids to become inflamed or appear scaly, a condition known as conjunctivitis.

Late in the course of rosacea, some people, mainly middle-aged men, may develop red, round, raised bumps (papules) and a bulbous nose, a condition known as rhinophyma.

When to see a doctor
Unfortunately, rosacea rarely clears up on its own, and it tends to worsen over time if left untreated. If you experience persistent redness of your face, see your doctor or a skin specialist (dermatologist) for a diagnosis and proper treatment.

Many over-the-counter skin care products contain ingredients — such as acids, alcohol and other irritants — that may worsen rosacea. Because of the progressive nature of rosacea, an early diagnosis is important. Treatments tend to be more effective when started earlier.

Causes

The cause of rosacea is unknown, but researchers believe it’s likely due to some combination of hereditary and environmental factors.

A number of factors can aggravate rosacea or make it worse by increasing blood flow to the surface of your skin. Some of these factors include:

  • Hot foods or beverages
  • Spicy foods
  • Alcohol
  • Temperature extremes
  • Sunlight
  • Stress, anger or embarrassment
  • Strenuous exercise
  • Hot baths, saunas
  • Corticosteroids
  • Drugs that dilate blood vessels, including some blood pressure medications

One thing is certain — alcohol doesn’t cause rosacea. Although drinking alcohol can lead to flushing of the skin and may worsen rosacea, people who don’t drink alcohol can get rosacea.

Risk factors

Although anyone can develop rosacea, you may be more likely to develop rosacea if you:

  • Have fair skin and light hair and eye color
  • Are between the ages of 30 and 60, especially if you’re going through menopause
  • Experience frequent flushing or blushing
  • Have a family history of rosacea

Complications

In severe and rare cases, the oil glands (sebaceous glands) in your nose and sometimes your cheeks become enlarged, resulting in a buildup of tissue on and around your nose — a condition called rhinophyma (ri-no-FI-muh). This complication is much more common in men and develops slowly over a period of years.

Preparing for your appointment

You’re likely to start by seeing your family doctor or a general practitioner. However, in many cases when you call to set up an appointment, you may be referred to a skin disease specialist (dermatologist).

It’s a good idea to prepare for your appointment. Here’s some information to help you.

What you can do
Preparing a list of questions will help you make the most of your appointment time. For rosacea, some basic questions to ask your doctor include:

  • What might be causing the signs and symptoms?
  • Do I need tests to confirm the diagnosis?
  • What is the best course of action?
  • Is this condition temporary or chronic?
  • Is there a generic alternative to the medicine you’re prescribing?
  • I have other medical problems; how can I manage them together?
  • Can I wait to see if the condition resolves on its own?
  • What are the alternatives to the approach that you’re suggesting?
  • What skin care routines do you recommend I use?

Don’t hesitate to ask any other questions that come up during your appointment.

What to expect from your doctor
Your doctor is likely to ask you several questions, including:

  • When did you begin experiencing symptoms?
  • How often do you experience these symptoms?
  • Have your symptoms been continuous or occasional?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to trigger or worsen your symptoms?

Tests and diagnosis

There’s no specific test for rosacea. Instead, doctors rely on the history of your symptoms, a physical examination of your skin and eliminating other conditions, such as acne, for which rosacea can be mistaken.

Treatments and drugs

Though there’s no way to eliminate rosacea, effective treatment can relieve signs and symptoms. Most often this requires a combination of prescription treatments and certain lifestyle changes on your part.

Your doctor also may recommend certain moisturizers, mild cleansers, sunscreens and other products to improve the health of your skin. If hot flashes appear to trigger your rosacea, you might ask your doctor what treatment options are available for the signs and symptoms of menopause.

Medications
You may need a combination of prescription-strength topical medication (lotion, cream or gel) and oral medication (pill, capsule or tablet) to treat rosacea.

  • Topical medications. Medications you apply to your skin once or twice daily may help reduce inflammation and redness. They may also be used along with oral medications or as part of a maintenance program to control symptoms. Common topical medications include antibiotics such as metronidazole (Metrocream, Metrogel, others), tretinoin (Atralin, Renova, others), benzoyl peroxide and azelaic acid (Azelex, Finacea). These topical applications can cause skin irritation, redness, dry skin, and stinging or burning of the skin.
  • Oral antibiotics. Doctors may prescribe oral antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria. Oral antibiotics are also prescribed because they tend to work faster than topical ones. Common prescription oral antibiotics include tetracycline, minocycline and erythromycin. Possible side effects include stomach discomfort, diarrhea, nausea or vomiting, and sore mouth or tongue.
  • Isotretinoin. Isotretinoin (Accutane, Amnesteem, others) is a powerful oral medication sometimes used for severe cases of inflammatory rosacea if other treatment options fail to improve symptoms. Usually prescribed for cystic acne, isotretinoin works to inhibit the production of oil by sebaceous glands. People who take it need close monitoring by a dermatologist because of the possibility of serious side effects, including depression and suicidal thoughts, bone or joint pain, and skin infection or rash. Also, this drug causes birth defects if taken during pregnancy. If you plan to become pregnant or suspect that you are pregnant, stop taking this medicine and check with your doctor.

Your doctor may treat ocular rosacea with oral antibiotics or steroid eyedrops.

The duration of your treatment depends on the type and severity of your symptoms, but typically you’ll notice an improvement within one to two months. Because symptoms may recur if you stop taking medications, long-term regular treatment is often necessary.

Surgical
Enlarged blood vessels, some redness and changes due to rhinophyma often become permanent. In these cases, surgical methods, such as laser surgery and electrosurgery, may reduce the visibility of blood vessels, remove tissue buildup around your nose and generally improve your appearance.

Lifestyle and home remedies

One of the most important things you can do if you have rosacea is to minimize your exposure to anything that causes a flare-up. Find out what factors affect you so that you can avoid them. Keep a list of things that trigger your flare-ups, and try to avoid your triggers.

Here are other suggestions for preventing flare-ups:

  • Wear broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher to protect your face from the sun.
  • Protect your face in the winter with a scarf or ski mask.
  • Avoid irritating your facial skin by rubbing or touching it too much.
  • Wash problem areas with a gentle cleanser (Dove, Cetaphil).
  • Avoid facial products that contain alcohol or other skin irritants.
  • When using moisturizer and a topical medication, apply the moisturizer after the medication has dried.
  • Use products that are labeled noncomedogenic. These won’t clog your oil and sweat gland openings (pores) as much.
  • Avoid overheating.
  • If you wear makeup, consider using green- or yellow-tinted pre-foundation creams and powders, because they’re designed to counter skin redness.
  • Avoid drinking alcohol.

Alternative medicine

Many alternative therapies — including colloidal silver, emu oil, laurelwood, oregano oil and vitamin K — have been touted as possible ways to treat rosacea. However, there’s no conclusive evidence that any of these alternative therapies are effective.

If you’re considering dietary supplements or other alternative therapies to treat rosacea, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Coping and support

Rosacea can be distressing. You might feel embarrassed or anxious about your symptoms and become withdrawn or self-conscious. You may be frustrated or upset by other people’s reactions.

If you’re having difficulty coping, you may find some of the following suggestions helpful:

  • Educate yourself about rosacea. The more you know, the better prepared you’ll be to deal with complications or recurrences. Besides talking to your doctor, you may want to talk to a counselor or medical social worker. Or you may find it helpful to talk to other people with rosacea.
  • Follow your doctor’s recommendations. If your doctor recommends certain treatments or lifestyle changes, be sure to follow them. Ask questions if anything is unclear.
  • Maintain a strong support system. Family and friends can help you tremendously as you go through this difficult time. Sometimes, though, you may find the concern and understanding of other people with rosacea especially comforting. Go online to connect with other people living with the condition. The National Rosacea Society indicates that there aren’t many face-to-face support groups for rosacea, but if you prefer a live support group, ask your doctor if there are any in your area.

Prevention

You can’t prevent rosacea, but you can take steps to reduce or control your symptoms long term.

  • Continue your treatment plan. Once rosacea improves or clears, you need to continue your maintenance treatment plan as outlined by your doctor. This may mean daily use of topical medications or continuing lifestyle or self-care measures.
  • Be gentle to your skin. Wash areas daily with a gentle cleanser and use oil-free, water-based skin care products. Avoid using products that contain skin irritants, such as alcohol.
  • Avoid rosacea triggers, if possible. Find out what triggers, if any, worsen your rosacea and take steps to prevent or avoid them. Extreme temperatures, sun exposure, spicy foods, alcohol and stress can all trigger rosacea.

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