Let's Talk About Rosacea - And How To Treat It!
Rosy cheeks have long been synonymous with youth and a healthy disposition. There are plenty of studies showing that increased oxygenated blood in facial skin increases the overall attractiveness level in humans and primates. But what if that redness is persistent, diffused, can be triggered by everyday things and comes with sensitivity and discomfort? Rosacea might be the cause.
According to the National Rosacea Society, it’s estimated that this chronic, but treatable, vascular skin disorder affects around 16 million Americans and as many as 415 million people worldwide. With this many individuals dealing with it, the cause of rosacea is still unclear even though there are several theories ranging from an overactive immune system to an over proliferation of demodex mites. More women than men are diagnosed with rosacea but men are more likely to have severe cases of it.
Anyone can get rosacea and it probably goes underdiagnosed in darker skin complexions as the symptoms aren’t as overtly obvious as compared to fairer skin types. Symptoms include rash- like redness mainly in the cheeks, nose, and chin area (it can also affect the eyes), visible capillaries, pimples and whiteheads, and thickening of the skin. These symptoms have a tendency to come and go while being triggered by things such as alcohol, UV exposure, extremes in temperature, stress, spicy foods, hot baths, and hard workouts. Rosacea presents so differently in people that knowing your triggers is an important measure in reducing flares since there is no cure. It’s all about maintenance.
Once you have a rosacea diagnosis from a doctor, topical medications like Rhofade, Metrogel, Azelex, and Finacea are often prescribed to help reduce redness and breakouts. Oral prescriptions might also be tried in more severe cases. Other tools like in-office aesthetic treatments and skin care can help temper redness and reduce the visibility of vessels.
Intense pulsed light (IPL) is a treatment that uses a broad spectrum of light wavelengths to target hemoglobin in the skin. The hemoglobin absorbs the energy, heats up, and destroys the vessels and capillaries that make the skin red. Over a period of several weeks the body cleans out the collapsed vessels resulting in a less red, more even complexion. A couple upfront sessions are required along with yearly maintenance to sustain the clarity.
Another in-office treatment that may help is a pulse dye laser such as VBeam. Unlike IPL that has multiple wavelengths present, a pulse dye laser only has one that is specifically absorbed by oxyhemoglobin. It’s very good at not only reducing rosacea redness but also lessening the visibility of port wine stains, angiomas, and venous lakes. After having either one of these treatments there is a high likelihood that there will be swelling and bruising in the treated areas that will resolve by itself over time.
In extreme cases where there is thickening of tissue specifically on the nose, a CO2 laser can be used to remove that skin, molding it back into a “normal” size and shape. A doctor might also combine the laser with a loop cautery handpiece when there is a lot of tissue to remove. Skin care is an important thing to mention as it can help or hinder calming the inflammation. Choose products that are fragrance-free as fragrance causes more incidences of allergic dermatitis than any other ingredient. Alcohol, witch hazel, peppermint oil, eucalyptus oil, and menthol should also be avoided. Aggressive exfoliators are a no go for rosacea sufferers too. Avene is a wonderful line for sensitive, reactive, irritated skin. Their formulations help calm and soothe angry skin while restoring the skin’s natural barrier function. Vanicream and Cerave also have some good products with a short list of ingredients to help maintain good skin health in the face of potential flares. Sun protection with a mineral component should be worn every day since UV exposure can be a trigger. Try EltaMD UV Clear that has 9.0% zinc oxide and is formulated for sensitive skin.
Uncontrolled rosacea can take an emotional toll on patients, socially isolating them when they have a flare due to the embarrassment of being so red and inflamed. While rosacea has no cure, advancements in treatments are being made. Being mindful of your personal triggers is at the frontline of rosacea maintenance to reduce flares and discomfort. Consult a dermatologist if you believe you might have rosacea as they will help guide you to receive appropriate care.
Bibliography
All about rosacea: Signs & symptoms and treatment (no date) Rosacea.org. Available at: https://www.rosacea.org/patients/all-about-rosacea (Accessed: December 9, 2022). Lasers and lights: How well do they treat rosacea? (no date) American Academy of Dermatology. Available at: https://www.aad.org/public/diseases/rosacea/treatment/lasers-lights (Accessed: December 9, 2022). Re, D.E. et al. (2011) “Oxygenated-blood colour change thresholds for perceived facial redness, health, and attractiveness,” PLoS ONE, 6(3). Available at: https://doi.org/10.1371/journal.pone.0017859. Rosacea (2021) Mayo Clinic. Mayo Foundation for Medical Education and Research. Available at: https://www.mayoclinic.org/diseases-conditions/rosacea/diagnosis-treatment/drc-2035382 0 (Accessed: December 9, 2022). Rosacea (2021) National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services. Available at: https://www.niams.nih.gov/health-topics/rosacea/more-info (Accessed: December 9, 2022). van Zuuren, E.J., Powell, F.C. and Graber, M. (2000) “Interventions for acne rosacea,” The Cochrane Database of Systematic Reviews [Preprint]. Available at: https://doi.org/10.1002/14651858.cd003262