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Derm Deep Dive: Rosacea Treatment

May 2022


All About Rosacea and What You Should Know With Dr. Sara Lohser, MD

We’re back with another Derm Deep Dive, a new series where we provide expert advice from one of our board-certified dermatologists about common skin conditions or treatments. This month, we’re speaking with Dr. Sara Lohser, MD, about rosacea, a chronic inflammatory skin condition that affects about 16 million Americans and can come and go throughout an individual’s life. While it’s not entirely known what causes this condition, Dr. Lohser provides more detail and options for rosacea treatment. 

What is Rosacea and What Causes It?

There are several factors that are believed to predispose an individual to rosacea or influence the appearance of rosacea. These include:

  • Immune system abnormalities
  • Changes in the skin’s blood vessels
  • Reactions to microorganisms found in the skin
  • Exposure to UV light
  • Disruptions to the barrier of the top layer of the skin
  • Possible underlying genetic conditions

If you are predisposed to rosacea, there are other rosacea triggers, such as physical or environmental conditions, that can cause your rosacea to flare up. These include:

  • Emotional stress
  • Spicy foods
  • Alcohol
  • Hot beverages
  • Extreme hot or cold temperatures
  • Chocolate

If any of these sound familiar to you, don’t worry – I’m going to help you understand how to bring this common skin condition under control even when you can’t avoid triggers all the time. 

But first, let’s understand the four different types of rosacea, what they look like, the symptoms they cause, and help you understand more about your rosacea. 

The Different Types of Rosacea

There are four types of rosacea. Sometimes, individuals can exhibit symptoms of more than one type of rosacea at once.

Erythematotelangiectatic – This is the most common type of rosacea. It gets its (very) long name from the way it causes facial erythema, otherwise known as facial flushing. It can sometimes be accompanied by facial edema, burning, or stinging. The appearance of small, dilated blood vessels is common. Erythematotelangiectatic Rosacea typically affects the central areas of the face and around the nose, but is not commonly found on the forehead or chin. It can sometimes extend to the neck or chest.

Papulopustular – As you may have gathered from the name, this type of rosacea is characterized by acne-like breakouts of pustules or papules that may flare up and then go away intermittently over time. The inflammation most commonly affects the central areas of the face and around the nose and may extend to the neck or chest. It is not as commonly located on the forehead or chin. Unlike acne, the pustules or papules are not accompanied by blackheads. This type of rosacea can sometimes cause burning or stinging. Patients with Papulopustular Rosacea often also exhibit features of Erythematotelangiectatic Rosacea.

Phymatous – This type of rosacea is characterized by a thickening of the skin or irregular surface areas. Most common on the nose, and less often around the chin, forehead, eyes, or ears. Phymatous Rosacea is often, but not always, the result of long-term or untreated rosacea, but it can also develop more rapidly than other rosacea types. It is more frequently found in men.

Ocular – Again, as evidenced by the name, Ocular Rosacea affects the eyes, bringing on inflammation that can cause redness, burning, and itching. More than 50 percent of patients who have rosacea on their face also experience Ocular Rosacea. Irritated eyes can also come on as the first symptom, indicating you may later develop the facial type.

How Can Someone Avoid Rosacea Flareups or Prevent Worsening Symptoms?

There are a few ways you can avoid rosacea flareups or help prevent more severe symptoms if you are experiencing a flareup. 

First, I recommend my patients keep a journal to document when flareups occur. Doing so helps you to identify trends in your activity or environment that could be bringing on your rosacea. 

Once you have identified potential triggers, of course it’s best to avoid them. I know this can be difficult as many triggers are some of my patients’ favorite things – such as chocolate or spicy foods. I simply recommend that if something is a trigger, you exercise moderation or find ways to replace that trigger with something else.

What About Environmental Triggers I Can’t Control?

While we can’t control the weather (hot or cold temperatures, wind, or bright sun), we can certainly prepare and take precautions to protect our skin. I recommend good skin protection to all my patients, but for those with rosacea, here are a few helpful tips:

  • Seek out shade as much as possible on bright sunny days
  • Wear protective clothing and accessories, such as hats, visors, scarves, and sunglasses
  • Use a broad-spectrum, water-resistant sunscreen (SPF 30 or higher). Mineral blockers zinc and titanium are often best tolerated by patients with rosacea. Sunscreen should be applied thoroughly and reapplied every two hours. 
  • Cover your face, ears, and neck when exposed to cold temperatures and wind
  • Use fragrance-free and dye-free personal products
  • Try to avoid emotional stress, or use stress-relieving techniques like breathing exercises or meditation

Who is at Risk of Suffering From Rosacea?

Rosacea can occur at any age, but it is most common between the ages of 30 and 60. Individuals with lighter skin types are most commonly affected; especially those with fair skin, blond hair, and blue eyes.

Rosacea tends to affect individuals of Northern European or Celtic descent. While it was previously thought to have higher incidence rates among women, more recent data doesn’t show this theory to be true. However, it has been shown to present in women going through menopause. 

What Do Rosacea Treatments Look Like?

There are several treatment options for rosacea to help relieve the symptoms and keep flareups at bay.

I approach my patients’ rosacea treatment in a step-by-step process: 

  1. Application of conservative therapies, such as avoiding triggers.
  2. Topical prescriptions, which carry the most benefit for Papulopustular Rosacea and are generally less effective for Erythematotelangiectatic Rosacea. 
  3. Topical medications can help decrease redness. There are two primary topical treatments and I help my rosacea patients understand which one is best for them.
  4. Systemic therapies, including a course of antibiotics to help bring your rosacea under control before tapering off. 
  5. Systemic medications can help decrease flushing. There are a couple of different options for medications, including beta-blockers, which slow down the heart rate and would be prescribed only if applicable for your individual type and severity of rosacea.

Often, a treatment regimen will be applied in conjunction with laser treatment, which targets the vascular component of Erythematotelangiectatic Rosacea, or a skin resurfacing treatment, which can help patients with Phymatous Rosacea.

When Should a Patient Consider Seeing a Dermatologist?

While there are over-the-counter products available for treating rosacea, these options can actually worsen rosacea symptoms because this skin condition is so variable depending on the trigger, type, and severity. 

That being said, sulfur soaps are often helpful for decreasing inflammation caused by rosacea, and patients can use makeup or cover-up products with green and yellow coloring, which can help camouflage the persistent redness associated with rosacea. 

I recommend visiting your dermatologist at the first onset of symptoms to develop a treatment plan, especially if over-the-counter treatments are not working. 

How Soon Should a Patient Expect to See Changes or Improvements?

Most treatments won’t work immediately; however, patients can expect to see improvements within the first few weeks of treatment. Ideal results and improvement can take between eight and 12 weeks. 

When Do You Bring Patients Back in for a Follow-Up Appointment?

I typically bring my rosacea patients back for a follow-up appointment between six and eight weeks after beginning treatment so I can monitor improvement and adjust the treatment regimen if necessary. 

Once the appropriate treatment has been achieved, I typically only need to see patients once every six months or once annually, depending on the severity of their rosacea.

It’s important to know that working with a board-certified dermatologist like myself is the best way to understand what might be causing your rosacea and how to minimize flareups. 

I understand that rosacea, like many other skin conditions – especially those with no determinate cause – can be difficult to manage and interfere with everyday life. I want to help you be confident and in control!

Think You Have Rosacea? Take Dr. Lohser’s Advice.

We hope this Derm Deep Dive provided some helpful advice about rosacea and what to do if you think you have it. 

If you have tried over-the-counter treatments and they haven’t worked, you should contact your dermatologist and discuss treatment options. 

At Optima Dermatology, our expert, board-certified dermatologists know the best approach to treating and managing your rosacea.
Request an appointment with Dr. Lohser to discuss the best treatment plan for your rosacea.