What Do You Know About Rosacea and Its Treatment?

Author, Soheila Mokmeli PHD, Medical & Aesthetic Laser Specialist:-

What is Rosacea?

Rosacea (roe-ZAY-she-uh) is a common skin condition that causes blushing, redness, flushing and it has visible blood vessels on the face. It can also produce little bumps filled with pus. These signs and symptoms can appear for weeks or months and then disappear for some time. Rosacea is a severe skin condition that is often underdiagnosed and undertreated. It can be a significant distress, affect daily functions and interfere with social relations. Simply, Rosacea may significantly reduce an individual’s quality of life.

What is the prevalence of Rosacea?

Prevalence estimates for rosacea in light-skinned populations range from 2 to 22 per cent. It is estimated that 5.46% of the world’s population suffers from rosacea, which affects more than 3 million Canadians. In the US, the prevalence of rosacea appears to be on the rise and in the UK, it is 1.65 per 1,000 person-years. A recent German prospective study reported a global prevalence of rosacea of 12 per cent. There is an epidemiological data on rosacea, with reported prevalence rates ranging from as little as 0.09% to as much as 22.00%.

Who gets the rosacea?

Anyone can get rosacea, which mainly affects adults around the age of 30 and typically predominates in women. It is most frequent in middle-aged and older adults. While more women than men get rosacea, 3 to 1 in some studies, men tend to have more severe symptoms. It is common in people with fair skin, but it may be underdiagnosed in people with dark skin because dark skin can hide the facial redness.

What are the etiologies?

The actual reason for the rosacea is unknown. Although, several factors are involved, including anomalies in the facial blood vessels and a reaction to microscopic mites commonly found on the face. It may relate to an overactive immune system, heredity, environmental factors, vascular hypersensitivity, ultraviolet radiation, microorganisms, and skin barrier dysfunction, or a combination of these. Rosacea is not caused by poor hygiene and it’s not infectious. Flare-ups might be triggered by hot drinks and spicy foods. Rosacea is linked to the type one diabetes, Celiac disease, Multiple Sclerosis, and Rheumatoid Arthritis in women, while in men, there is a statistically significant link to Rheumatoid Arthritis. Studies have shown that rosacea is linked to abnormalities of the blood vessels (vascular system) and the immune system. In people with this skin condition, blood vessels expand (dilate) too easily, which can lead to redness and flushing of the skin. Rosacea is also related to abnormal inflammation. It is reported that rosacea is associated with an increased risk of death by liver disease and alcoholic liver cirrhosis.

What are the signs and symptoms?

Signs and symptoms include the flushing and redness in the center of the face, visible broken blood vessels (spider veins), swollen skin· Skin may be very sensitive, sting and burn. Without adequate treatment of your skin, rosacea may become more visible. The redness becomes a permanent skin condition on your face and spider veins may appear on your cheeks, nose, and chin. Some people get acne flare-ups. Eye problems and enlarged nose (Rhinophyma) can be developed as the Rosacea progresses.

Which skin conditions are similar as rosacea?

Eczema and seborrheic dermatitis are the skin diseases which mostly are mistaken with rosacea. Seborrheic dermatitis happens at about the same age as rosacea and has the same triggers. The term “dermatitis” often refers to itchy, red, or swollen skin, the same signs of rosacea. The dermatitis is oozing, crusty and scaling without any treatment, like rosacea. However, unlike rosacea, contact dermatitis is often caused by environmental factors and once treated, will disappear.

What are the rosacea classifications?

The National Rosacea Society (NRS) in the US has classified rosacea into four sub-types, although many people experience symptoms of more than one type.

1) Erythematotelangiectatic rosacea. This type of rosacea is characterized by a persistent redness of the face. The small blood vessels of the skin become large and visible; These symptoms frequently appear and then disappear. If left untreated, the rash and redness may become more persistent, cover the skin more, or become permanent.

2) Papulopustular rosacea: It is associated with “whitehead” pustules, which are pus-filled blemishes, and red, swollen bumps. They usually appear on the cheeks, chin and forehead and are commonly misidentified as acne.

3) Phymatous rosacea: Phymatous Rosacea causes skin to thicken and scar, making it bumpy, swollen, and sometimes discolored. This rare but treatable type mostly affects your nose.

4) Ocular rosacea: Ocular rosacea causes lingering dryness of the eyes and the formation of cysts on the eyelids. Ocular symptoms of rosacea can be more frequent and there is a link between skin symptoms and the eyes.

What are the triggers for rosacea?

Anything that causes the rosacea to flare is called a trigger. Sunlight is the common rosacea trigger. Other common triggers include:

• Red wine and other alcoholic beverages, Hot drinks,
• Temperature extremes, hot, or cold,
• Weather’s temperature changes and wind,
• Histamine-rich foods (aged cheese, wine, processed meats), Spicy foods,
• Cinnamaldehyde-containing foods (e.g., tomatoes, citrus fruits, chocolate),
• Drug, including some blood pressure medications.
• Medical conditions: Chronic cough, menopause, etc.
• Skin care and cosmetic products,
• Hair care products,
• Emotions, insomnia, stress, etc.
• High intense exercise,

What are the treatments?

Rosacea cannot be cured, but treatment can help manage the symptoms. It can get worse if it’s not treated. The treatment aims on the managing of the signs and symptoms. Most often this requires a combination of good skin care, laser treatments and prescribed medications. The duration of your treatment depends on the type and severity of your signs and symptoms. Recurrence is very common.

Medications:

The type of medication depends on the severity of the skin condition. You may need to try different options or a combination of different medicines to get an efficient treatment.

Prescribed drugs for Rosacea include:

• Topical medications to reduce the redness and flushing. Brimonidine (Mirvaso) and oxymetazoline (Rhofade) reduce flushing by constricting blood vessels and it can be used for mild to moderate rosacea. The results may be seen within 12 hours after use. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to keep the results.
• Topical products for treating the pimples of mild rosacea, including azelaic acid (Azelex, Finacea), metronidazole (Metrogel, Noritate, others) and ivermectin (Soolantra). The noticeable improvements usually appear in 2-6 weeks. Ivermectin may take even longer time to improve the skin symptoms and it has longer remission compared to metronidazole.
• Oral antibiotics such as doxycycline (Oracea, others) for moderate to severe rosacea with bumps and pimples. If the severe rosacea is not responsive to other topical and oral treatments, your doctor may prescribe isotretinoin (Amnesteem, Claravis, others). It’s a strong oral medication for acne and it also reduces acne like lesions of rosacea. It is prohibited to use this drug during pregnancy as it can cause serious congenital defects.

Laser therapy:

Laser treatment cauterizes the enlarged blood vessels and makes them less visible. It reduces the enlarged pores and improves the texture and thickness of the skin. The treatment is noninvasive and highly tolerable, and you will need 3-6 sessions depending on the severity of the rosacea. Side effects of laser therapy for rosacea include swelling and bruising that can last for a couple of days. During your recovery, you should use ice or a cold compress and a soft moisturizer. You should avoid sun exposure and put on screen for a few weeks after a laser treatment. It is more efficacious on lighter skins. In brown or black skin, laser treatment can result in long-term or permanent discoloration of the treated skin. And it must be done by a laser professional with a suitable laser adjustment to avoid this condition. The complete effects of the treatment may not be visible for weeks. Repeated treatments may be required more often to keep the improved appearance of the skin.  Mostly after a couple of sessions, you may need a touch-up treatment every 6-9 months to keep the results accumulated. Like a dental hygiene treatment, laser treatment is recommended 2-3 times per year for rosacea. Laser The treatment of rosacea is generally regarded as a cosmetic intervention, which is commonly not covered by the insurance.

Laser treatment for ophthalmic rosacea, or Dry Eyes:

Laser treatment of ophthalmic rosacea/dry eye: Laser therapy and IPL are the FDA-approved treatment for acne and rosacea that has been used in dermatology for years. In recent years, ophthalmology has discovered about the therapeutic effects of laser therapies to help patients with ocular rosacea minimize the impact of dry eye. Four to six treatments at three-week intervals can improve long-term eyelid conditions and ocular symptoms without side effects. You should feel relieved in the minutes following your first session, and the results may last from 6 months to 3 years, depending on your eyes. Your optometrist will probably recommend maintenance sessions over your lifetime to maintain long-term results.

How to manage the Rosacea flare-ups:

The Rosacea eruption calms down when the triggers are avoided. However, avoiding all triggers is not a simple task. A rosacea flare-up can last from days to months, and it varies in different persons. To manage a flare up follow the recommended steps:

• Use the recommended meditation by your doctor.
• Calm the skin with a gentle, allergic tested and fragrance-free moisturizer.
• Use a humidifier, dry air eliminates the moisture from the skin.
• Stay hydrated by drinking more water, it prevents a dry skin. Drinking water helps wash out the toxins that clog the skin
• Use a cold wet compress on the face and neck to reduce the heat.
• Get enough sleep and try a few stress relievers, such as meditation and yoga.
• Seek a laser treatment by an experienced professional.

At Canadian Optic and Laser clinic, COL Clinic, our skilled medical and aesthetic laser specialists have been practicing laser therapy for many years. We have many years of experience in laser-assisted rosacea treatment and can help you achieve a healthy skin. Call, or text 250 480 7868 for a complimentary consultation. Let us assess your skin and discuss the available options for you.