Causes of Rosacea

Rosacea is an often under-diagnosed and misunderstood condition of the skin. The first sign is often a persistent redness of the face, particularly on the cheeks and nose. At first it may come and go as a 'flush' or 'blush'. The redness gradually becomes permanent and more pronounced, with enlarged blood vessels. Skin may be dry and sensitive. Red bumps and pus bumps may appear and be mistaken for acne. In more severe cases that are untreated, especially in men, knobby bumps may develop on the nose and it may appear swollen. In some patients the eyes and eyelids may be irritated and red. Without treatment, it often progresses. Early treatment helps prevent worsening of rosacea and formation of permanent facial veins and skin texture changes.

The cause of Rosacea is unknown but it affects people with fair skin and a history of blushing more easily and more frequently than the average person. It is more common in women but men are more likely to develop thickening of the tissue on the nose. There is presently no cure, but treatment can decrease or eliminate symptoms and slow or stop progression of the disease.

Everyday Exposures Often Makes Rosacea Worse

  • Foods—cheese, spicy foods, thermally hot foods, chocolate, soy sauce, vanilla
  • Heat—hot baths or showers, sauna, radiant heaters
  • Beverages—alcohol, especially red wine, hot drinks
  • Environmental Factors—sun, hot environments, cold, wind
  • Emotional influences—stress, embarrassment, rage, anxiety
  • Medications—certain blood pressure or heart medications, steroid creams or lotions
  • Physical exertion—exercise, frequent flushing, straining, chronic cough
  • Skin care products—skin care products with alcohol, acetone or Sorbic acid, any product that causes redness or stinging. Dr. Elaine recommends our Extra Gentle Cleanser or Facial Cleansing Lotion, and Facial Moisturizing Cream or Oil Free Moisturizer.

How Rosacea is Treated

Avoidance of triggers—often improves rosacea and slows the progression, but may be hard to do.

Sun Protection—broad spectrum sunscreen with a SPF of 30 or more that blocks both UVA and UVB should be used every day year-round. Dr. Elaine recommends our DCL Super Sheer Sunscreen SPF 50.

Surface Treatment—with the antibiotic metronidazole, azelaic acid, clindamycin, erythromycin or sulfacetamide/sulfur is used.

Oral Treatment— some patients may also need oral antibiotics such as minocycline (Minocin) or doxycycline (Adoxa, Doryx, Monodox, Oracea), either intermittently for flare ups, or on a continuous basis. Oral antibiotics help with red bumps, pus bumps but not with overall redness or dilated blood vessels. Most patients have no problems with these medications, but occasional side effects include: headache, vertigo (dizziness), sun sensitivity, stomach upset, allergic reaction (hives, hepatitis), and blue/grey pigmentation of skin or teeth. Possible side effects in females also include interference with effectiveness of birth control pills, yeast infections, and if taken during pregnancy, discoloration of the infant's bones and teeth.

IPL —dilated blood vessels and persistent redness are treated with intense pulsed light (IPL) or other laser treatment. IPL also treats brown spots from sun damage. It may not be used if you are/have: pregnant, using medication which prohibits exposure to sun, porphyria, iron storage disorders, seizures, or photosensitivity diseases such as Lupus.

Number of Treatments— varies from 3-5 treatments scheduled at 4 week intervals for best results.

Time to See Results— improvement usually starts in 5 days.

Duration of Results— much of the results are permanent if medications and sun protection are continued and triggers are avoided. New areas may develop if rosacea progresses. You may need intermittent maintenance treatments to maintain optimum results.

Recovery Time/Side Effects—surface anesthetic is used to reduce discomfort, which feels similar to brief mild "grease pop". Redness, mild swelling or bruising may occur, and rarely crusting or blisters lasting several days. This is most common in patients with larger veins. Brown spots darken and peel off in 5 days. Most patients resume normal activities immediately. Treated area can turn darker or lighter than surrounding skin, may take several months to fade or rarely be permanent. There is a possibility of temporary or permanent, partial or complete hair loss if beard or mustache area is treated. There is a very small chance of scarring. Patients with tanned skin and patients whose ethnic ancestry includes darkly pigmented skin have an increased risk of complications.