April is Rosacea Awareness Month. We will feature a series of blogs and tips on rosacea and management of rosacea and sensitive skin. Early treatment is essential to prevent long term worsening of rosacea.
Rosacea (pronounced “roh-ZAY-sha”) is a chronic disorder of facial skin that can consist of redness, flushing, bumps and pimples, sensitive skin, increased oil and other symptoms. Rosacea is very common affecting an estimated 16 million Americans. It is a disorder more common in women and in fair skin types.
Common symptoms of rosacea:
- Flushing, redness, broken blood vessels (telangiectasias)
- Red bumps, pimples, pustules typically on central face area
- Swelling or thickened skin
- Dry sensitive skin
- Oily skin and increased size of oil glands, enlargement of nose oil glands (rhinophyma)
- Burning, stinging
- Irritated, gritty feeling eyes and swollen eyelids
4 main subtypes of rosacea are recognized:
Subtype 1, erythematotelangiectatic rosacea, is just flushing and persistent redness, and may also include visible blood vessels -but no pimples. The red face fits this category.
Subtype 2, papulopustular rosacea, like the first subtype, has redness but also red bumps and pimples.
Subtype 3, phymatous rosacea, has skin thickening, often to the point of enlargement of the nose from excess oil gland tissue. This is called rhinophyma.
Subtype 4, ocular or eye rosacea, has eye symptoms including dry eye or gritty/sandy feeling in eye, tearing and burning, swollen eyelids, and recurrent styes or cysts.
Many patients experience characteristics of more than one subtype at the same time, and those may develop in succession. While rosacea may or may not evolve from one subtype to another, each individual sign or symptom within each subtype may progress from mild to moderate to severe. These subtypes help determine treatment. It has been my observation that there are many individuals that have redness and broken capillaries that are common from sun damage and likely not true rosacea.
Treatment of Rosacea:
The treatment of rosacea depends on the subtype and severity of lesions. All rosacea patients should stick to a consistent routine of cleansing, moisturizing and daily sun block. Redness and broken capillaries are best managed with laser treatment. Often topical prescription medications are all that is needed for mild to moderate cases. More severe cases or cases with eye involvement require treatment with an oral antibiotic or oral antifungal medication.
Treatment of rosacea includes one or more of the following:
- Gentle and consistent skin care routine
- Diligent sun protection
- Avoidance of triggers
- Topical medications that contain sulfur, metronidazole, azeleic acid, retinol, or anti-inflammatory ingredients
- Oral antibiotics
- Oral steroids for severe flares
- Laser treatment for redness, flushing and broken blood vessels
Next topic will be skin care for the different types of rosacea.