Rosacea - written by J. Drew Laurusonis, M.D.

Rosacea is a chronic skin inflammation that primarily affects the central face. It occurs in about fourteen million American adults, with a preponderance of them being of northern European descent (hence, the nickname: "the Celt's curse"). It causes a rash that occurs primarily on the central face (the nose, the cheeks, the forehead and chin, and in some cases on the eyelids). Since it is a chronic condition, thus far there has not been a cause-related cure, but there are many excellent ways to control it to the point that it, for all practical purposes, "disappears". It can occur on the ears and upper chest, but this is relatively rare.
Rosacea tends to become manifested in the thirty to fifty age group. The central feature of the rash is redness, like a blush. In fact, early on in the disease, a symptom is an increased tendency to blush in the central facial areas. However as the condition becomes more chronic the redness tends to stay. Another feature of the rash is small blood vessels forming a vascular pattern called a telangiectasia, of which there can be several. There can be red bumps which look like acne (the condition used to be called adult acne), and though they can form pustules, they're not really like the whiteheads and blackheads of acne. The dilated blood vessels can become very prominent on the nose, especially in men, which can give an enlarged red nose like the one for which W.C. Fields was well known. This condition is called rhinophyma. It can also occur on the chin or forehead for which other technical names are applied
There are a number of theories about why certain people develop rosacea. Hydrogen breath testing is very often positive in this condition for bacterial overgrowth in the small intestine. Certainly there seems to be hereditary components as certain families tend to develop it more often than others. There are several triggers for rosacea which in themselves are not causes, but which cause the condition to flare. One of these is certainly alcohol; a man with rhinophyma would be counseled not to drink. Another trigger is spicy foods; cayenne and red pepper are possible triggers, as are chili pepper, black peeper and salsa. Other foods which can act as triggers include hot beverages, vinegar, soy sauce, dairy products and certain fruits and vegetables. When somebody has a rosacea flare, it may be important to make a list of everything eaten in the last twenty-four hours, and then compare it with the list made from future flares. Other flares may be caused by temperature changes on the face, like coming in from the cold into a warm house. Skin products which contain alcohol or strong soaps can cause a flare. Another trigger which must be considered is stress; prolonged exposure to circumstances of stress can cause a flare, and treatment includes alleviating this stress. Very importantly, the rosacea patient must avoid extreme ultraviolet radiation of sunlight. A sunscreen of at least SPF of 35 should be worn while outside.
There are numerous treatments for rosacea. One is preventive by using non-alcohol based skin products on the face and very mild soap products to clean. Then there are topical agents which work very nicely. One is metronidazole gel which is applied daily and has both antibacterial and anti-inflammatory effects. Azelaic acid cream can be applied twice daily with good result. Generally strong corticosteroid creams are avoided on the face due to side effects. Medicines can be given orally also. One would be therapeutic doses of antibiotics for apparent skin infection. Another interesting product which is out now, is a half-strength dose of doxycycline antibiotic called Oracea. Due to its low strength it does not act as an antibiotic but rather has purely anti-inflammatory benefits.
Some of the best results are being seen with vascular laser and broad based light therapy (BBL). With the vascular laser, each of the dilated blood vessels can be addressed with this laser which targets the blood hemoglobin within the vessel. The results are excellent. Then the BBL can be used to treat the redness and very tiny blood vessels which are too small to be identified individually. This may require a few sessions and follow-up maintenance two or three times a year. Usually the other topical and oral treatments may be continued between light therapy sessions for best results
The bottom line is that you don't have to be miserable with the condition of rosacea. You make up your mind to take care of your face. You avoid topical skin products which cause it to flare and worsen. You avoid alcohol and the foods which cause it to flare and you stay out of the sun either directly or by using strong sun blockers. Consult your doctor about prescription therapies, and check into light therapy treatment options.