Rosacea: Causes, Symptoms, Treatments
Many women incorporate blush into their daily makeup routine to accentuate their cheekbones with a rosy-red look. But for the millions of people living with the skin condition rosacea, unintentional blushing and flushing can be an uncomfortable and embarrassing problem.
Adam Friedman, MD, FAAD, is an Assistant Professor of Dermatology and Director of Dermatologic Research at the Einstein College of Medicine in Bronx, NY. He is also a board-certified dermatologist at the Montefiore Medical Center in the Bronx. Read on as he provides insight on rosacea, including the most common triggers and tips on how to manage and treat the condition.
What Does Rosacea Look Like?
Rosacea presents itself as persistent facial redness that surrounds the central part of the face. The redness can last for at least three months and in some people, it can be accompanied by facial flushing, widened facial blood vessels, and even severe acne-like lesions.
What Causes Rosacea?
The exact cause of rosacea is not known. However, medical experts have identified factors that can play a role in its occurrence:
- Increased blood flow to the blood vessels of the face
- Abnormalities in hair and oil glands
- Excessive breakdown of connective tissues (the structural component of the skin)
- Sensitivity to microbial organisms on the skin
- Free radicals
- Dysfunction or over-activity of antimicrobial peptides
What Triggers Rosacea Symptoms?
The following can cause rosacea symptoms to flare up:
- Wind and hot or cold temperatures
- Hot beverages
- Spicy food
- Alcohol (note: rosacea is not caused by alcohol abuse as previously thought, but drinking alcohol can exacerbate symptoms.)
- Emotional stress
- Topical and nasal steroids
- High doses of vitamin B6 and B12
- Cosmetic products containing astringents, toners, menthols, camphor, or sodium lauryl sulfate
What Are Some Steps I Can Take to Minimize Symptoms?
You can use over-the-counter products such as Eucerin® Redness Relief and Clinique® Redness Solutions. These are designed to soothe the redness and also counterbalance the color with a green tint.
Additionally, use a broad-spectrum sunscreen with SPF 30 or 50, daily. A note of caution: the chemical blockers, oxybenzone and avobenzone, can irritate skin. Use a sunscreen with physical blockers, titanium dioxide and zinc oxide, and protective silicones such as dimenthicone or cyclomethicone since these ingredients are more tolerable for people with rosacea.
What Are the Treatment Options?
Antibiotics: They're prescribed to patients because of their anti-inflammatory properties. Rosacea can break down connective tissues and increase the production of antimicrobial peptides. Generally, oral and topical antibiotics are used in combination. The oral treatment is eventually withdrawn after several months, and it usually takes this long to see a response (so try not to get stressed if you don't see a major change in a week or two), and the topical treatment is used alone as maintenance therapy. Women who are pregnant should not use certain antibiotic creams or pills.
Creams, foams, and soaps: These and topical acne medications such as benzoyl peroxide have been commonly used to treat rosacea. Benzoyl peroxide has antibacterial and anti-inflammatory properties and the sulfur contained in this treatment breaks down the thickened skin that can block pores. However, sulfur-based products have been known to cause irritation and more skin redness in some people.
Retinoids: This form of medication has been effective thanks to the vitamin A it contains. However, doctors caution against using retinoids too often as they can cause skin irritation.
Laser treatment and surgery: Vascular lasers such as pulsed dye lasers, KTP lasers, and the diode-pumped frequency-doubled lasers are the main types of laser therapies used to treating rosacea. They're considered very effective because the wavelengths selectively absorb proteins in the blood, and specifically target rosacea-causing blood vessels to prevent damage to surrounding tissue.
Nonabrasive lasers have also been shown to be effective. They help repair the damage incurred to the skin's connective tissue and improve the overall texture and appearance of the skin. However, this therapy can be costly as it is not covered by health insurance and requires several sessions for significant results.
Intense pulsed-light therapy: This therapy is not actually a laser-rather, it uses many wavelengths of light for specific clinical purposes. It can target dark spots caused by deposited melanin and pronounced blood vessels. It also helps promote facial rejuvenation-as it can hit both vascular and colored (pigmented) lesions.
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