Rosacea: Seeing Red
Rosacea, a common skin condition that affects the face, isn’t curable, but it is treatable.
Illustration by Nguyen Tran / Spinning Yarn
For millions of adults, the condition starts with mild blemishes and redness. Then it goes away. When it returns, it’s a bit worse. They try over-the-counter remedies, but the condition keeps coming back.
An estimated 16 million Americans have rosacea, according to the National Rosacea Society, but “only a small fraction are being treated.”
Like Sara Beth Glausier, an LPN who lives in Windermere, they don’t realize what they’re dealing with. “I had breakouts as a teenager on my forehead and chin,” says Glausier, 48. “As I got into my 20s, I started breaking out around my nose and cheeks. I thought it was just my genetics and I just dealt with it.”
The cause of rosacea is unknown; genes may play a role, but researchers are focusing on other possibilities, including flushing, inflammatory pathways, and an excess of Demodex mites, which are a natural part of the human microbiome.
Rosacea tends to affect mostly fair-skinned adults, but anyone can get it—and there’s no way to prevent the condition.
“Once you have it, there are certain things we can do to control it,” says Orlando dermatologist Dr. John Meisenheimer. “Some people undergo treatment and after a year or two don’t require other medications, while other people require medications for decades to keep it in control.”
It’s important to distinguish between telangiectasia, or spider veins, and rosacea, he says. Spider veins can be treated with lasers, says Meisenheimer, but they aren’t rosacea and aren’t necessarily a precursor to it.
The rosacea society notes that the disorder is diagnosed more often in women, but can be more severe in men, possibly because men usually delay seeking medical help.
Jerry Klein describes himself as an example of procrastination. The Winter Springs TV producer noticed blemishes and red spots on his face about five years ago, he says, and was given pills and a skin cleanser. He took the medication, but let the prescription lapse because “everything cleared up for about a year.” He didn’t think about it again until the redness and bumps returned—this time around his eyes. “That really got annoying,” says Klein, 71, because his eyelids itched.
After a gentle talking-to from his ophthalmologist, he realized that he needed to take antibiotics, use the skin cleanser and protect himself from the sun for the rest of his life. “I wear a hat walking down to the end of the driveway to get the mail,” he says.
Topical treatments are the mainstay of rosacea treatment, says Meisenheimer, but antibiotics and laser therapy are also used to treat the condition. “We can control 80 percent of people very nicely with topical therapies like Metrogel,” he says. Patients whose rosacea doesn’t respond to Metrogel may do better with another topical medication, he adds.
Glausier, for example, experienced flaky skin with Metrogel. Meisenheimer, for whom Glausier has worked for two years, switched her to Soolantra cream. “I’m so happy with it,” she says. “Even though my skin is clear, I still use it every night because it keeps me from having breakouts.”
Says Meisenheimer: “There’s no one treatment that’s going to work for everybody, but we evaluate each patient individually and try to select the treatments from our armamentarium that we think will be the simplest and safest for long-term control.”
What You Need to Know if You Have Rosacea
- Clean your face with a mild and non-abrasive cleanser. Unless your skin is oily, select non-soap cleansers that contain less than 10 percent soap, rinse off easily, and have a neutral pH that’s closer to the natural pH of your skin. For oily skin, wash with a mild soap, and avoid scrubbing your skin.
- Rinse your face with lukewarm water, and gently blot dry with a thick cotton towel. Avoid pulling, tugging or using rough washcloths.
- Cleanse and moisturize your face before applying makeup.
- Use a green-tinted base to counter the redness. Select one with UVA/UVB protection to shield your skin from sun exposure that can worsen rosacea.
- Choose oil-free foundation and concealer. Foundation should match your natural skin tone; concealer should be one shade lighter than your skin tone.
- Use an antibacterial foundation brush to apply foundation. A sponge can be too harsh for skin, and your fingertips can add unnecessary oil.
Shaving Tips for Men
- An electric razor may be a better choice to avoid the irritation of a dull razor blade.
- Avoid shaving creams or lotions that sting your skin.
- Use an aftershave balm and/or moisturizer to soothe your skin.
- Choose a sunscreen with zinc or titanium dioxide that delivers UVA/UVB protection with an SPF of 15 or higher. Look for sunscreens designed for sensitive skin, such as mineral formulations, which can help lower the risk of irritation.
- Wear sunscreen every day, year-round.
- For intense sun exposure, apply sunscreen 30 minutes before going outside so the skin can absorb it; reapply at least every two hours after sweating or swimming.
Most Common Rosacea Triggers
Sun exposure; emotional stress; hot weather; wind; heavy exercise; alcohol consumption; hot baths; cold weather; spicy foods; humidity; indoor heat; certain skin care products.
Source: National Rosacea Society
Common Rosacea Treatments
Prescription medications that reduce redness:
Brimonidine (Mirvaso) is applied to the skin as a gel. It works by constricting blood vessels. You may see results within 12 hours after application. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to maintain any improvements seen.
Azelaic acid and Metronidazole can reduce redness and the pimples of mild rosacea. Improvements generally appear after three to six weeks.
Antibiotics help reduce some types of bacteria, but mainly fight inflammation when used for rosacea. Doxycycline is taken as a pill for moderate to severe rosacea with bumps and pustules. Other oral antibiotics sometimes used include tetracycline and minocycline.
For severe rosacea that doesn't respond to other therapies, doctors may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acne-like lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects.
Laser therapy may help reduce the redness of enlarged blood vessels.
Other options for treating visible blood vessels and changes due to rhinophyma (enlarged, bulbous nose) are dermabrasion, intense pulsed light therapy and electrosurgery.
- In dermabrasion, a surgeon scrapes away the outermost layer of skin with an implement containing diamond particles that is attached to a motorized handle.
- Intense pulsed light therapy creates heat that helps destroy capillaries that contribute to the appearance of rosacea. Over time, the facial redness disappears. But the treatment doesn’t do much for papules or flushing.
- In electrosurgery, a doctor uses a thin needle to apply a weak electrical current to blood vessels, causing them to clot and shrink. The vessels form small scabs that disappear in a few days.
Sources: The Mayor Clinic; The American Society of Plastic Surgeons; Dermatology News; NYU Langone Health