What is Rosacea?

Rosacea (roe-ZAY-she-uh) is a common skin condition that causes redness and visible blood vessels in your face. It may also produce small, red, pus-filled bumps. These signs and symptoms may flare up for weeks to months and then go away for a while. Rosacea can be mistaken for acne, other skin problems, or natural ruddiness.

Rosacea can affect anyone. But it’s most common in middle-aged women who have light skin. There’s no cure for rosacea, but treatment can control and reduce the signs and symptoms.

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

The cause of rosacea is unknown. Risk factors are believed to include a family history of the condition. Factors that may potentially worsen the condition include heat, exercise, sunlight, cold, spicy food, alcohol, menopause, psychological stress, or steroid cream on the face. The diagnosis is based on symptoms.

While not curable, treatment usually improves symptoms. Treatment is typical with metronidazole, doxycycline, minocycline, or tetracycline. When the eyes are affected, azithromycin eye drops may help. Other treatments with tentative benefits include brimonidine cream, ivermectin cream, and isotretinoin. Dermabrasion or laser surgery may also be used. The use of sunscreen is typically recommended.

Rosacea affects between 1 and 10% of people. Those affected are most often 30 to 50 years old and female. Caucasians are more frequently affected.

Always consult with a medical practitioner for the most accurate diagnosis. Perhaps a dermatologist in this case.

The Types of Rosacea

Symptoms can be different from person to person. There are four basic types of rosacea. You can have just one type, or you can have more. Women tend to have rosacea more often than men, but men tend to
have more severe symptoms.

Type 1: Facial Redness

This is the most common type of rosacea and the type most people know.

Symptoms can include:

• Stinging, burning, sensitive skin
• Visible small blood vessels and redness of the skin
• Dry or rough skin
• Swollen skin
• Blushing or flushing easily

Type 2: Breakouts

This type causes pimples on the skin that can look like acne. It’s the second most common type of rosacea.

Other symptoms can include:

• Oily skin
• Patchy raised areas on the skin
• Visible small blood vessels
• Sensitive skin

Type 3: Thick Skin

This type of rosacea is rare. Most people have another type first. Left untreated, it can cause skin thickening on the nose, making it look enlarged.

It can also cause:

• Bumpy skin
• Large pores
• Oily skin

Type 4: Ocular Rosacea

This type of rosacea affects the eyes. People often say it feels like having grit or sand in your eyes.
If you have another type of rosacea, it’s important to watch for
symptoms of ocular rosacea. If not treated, it can cause problems with vision.

Other symptoms include:

• Dry eyes
• Burning or stinging in the eyes
• Blurry vision
• Frequent styes

Symptoms

• Facial redness. Rosacea usually causes a persistent redness in the central part of your face. Small blood vessels on your nose and cheeks often swell and become visible.
• Swollen, red bumps. Many people with rosacea also develop pimples on their faces that resemble acne. These bumps sometimes contain pus. Your skin may feel hot and tender.
• Eye problems. Many people with rosacea also experience dry, irritated, swollen eyes and red, swollen eyelids. This is known as ocular rosacea. In some people, the eye symptoms precede the skin symptoms.
• Enlarged nose. Over time, rosacea can thicken the skin on the nose, causing the nose to appear bulbous (rhinophyma). This occurs more often in men than in women.

Causes

The cause of rosacea is unknown, but it could be due to a combination of hereditary and environmental factors. Rosacea is not caused by poor hygiene.

A number of factors can trigger flare-ups, including:

• Hot drinks and spicy foods
• Red wine and other alcoholic beverages
• Temperature extremes
• Sunlight or wind
• Emotions
• Exercise
• Drugs that dilate blood vessels, including some blood pressure medications
• Various cosmetic products

Risk factors

Anyone can develop rosacea. But you may be more likely to develop it if you:

• Are female
• Have light skin, particularly if it has been damaged by the sun
• Are over age 30
• Smoke
• Have a family history of rosacea

Complications

Over time, 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 (rie-no-FIE-muh). This complication is much more common in men and develops slowly over a period of years.

Expected Duration

Symptoms of rosacea commonly come and go in cycles, often triggered by substances and situations that make the face flush. By seeking medical help early and adhering to medical treatments, you can improve your skin condition and perhaps stop, or reverse, the progress of this condition.

Diagnosis

No specific test is used for the diagnosis of rosacea. Instead, your doctor relies on the history of your symptoms and an examination of your skin. You may have tests to rule out other conditions, such as psoriasis, eczema, or lupus. These conditions can sometimes cause signs and symptoms similar to those of rosacea.

If your symptoms involve your eyes, your doctor may refer you to an eye specialist (ophthalmologist) for evaluation.

Treatment

Treatment for rosacea focuses on controlling signs and symptoms. Most often this requires a combination of good skincare and prescription drugs.

The duration of your treatment depends on the type and severity of your signs and symptoms. Recurrence is common.

Depending on your symptoms, your doctor may prescribe the following:

• Brimonidine (Mirvaso) or oxymetazoline (Rhofade) – These topical medications constrict blood vessels and may work best for the facial redness of rosacea.
• Antibiotics — Topical metronidazole cream or gel (MetroCream, MetroGel) is the most frequently prescribed first-line therapy. Other topical antibiotics also may be effective. Tetracycline and tetracycline derivatives, such as doxycycline, are prescription drugs taken by mouth once or twice per day. They are sold under several brand names. Improvement is usually noticeable within the first two months after beginning treatment.  Other options include topical ivermectin (Sklice or Soolantra) or sodium sulfacetamide (Klaron and others), especially for rosacea manifest by pimples and papules.
• Azelaic acid (Finacea) —
  The U.S. Food and Drug Administration (FDA) approved this drug in January 2003 for topical (applied to the skin) use. It is a gel containing dicarboxylic acid and is used for the inflammatory pimples of mild to moderate rosacea.
• Beta-blockers and alpha antagonists — These medications may reduce flushing through their effect on blood vessels. Propranolol (Inderal) and nadolol (Corgard) are beta-blockers, and clonidine (Catapres) is an alpha antagonist. The use of these drugs for rosacea is off-label, meaning that the FDA has not approved their use for rosacea. Beta-blockers usually are used to treat high blood pressure and heart disease. Clonidine was developed to treat high blood pressure, but also
  is used to decrease hot flashes in menopause.
• Estrogen — This female hormone is used when rosacea is aggravated by the hot flashes of menopause. The smallest dose of estrogen that controls menopausal symptoms should be used, then the hormone should be stopped when hot flashes no longer occur.
• Laser treatment — This is used to get rid of dilated blood vessels or to remove excess nose tissue.
• Surgical procedures — Surgical shave techniques or dermabrasion can also be helpful in removing excess nose tissue in rhinophyma.

Medications

New rosacea medications have been developed in recent years. The type of medication your doctor prescribes depends on which signs and symptoms you’re experiencing. You may need to try different options or a combination of drugs to find a treatment that works for you.

Prescription drugs for rosacea include:

• Topical drugs that reduce redness. For mild to moderate rosacea, your doctor may prescribe a cream or gel that you apply to the affected skin. Brimonidine (Mirvaso) and oxymetazoline (Rhofade) reduce redness by constricting blood vessels. You may see results within 12 hours after use. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to maintain improvements. Other topical products have less effect on the redness but help control the pimples of mild rosacea. These drugs include azelaic acid (Azelex, Finacea), metronidazole (Metrogel, Noritate, others), and ivermectin (Soolantra). With azelaic acid and metronidazole, noticeable improvements generally don’t appear for two to six weeks. Ivermectin may take even longer to improve skin, but it results in a longer remission than metronidazole.
• Oral antibiotics. Your doctor may prescribe an oral antibiotic such as doxycycline (Oracea, others) for moderate to severe rosacea with bumps and pimples.
• Oral acne drug. If you have severe rosacea that doesn’t respond to other therapies, your doctor 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.

Therapies

Laser therapy and other light-based therapies may help reduce the redness of enlarged blood vessels. Repeat treatments may be needed periodically to maintain the improved appearance of your skin.

Prevention

Although a recent study found fewer cases of rosacea among people who drank caffeinated coffee, there is no proven way to prevent rosacea. The symptoms may be reduced by recognizing these common
triggers: hot drinks, alcohol, spicy foods, stress, sunlight, extreme heat, or cold. These conditions increase blood flow and cause the small blood vessels in the face to widen (dilate). If you have rosacea, try to identify your particular triggers and either modify them or avoid them entirely.

To cleanse and moisturize your face, you should select facial products that do not burn, sting, irritate, or cause redness when they are applied. You should wash your face with lukewarm water and mild soap, using your fingertips to apply the soap gently. You should avoid toners, astringents, scrubs, exfoliating agents, and products that contain alcohol or acetone. Hydroxy acids and tretinoin (for example, Retin A) may sensitize the skin to the sun and can worsen rosacea.

Sunscreens and sun blockers should be used regularly and liberally to protect the face. Use sunscreens with an SPF factor of 30 or higher. If chemical sunscreens cause stinging, switch to the physical sun
block, which contains titanium or zinc oxide.

DIY Skin Care for Rosacea

There’s a lot you can do on your own. For starters, try to figure out the things that trigger an outbreak, and then avoid them. To help you do this, keep a journal that tracks your activities and your flare-ups.

Some things that often trigger rosacea are:

• Sunlight
• Hot or cold temperatures
• Wind
• Stress
• Hot baths
• Hot or spicy foods or drinks
• Alcohol
• Intense exercise
• Medicines such as blood pressure drugs or steroids you put on your skin

Also, try to follow these tips every day to help fade the redness on your skin:

Put on sunscreen. Use one that’s a broad spectrum (blocks UVA and UVB rays) and SPF 30 or higher whenever you go outside. Also, wear a wide-brimmed hat that covers your face.

Use only gentle skin care products. Avoid cleansers and creams that have alcohol, fragrance, witch hazel, and other harsh ingredients. After you wash your face, gently blot your skin dry with a soft cloth.

Use a moisturizer. It’s especially helpful in cold weather. Low temps and wind can dry up your skin.

Massage your face. Gently rub your skin in a circular motion. Start in the middle of your face and work your way outward toward your ears.

Cover up. Put a green-tinted cover-up on your face to hide redness and broken blood vessels.

Go indoors. Get out of the heat and sun and cool off in an air-conditioned room.

Care for your eyes. If rosacea has made them red and irritated, use a watered-down baby shampoo or eyelid cleaner to gently clean your eyelids every day. Also, put a warm compress on your eyes a few times a day.

Eating an anti-inflammatory diet, like a Mediterranean diet, seems to help some people suffering from rosacea.

It’s also important to care for your emotions along with your skin problems. If you feel embarrassed by the way you look, or you think it’s starting to affect your self-esteem, talk to your doctor or a counselor. You can also join a support group where you can meet people who know just what you’re going through.

Natural Herbal Treatments

Aloe vera

The gel from the inner leaf of the aloe vera plant is emollient and moisturizing. It can be successful as a topical remedy for rosacea.

Many moisturizers contain aloe. You can use these and follow package directions. Or, harvest a leaf from a live aloe plant and apply the inner gel directly to your skin. It’s possible to be sensitive or allergic to aloe vera, so do a patch test before you apply it to larger areas.

Burdock

Burdock is available as a supplement, extract, or food.

As an edible remedy, burdock root can purify your liver and clear up skin conditions such as acne. Burdock plant extract can be an effective treatment for rosacea.

Chamomile

Like aloe, chamomile is common in moisturizing skin products. It’s often used topically in herbal treatment for inflamed skin.

Many studies support it as a successful remedy. Purchase a moisturizing product containing natural chamomile and use it by following label directions.

Chamomile essential oil can be diluted and applied, too. You can also make chamomile tea, wait for it to cool, and apply it as a skin wash or compress.

Coconut Oil

Moisturizers like coconut oil are popular for all sorts of inflammatory skin conditions, including rosacea.

There aren’t recent studies showing coconut oil to be effective for rosacea. Still, it could help as a known anti-inflammatory, antioxidant, and moisturizer.

Apply a small amount of high-quality coconut oil to your skin. You can also use it as a carrier oil for appropriate essential oils if desired.

Comfrey

Comfrey is a plant that produces a compound called allantoin. This compound has drawn attention to alleviating skin reactions.

A 2017 study on a product containing allantoin found it improved symptoms with virtually no side effects. It also reduced redness and appearance.

Find products such as creams, lotions, or salves that contain natural comfrey or allantoin and follow label directions.

Feverfew

Feverfew is another plant frequently named as a natural rosacea remedy.

Feverfew has antioxidant qualities. It’s also known to protect against UV exposure, somewhat like a mild sunscreen. UV exposure is sometimes known to worsen rosacea.

Be sure to use topical feverfew products that are parthenolide-free. Parthenolide may increase skin sensitivity.

Green tea

Green tea is very rich in antioxidants and is available as a tea and herbal supplement. Research has shown it can be effective in the treatment of rosacea.

Antioxidants are helpful for inflammation, including skin conditions. As such, green tea may be a popular ingredient in skin products and creams for rosacea. Applying topical products with green tea is the best method for treating rosacea.

Cooled green tea may also be used as a compress and you can drink the tea for numerous health benefits, too.

Lavender essential oil

Different essential oils may be used topically to improve rosacea. Of all these, lavender is the best studied-and easiest to obtain.

Dilute the lavender essential oil in a carrier oil and apply it to your skin. Or, mix some drops in your favorite moisturizer. Use about five drops per ounce of product.

Niacinamide

Niacinamide is a B vitamin found in foods. It’s not to be confused with niacin or vitamin B-3.

It’s extracted into creams and lotions for topical skin conditions. Niacinamide is especially good for preventing and relieving skin flushing, which happens with rosacea.

Purchase creams containing niacinamide from reliable companies and follow label directions.

Oatmeal

Oatmeal is a long-time home remedy for rosacea. It’s thought to strengthen skin and reduce water loss, which can worsen the condition. Oatmeal may also help with itching problems.

Some skin products, like face masks, include oatmeal as an ingredient — these are great options.

You can also mix a couple of tablespoons of oatmeal with water and apply it directly to your skin.

Raw honey

Some types of honey, especially raw honey, may be effective and easy relievers for rosacea.

This may be because honey helps skin retain moisture and dryness worsens rosacea. In a 2015 study, a type of honey called kanuka honey was shown to be very effective against rosacea.

Purchase high-quality, raw honey. Kanuka or manuka honey is recommended. Apply a small amount directly to your skin.

Tea tree essential oil

Tea tree oil is useful for all sorts of skin conditions because of its anti-inflammatory properties. It can also help with itching problems.

There aren’t many studies on tea tree oil for rosacea specifically. Still, its evidence for helping similar skin conditions makes it a great contender.

Tea tree essential oil can be diluted in a carrier oil and applied directly to your skin.

Turmeric

Turmeric is a famous herbal anti-inflammatory. It may be recommended for painful and inflamed rosacea symptoms. You can also eat the herb or use it in cooking for its numerous health benefits.

Try applying turmeric essential oil diluted in a carrier oil. Some creams and lotions contain turmeric. You can also mix turmeric powder with water and apply it to your skin as a poultice.

When taking any herbal remedy always consult with your doctor first.

Thank you for reading

Michael

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