Rosacea Treatment

Rosacea is a common skin condition, but rosacea treatment must be tailored to each individual. It may take a while to find a combination of treatments that gives a satisfactory result.

Definition of Rosacea

Former President Bill Clinton purportedly suffers from rosacea

Rosacea begins with increased facial flushing and may develop into permanent facial redness. Symptoms include coarsened skin, visible blood vessels, and bumps or pustules that look like acne. There is no official test for rosacea, but sometimes a skin biopsy is needed to rule out conditions which cause similar symptoms. The condition is more common among fair-skinned people of European and Celtic origin, but anyone can develop it.

One problem with finding the right rosacea treatment is that doctors aren't sure what causes it. It's possible that it's caused by an infection, but the infecting organism hasn't been identified. It's also possible that some people are genetically susceptible.

Identifying Trigger Factors

Many people with rosacea find that spicy foods or strong emotions trigger the facial flushing. Exercise, hot or cold water, alcohol, and certain creams or lotions also may cause exacerbations. Triggers that affect one person may not affect another.

The first step in rosacea treatment is to figure out an individual's triggers and find ways to avoid or minimize them.

Caring for the Skin

Doctors recommend that people with this skin condition use sunscreen daily. It should protect against both UVA and UVB rays. Patients should avoid using products that are potential skin irritants. Things to avoid include astringents and toners, menthol products, and shampoos or soaps containing sodium lauryl sulfate. Women should avoid cosmetics, such as waterproof mascara, that can not be removed easily with gentle soap and water. Makeup and moisturizers should be non-comedogenic, meaning they won't clog pores.

Laser Treatment

Laser treatment can destroy unsightly telangectasias, which are tangles of blood vessels near the skin's surface. It can also help to improve the texture of the skin. Multiple treatments over several months may be required. Unfortunately, insurance usually does not cover these treatments.

Medication

Acne Medicines

Acne medicines can help reduce the acne-like pustules that are often part of the condition. Common choices are benzoyl peroxide, azelaic acid, and a combination of sodium sulfacetamide and sulfur. Rosac is one brand of cream that is commonly prescribed for this. They are applied topically (directly to the skin) as creams or gels. Each has the potential to cause skin irritation itself, so it may take a few tries to find the right medicine and dose.

The acne pill isotretinoin (brand name Accutane) and a topical form, retinoin (sold as Retin-A), may also be helpful, although Retin-A may be too harsh for some skin.

Antibiotics

Antibiotics may be applied to the skin or taken in pill form. Since doctors don't know what, if any, bacteria cause rosacea, it's not clear which antibiotic is best or even why they seem to help. Many doctors think that the anti-inflammatory properties of antibiotics, not their ability to kill bacteria, are the reason for their effectiveness in rosacea treatment.

Antibiotics are often prescribed to be taken by mouth at first, because pills seem to work faster than creams. However, creams and gels can then be used for long-term care.

Studies have shown that metronidazole, taken by mouth, helps decrease pustules. Metronidazole cream is helpful in mild cases or may be prescribed along with another medicine. Metrogel 1% is a clear gel that contains metronidazole and is helpful to some people with rosacea. There are many other potentially useful antibiotics, and a doctor can help guide you to the one most likely to help.

Anti-Inflammatories

Medicines that decrease the strength of immune reactions are sometimes used to reduce the redness and swelling. They are generally used when other treatments have failed. Tacrolimus (brand name Protopic), available as a topical ointment, is one choice. Steroids, which also decrease inflammation, should be avoided if possible because long-term steroid use can cause a rosacea-like condition. However, occasionally a short course of steroids can be helpful.

When the Eyes Are Affected

Rosacea most commonly affects the skin of the face, and sometimes the eyes are involved. Antibiotics are the mainstay of treatment for eye involvement, along with careful hygiene. Cleaning eyelids several times a day with gentle cleanser may help. To avoid making the condition worse, it's important to discuss eye care with your doctor.

Length of Rosacea Treatment

Every person's experience with rosacea is different. Many people have intermittent flare-ups and some find that the condition continues to worsen over many years. Once medication is started, improvement may take a month or two. People who continue treatment, at a maintenance level, seem to have fewer flare-ups than people who stop treatment.

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