How to Deal with Rosacea

As a dermatologist I see plenty of patients who suffer from persistent redness and flushing. But one woman in particular—who was featured in my Skin Type Solutions PBS special—truly inspired me to educate the world at large about rosacea.

 

What is rosacea?

This ailment, characterized by facial flushing and prominent blood vessels, affects up to 14 million Americans and is most common in the fair skinned. It’s often accompanied by pimples, broken blood vessels, enlarged oil glands and redness and thickening of the skin on the nose.

What causes rosacea?

To be honest, we don’t really know what causes rosacea, and as with many conditions, there is probably a strong genetic component. Those descended from Scandinavian or other Northern European stock are much more susceptible, though it can affect people of all ethnicities.

What can I do about rosacea?

I cannot stress enough the importance of seeing a dermatologist if you experience any of the symptoms of rosacea. If caught early, treatment can keep rosacea from developing to its later stages, which should be avoided at all costs.

Are there products that rosacea sufferers should avoid?

Yes! A lot of products that are supposedly soothing actually contain ingredients that can exacerbate rosacea. I always warn my patients not to use "anti-redness" creams that contain hydrocortisone or other steroids—these temporarily shrink dilated blood vessels, but the vessels eventually rebound and may even become larger, creating a vicious cycle of redness.

Many people don’t realize they have rosacea and think they have acne. They use over-the-counter products with benzoyl peroxide or other ingredients that can be extremely drying and make rosacea worse. So, once again, that’s another reason to see a dermatologist.

You should also avoid spa treatments like facials, some forms of chemical peels, microdermabrasion, hot wax, saunas and steam rooms, as they can irritate your sensitive skin. If you do opt for such treatments, make sure your aesthetician is aware of your rosacea and uses suitable anti-inflammatory ingredients.

What are the treatments for rosacea?

Proper skin care is crucial for those with rosacea. You have to avoid hydroxy acids such as glycolic acid, as well as other acidic product like serums or creams that contain vitamin C. Rosacea sufferers should also avoid facial scrubs and microdermabrasion creams. Instead, opt for a cleanser that includes anti-inflammatory ingredients such as chamomile, feverfew, licorice extract, mushroom extract, caffeine and green tea.

Some inexpensive drugstore brands that I recommend include the Eucerin Redness Relief cleansers and moisturizers, which contain licorice extract, and the Aveeno Ultra Calming products, which contain feverfew. A good one with caffeine is La Roche Posay Rosaliac. I also like Replenix CF, an antioxidant topical product with both green tea and caffeine. The caffeine helps control inflammation by constricting the blood vessels, making them shrink down and reducing redness.

Your doctor can also prescribe a topical antibiotic that contains the ingredient metronidazole (such as Metro Gel) or a cleanser with sulfacetamide, which is an anti-inflammatory. Elidel cream is the commercial name for pimecrolimus, a prescription cream that calms the immune system down and helps control inflammation. Another great anti-inflammatory found in prescription medications is sulfur, though it doesn’t smell very nice.

Azelaic acid, as found in the prescription product Finacea, has been shown to improve rosacea as well. One study performed at the University of Miami showed that Finacea helped keep rosacea at bay after oral antibiotics were stopped. Azelaic acid is a natural grain extract that’s both an antibiotic and an antioxidant, but it can cause stinging in some sensitive types.

In moderate to severe cases of rosacea, oral antibiotics are used. These can be prescribed for months or even years. Tetracyclines are the most commonly used antibiotics, but these may not be right for everybody, as they can lead to sun sensitivity and yeast infections. It’s also possible they could make the birth control pill ineffective.

Several years ago, a low dose form of doxycycline called Oracea was developed. This drug is not a true antibiotic. Instead, it works through its anti-inflammatory properties. Oracea can be used for months or years to prevent and treat rosacea without the complications associated with long-term antibiotic use. As a bonus, it may have an anti-aging effect due to its inhibition of matrix metalloproteinases (MMPs), which are the enzymes that break down collagen.

Intense Pulsed Light (IPL) treatments have revolutionized the treatment of rosacea. Whether your rosacea is early or late stage, IPL will help—it shrinks blood vessels to improve facial redness and broken blood vessels with no down time. I love these treatments and get them myself every month.

The IPL that is performed by a physician is different than that found in a salon or spa. “IPL” is the nonspecific name of a treatment—just like "a peel” can mean many things, “IPL” can mean many different types of treatments. Reputable laser and light companies only sell the stronger light systems to physicians, who are more able to avoid complications. Only physicians have the most effective technology. I prefer the IPL system called Lumenis One or Quantum by the company Lumenis. Ask your doctor what IPL system they use.

What lifestyle changes can improve rosacea?

It’s helpful to avoid spicy foods and hot drinks, but there are some foods that can actually help your rosacea. I mentioned the benefits of topical caffeine treatments, and you can get those benefits through diet, as well. Just give your coffee or tea a chance to cool down a bit, or better yet, drink it iced.

It’s also important to get enough omega-3 fatty acids in your diet. Studies show they can help fight redness and irritation; there’s also some evidence that omega-3s can boost your skin’s defenses against sun damage. Ground flaxseed and fatty fishes like salmon are both great sources—you can also take a supplement.

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