WHEN SHOULD I WORRY ABOUT...

What Is Rosacea & How Is It Treated?

April 12, 2022 - Katie McCallum

Are flushed cheeks and acne-like bumps that flare up from time to time a sign of rosacea?

If you've already decided yours might be, you're likely also wondering whether you should see a dermatologist about it.

"Rosacea is a chronic skin condition that can worsen over time, so it's important to be evaluated by a dermatologist if you think you may have it," says Dr. Ming Jih, a dermatologist at Houston Methodist. "There are many skin care tips and medications that can help reduce the chance of rosacea flare-ups and prevent it from worsening."

What is rosacea?

"Rosacea is a chronic inflammatory skin condition that most commonly affects the center of the face — from the forehead to the nose and the middle of the cheeks — and sometimes the eyes," explains Dr. Jih. "Rarely, it occurs in other areas like the upper chest and upper back."

What does rosacea look like exactly? Here are the distinguishing features:

  • Skin redness and flushing
  • Swollen bumps, which are often confused for acne
  • Thickening of the skin
  • Broken blood vessels
  • Burning sensation in the skin

A person may not have all of these symptoms, however.

There are four major types of rosacea, each characterized by one or more symptoms. Individuals may have one or a combination:

  • Erythematotelangiectatic rosacea – skin redness
  • Papulopustular rosacea – pus-filled bumps (pustules) and red, swollen blemishes
  • Phymatous rosacea – thickening of the skin
  • Ocular rosacea – dry eyes, eye redness, increased blood vessels around the eyes

"The most common type is erythematotelangiectatic rosacea, but people usually have a combination of that and papulopustular rosacea — ultimately resulting in skin redness that's accompanied by acne-like bumps and pimples," says Dr. Jih.

What causes rosacea?

No one knows exactly what causes rosacea, but Dr. Jih says it occurs when the skin becomes overly sensitive to certain aspects of everyday life.

"Rosacea is essentially thought to be the result of an overactive immune response, occurring when blood vessels and nerves near the surface of the skin respond with abnormal and excessive inflammation to common things found on the skin and in the environment," says Dr. Jih.

For instance, we all normally have healthy bacteria and Demodex mites on our skin, but people who have rosacea are highly reactive to these natural skin inhabitants.

Rosacea triggers can also be physical and chemical, including:

  • Hot weather
  • Sun exposure
  • Cleansers, lotions, sunscreens and cosmetics
  • Physical irritation from scrubbing
  • Exercise
  • Alcohol
  • Spicy foods

And although rosacea is a chronic condition, its symptoms aren't constant — explaining why it flares up in response to one or more of said triggers, then typically recedes for some time.

"There's also a cycle that can develop with rosacea since this inflammatory reaction doesn't just cause the rosacea symptoms we see visibly," explains Dr. Jih. "It also triggers the development of new blood vessels. The more blood vessels, the more prominent this inflammation can become."

Why, though, does this inflammatory skin reaction occur in some people but not others?

"There definitely seems to be a genetic component to rosacea, meaning it's common for a family history to be there," says Dr. Jih. "Additionally, while we see rosacea in all skin types, it does seem to be most prevalent in people with fair skin."

Should you see a doctor for rosacea treatment?

According to Dr. Jih, even mild rosacea should be evaluated by a dermatologist.

"Even if it's just causing redness on the cheeks for now, rosacea does tend to progress if left untreated and uncontrolled," Dr. Jih warns.

What's more, some rosacea symptoms, like skin thickening, are permanent. And scarring from pustules don't always fade over time.

The good news is that there are treatments that can help prevent rosacea from worsening, which is why it's important to get checked out if you think you have it.

"A dermatologist can help you understand what to do to help keep rosacea from flaring up, as well as prescribe topical medications that help reduce redness and prevent bumps if needed," says Dr. Jih. "Additionally, oral antibiotics might be needed to adequately control moderate to severe cases of rosacea."

Cosmetic treatments such as intense pulsed light and laser treatments can also improve not only rosacea patients' appearance but even some symptoms.

Seeing a dermatologist is also important for those who've already been diagnosed but are still experiencing frequent flare-ups or worsening symptoms.

"Rosacea is a chronic condition and working with your doctor can help make sure it remains well-managed, reducing the chance of permanent skin changes," adds Dr. Jih.

5 skin care tips to help prevent rosacea flare-ups

In addition to the prescription medications available, Dr. Jih has at-home advice for controlling rosacea and preventing it from worsening:

1. Identify your specific triggers

"Rosacea triggers vary from person to person, so it's important to identify what's triggering your rosacea, specifically," says Dr. Jih. "Once you know what causes your flare-ups, make a point to avoid your triggers whenever possible."

Some, like exercise, are too essential to overall health to eliminate. But other triggers, like taking hot showers, using scented detergents and cleansers, drinking alcohol and eating spicy foods, can be limited and even avoided completely.

2. Wash your face gently

It's important to keep sensitive skin clean, but be sure to do so gently.

Wash your face twice a day using a mild or gentle cleanser — making sure to rinse your face thoroughly afterward, as any residue that remains could irritate your skin.

3. Moisturize every day

Keep rosacea-prone skin well hydrated using a non-irritating moisturizer.

"People with rosacea tend to have very sensitive skin and a good skin moisturizing routine can help repair the skin barrier and prevent the dryness that can make your skin even more vulnerable to rosacea triggers," says Dr. Jih.

4. Protect your skin from the sun

"Sun exposure is a very common trigger of rosacea flare-ups," says Dr. Jih. "Additionally, sun damage can worsen rosacea symptoms."

Before going outside, be sure to slather on plenty of broad-spectrum sunscreen with an SPF of at least 30, especially to your face. Apply sunscreen after topical medications but before applying makeup.

It may also help to wear sun-protective clothing and layers, such as wide-brimmed hats, long sleeved shirts and pants.

5. Choose physical sunscreens over chemical ones

Physical sunscreens, which use mineral-based ingredients such as zinc oxide and titanium dioxide, sit on top of the skin and act like a mirror. In contrast, chemical sunscreens are absorbed into the skin and prevent UV damage through a chemical reaction.

"Physical sunscreens aren't absorbed like chemical ones, so they're less irritating to the skin," says Dr. Jih. "Additionally, there's a thought that the heat generated by chemical sunscreens as they deactivate UV rays may trigger rosacea to some extent as well."

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