If your skin turns red for long periods of time and you experience flushing, broken blood vessels, or swollen bumps on the nose, cheeks, forehead and ears, it may be rosacea.
Topical medications, such as azelaic acid and metronidazole, can decrease inflammation and reduce the appearance of redness. If redness is severe, oral medication, such as doxycycline, may be prescribed.
Symptoms
Rosacea is a skin condition that most often affects the face and eyes. The condition can cause redness that comes and goes and bumps or pimples that resemble acne. It can also lead to a thickening of the skin and swollen or blood-shot eyes (puffiness). Other symptoms include a feeling that your skin is burning or itching.
People with rosacea have relapsing and remitting courses of symptoms that can be controlled by lifestyle measures, general skin care, medications and procedures. Taking steps to avoid triggers is important for all types of rosacea. It may help to keep a diary of the foods, beverages, skincare products and activities that cause your symptoms to flare up. It can take a few weeks or months of keeping a diary to identify the things that are specific to your rosacea.
In the more severe form of rosacea, papulopustular rosacea, small red solid bumps or pus-filled blemishes develop on the nose and cheeks. These resemble acne, but they don’t have blackheads and aren’t oily. Some people with papulopustular rosacea have red, swollen eyelids that feel like they have grit in their eyes.
If rosacea is left untreated, it can lead to damage of the cornea, which can threaten your sight. If this happens, see your GP immediately. They will probably prescribe a steroid cream, which can help restore the cornea’s normal structure. There are also oral medications such as doxycycline (Oracea) and metronidazole (Metrogel, Noritate, others) that can reduce the number of bumps and pimples and slow down the progression of rosacea.
Diagnosis
A healthcare provider can diagnose rosacea from a patient’s symptoms and a physical exam. The healthcare provider may also ask about your family history and look at your eyes (if you have eye-related symptoms).
There are no specific tests to confirm rosacea. Your healthcare provider may order other tests to rule out other conditions with similar signs and symptoms, such as psoriasis or lupus.
Your doctor can prescribe oral and topical medications to treat rosacea. Medications can reduce redness and clear up acne-like lesions, says Tsippora Shainhouse, MD, of the Los Angeles Dermatology Center. Topical products include prescription creams, washes and gels. Typically, these are designed to control skin irritation and inflammation that causes redness and a rash. For example, a medicine called brimonidine decreases redness by temporarily constricting blood vessels. Your doctor can also prescribe a cream that treats a common cause of rosacea: an overgrowth of the demodex mite, says Shainhouse. This medication, ivermectin, is approved by the Food and Drug Administration for use in rosacea.
In addition to taking prescription medicines, patients can try lifestyle changes to help control their rosacea. This may include avoiding triggers that can make the condition worse. These include sun exposure, emotional stress, hot or cold temperatures, heavy exercise and alcohol use. Keeping a diary can help patients pinpoint their triggers.
Treatment
While rosacea is not curable, there are many treatments that can reduce your symptoms and help prevent them from returning. These include gentle skin cleansing, daily facial massage and avoiding irritants (e.g., hot drinks, spicy foods and alcohol). Your health care provider can recommend facial products that are appropriate for your condition.
You can also use a sunscreen with a high sun-protection factor to protect your skin from the ultraviolet rays that can worsen rosacea. Your provider can prescribe oral or topical medicines to treat your rosacea, such as antibiotics like doxycycline or azelaic acid to help reduce redness and bumps; retinoids to help reduce wrinkles; and laser therapies to shrink visible blood vessels. Your provider can also prescribe a prescription or over-the-counter makeup to cover up the discoloration of your skin.
You can reduce the frequency of rosacea flare-ups by avoiding things that make your skin act up, such as changes in the temperature of your skin, sunlight, exercise, stressful situations, heavy wind or cold temperatures, smoking, spicy food and alcohol. You can also try using an electric shaver when you shave, as this might be less likely to trigger the redness that can come with rosacea. You can also avoid irritating your eyes by using non-comedogenic makeup, and gently massaging your face daily with a light rubbing motion starting at the center of your forehead and moving toward your ears.
Prevention
It is impossible to completely prevent rosacea flare-ups, but taking steps to avoid common triggers can help reduce them. For example, some people have reported that certain foods can aggravate their condition, such as tomatoes, cheese and other dairy products, alcohol, citrus fruits, chocolate, soy sauce, yeast extract (though bread is OK), eggplant, spinach, and broad-leafed beans and pods. It is a good idea to keep a food diary to track what irritates your skin and when, in order to identify possible triggers.
Using gentle skin care and makeup may also make a difference. Choose moisturizers and facial cleansers that are labeled hypoallergenic, non-comedogenic, and fragrance-free. Use a non-soap cleanser twice a day and avoid facial scrubs or astringents. If you use a razor, opt for one that does not sting or burn. Try not to scratch or rub the face, as this can lead to more redness and itchiness.
Avoid sun exposure, as it can increase the symptoms of rosacea. Wearing a wide-brimmed hat and broad-spectrum sunscreen may help. In addition, avoiding hot or cold temperatures, intense exercise, and spicy foods can help minimize flare-ups. Excessive stress, if not managed effectively, can also cause a flare-up in some people. It is recommended to talk with your doctor about any emotional or psychological stresses and see if anything can be done to help relieve these.