Rosacea can be alleviated
Dear Doctor K: I have rosacea, and it makes me very self-conscious. What can I do to make it less noticeable?
Dear Reader: Rosacea is a common, long-lasting skin condition that causes inflammation and redness of the face.
(I’ve put a photo of skin affected by rosacea on my website, AskDoctorK.com.)
As with many diseases, we don’t know what causes rosacea.
People with the condition are more likely to have high levels of certain natural inflammatory chemicals in their skin.
There also is evidence that tiny little insects (dust mites) and a particular type of bacteria living on the skin can trigger rosacea.
Rosacea usually progresses through four stages.
In the first stage, a person has flushing and occasional facial redness.
In the second stage, there is persistent redness on the cheeks, nose, chin or forehead.
By the third stage, small, pus-colored or red bumps appear on the face, along with tiny blood vessels that appear as thin, red lines.
In the fourth stage, knobby bumps appear on the nose and the skin on the nose may thicken.
Symptoms commonly come and go in cycles.
The good news is that treatments can improve the appearance of rosacea.
They may even stop, or reverse, its progress.
Depending on your specific symptoms, your doctor may prescribe:
n ANTIBIOTICS
Topical antibiotics, which are applied directly to the skin, are usually prescribed first.
You may also be prescribed antibiotics to take by mouth.
n AZELAIC ACID (Finacea)
This gel containing dicarboxylic acid is applied directly to the face.
It is used to treat the inflammatory pimples of mild to moderate rosacea.
n BETA-BLOCKERS AND ALPHA ANTAGONISTS
These medications may reduce flushing through their effect on blood vessels.
n ESTROGEN
This female hormone is used when rosacea is aggravated by the hot flashes of menopause, since estrogen treatment reduces the number and severity of hot flashes.
n LASER
This treatment is used to get rid of dilated blood vessels or to remove excess nose tissue.
n SURGICAL PROCEDURES
Surgical shave techniques or skin resurfacing procedures can help remove excess nose tissue.
You can also help control symptoms by recognizing and avoiding things that make your condition worse.
Common triggers include hot drinks, alcohol, spicy foods, stress, sunlight and extreme heat or cold.
These triggers increase blood flow and cause the small blood vessels in the face to dilate.
Also, select facial cleansers and moisturizers that do not burn, sting, irritate or cause redness when you apply them.
Wash your face with lukewarm water and a mild soap.
Avoid toners, astringents, scrubs, exfoliating agents and products that contain alcohol or acetone.
Hydroxy acids and tretinoin (for example, Retin-A) are very helpful for other skin conditions, but can worsen rosacea.
Finally, use sunscreens and sun blockers regularly and liberally to protect your face.
While rosacea is not a “serious” condition, the embarrassment it causes some people can affect their lives.
Fortunately, effective treatments are now readily available.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.