National rosacea awareness month

Rosacea affects 14 million people in the US, men more severely than women, including famous figures such as Bill Clinton and W. C. Fields. However, to this day, 78% of Americans have no accurate knowledge of this condition and wouldn’t know how to recognize it.

April is National Rosacea Awareness Month, which is the perfect excuse and opportunity to review this skin condition, and share some tips about how to best manage the symptoms of rosacea (unfortunately, there is no cure for rosacea).

Causes of rosacea: The pathogenesis of rosacea is multi-factorial (translated in English: we don’t really fully understand what causes rosacea). Indeed, rosacea is precipitated by multiple causes including:

• Genetic factors
• Vascular factors
• Immune-mediated factors
• Emotional factors
• Environmental factors
• Infectious factors

There are various triggers that will aggravate this condition, including:

• Environmental stimuli:
  • Exposure to temperature extremes
  • Moving to a warm or hot environment from a cold one
  • Heat from sunlight and severe sunburn
  • Cold wind
• Emotional stimuli:
  • Stress
  • Anxiety
• Physiological stimuli:
  • Some foods and drinks, including alcohol, caffeine, spicy foods
  • Strenuous exercise
• Exogenous stimuli:
  • Microdermabrasion
  • Chemical peels
  • Products containing alcohol, witch hazel, menthol, peppermint, eucalyptus, clove oils, and other irritants

Diagnosis of rosacea: When diagnosing rosacea, it is important to look for the following:

• Presence of one or more of the following primary features:
  • Flushing (transient erythema)
  • Long-lasting erythema
  • Papules and pustules  (red or yellow little bumps)
  • Telangiectasia (visible broken red blood vessels)
• May include one or more of the following secondary features:
  • Burning or stinging
  • Plaque
  • Excessive dryness
  • Edema
  • Ocular manifestations (burning, redness)
  • Peripheral locations (rosacea on areas other than face)
  • Phymatous changes (e.g. rhinophyma) enlarged nose extremity

Rosace is typically classified in three stages:

Stage 1: Mild rosacea

• Predominantly vascular symptoms
• Characterized by recurring flushing on the face, neck and upper chest
• May include facial edema and erythema
• Telangiectasia may appear

Stage 2: Inflammatory rosacea

• This stage is marked by the appearance of follicular-based papules and pustules
• In addition to the symptoms of Stage 1 rosacea, there are also increasingly prominent facial pores

Stage 3: Severe rosacea

• Characterized by a proliferation of sebaceous, connective, and vascular tissue
• Typically results in the bulbous hypertrophy of the nose known as rhinophyma
• This stage is most commonly found in men

Treatment options The first treatment option is truly behavioral, focusing on avoiding all of the triggers identified above. A typical treatment course for severe rosacea will however also include medications, such as:

• Oral antibiotics (tetracycline, doxycycline, minocycline)
• Topical antibiotics such as metronidazole (Metrogel)
• Topical azelaic acid such as Finacea (15%) or Skinoren (20%) may help reduce inflammatory lesions, bumps and papules
• If papules and pustules persist, isotretinoin can be prescribed

Finally, for the treatment of the erythema and redness specifically, the pulsed dye laser remains the gold standard.

From a product standpoint, it is essential to use products formulated for sensitive skin and to avoid harsh ingredients such as acids or vitamin C (and certainly no peels!). Furthermore, vaso-constrictors (ingredients that tighten our red blood cells and protect their capillary walls) are ideal for rosacea-prone skin (think blueberries for example). Finally, from a cosmetic standpoint, makeup bases that have some green in them will help to alleviate the look of redness.

For a webinar on how to treat rosacea-prone skin, please click here.

Sources: National Rosacea Society, The Treatment of Rosacea with Glycolic Acid, Cleveland Clinic Foundation, JAAD, April 2002, Vol 46, Number 4, JAAD, June 2004, Vol 50, Number 6