Rosacea is an inflammatory condition characterized by red patches, pink bumps, pustules, and broken blood vessels on the cheeks and nose. It occurs in both men and women as a result of environmental triggers.
While the exact cause is unknown, rosacea likely occurs due to environmental triggers and genetic predisposition. Environmental triggers for rosacea include sun exposure, alcohol and spicy food intake, and stressors. There is also an increased number of Demodex mites found on the skin compared to those without rosacea.
Rosacea is characterized by the presence of red patches, pink bumps, pustules, and broken blood vessels on the cheeks and nose. Patients often complain of persistent redness, increased flushing, and dryness of the skin. Over time, rhinophyma or the presence of increased scarring and sebaceous gland size can develop on the nose, especially in men. Patients can also have involvement of the eyes, with increased redness of the conjunctiva, itching, tearing, and dryness.
The increased redness of the face is a result of increased blood flow, development of blood vessels, and inflammation. There is also skin barrier dysfunction, as there is increased dryness as a result of water loss in the skin barrier. The presence of increased Demodex mites can also contribute to inflammation.
Risk factors associated with rosacea include genetics, sun exposure, and consumption of alcohol and spicy foods.
Rosacea is a clinical diagnosis, based on the appearance of red patches, pink bumps, pustules, and broken blood vessels usually on the cheeks and nose.
Treatment for rosacea focuses on decreasing inflammation and restoring the skin barrier. It is also dependent on how the condition presents on each patient. Patients who have red patches or flushing would benefit from metronidazole cream or gel and azelaic acid 15% gel, as these medications have anti-inflammatory properties. Patients who have red patches, pink bumps, and pustules would benefit from a combination of oral antibiotics, such as doxycycline or minocycline, and topical medications including metronidazole gel, ivermectin cream, and sodium sulfacetamide cleanser or cream. Over the counter products such as Derma-e Pure Biome Balancing Cleanser and Moisturizer and Skinbetter ScienceⓇ Mystro can also help reduce inflammation and restore the skin barrier.
Patients with broken blood vessels and chronic red patches can also be treated with multiple sessions of Excel VⓇ laser. The Excel VⓇ laser targets blood vessels, resulting in decreased background redness and appearance of telangiectasias. Treatment with Excel VⓇ laser is not covered by insurance.
Patients are encouraged to use sun protection, including a broad spectrum sunscreen of sun protection factor equal or greater than 30 containing zinc oxide and/or titanium dioxide. Sunscreen should be reapplied every one to two hours while in the sun. Patients are recommended to avoid alcohol and spicy food intake and address stressors. Finally, they are encouraged to stop using harsh products, such as benzoyl peroxide, salicylic acid, and topical retinoids, as they can further disrupt the skin barrier.
Untreated rosacea can lead to increased chronic inflammation and consequent development of granulomatous rosacea and rhinophyma of the nose. Both conditions can be more resistant to treatment.
Rosacea can often overlap with periorificial dermatitis, acne vulgaris, and seborrheic dermatitis.
Individuals are recommended to see a board-certified dermatologist for evaluation and management. They are also encouraged to avoid risk factors such as direct sun exposure and alcohol and spicy food intake.
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