Acne Rosacea

Rosacea, or acne rosacea, is a skin disorder leading to redness and pimples on the nose, forehead, cheekbones, and chin. The inflamed pimples and redness of rosacea can look a great deal like acne, but blackheads are almost never present. It is a fairly common disorder with about one in every twenty Americans is afflicted with it. Rosacea is most common in white women between the ages of 30 and 60. When it occurs in men, it tends to be more severe and may eventually cause the nose to become red and enlarged (rhinophyma - think of W.C. Fields). Fair-skinned individuals and people who flush easily seem to be more susceptible to this condition. Sometimes rosacea can affect the eyes, causing a grittiness and dryness, as well as styes. The severity of these eye symptoms is unrelated to the severity of the skin rash.

Flushing triggers include a steady diet of hot beverages, spicy food, alcohol (either topically applied or drinking in excess), excessive prescription steroids, physical and mental stress, extremes of weather, harsh soaps, exfoliating creams, and hot baths. Controlling the flushing can allow one to control the rosacea, sometimes without using medication. Unfortunately, what aggravates one person's rosacea may have no effect on another's.

Many cases of rosacea respond well to simple topical medicines and avoidance of harsh weather (both cold as well as strong sun), hot showers and spicy foods. A meta-analysis of 29 randomized trials looking at many treatment options (published in 2007) found the following medicines were significantly superior to placebo:

There were no differences in effectiveness between topical metronidazole and azelaic acid, OR between topical metronidazole and oral tetracycline. Rilmenidine and permethrin were no better than placebo. Oral antibiotics are also helpful for ocular symptoms (gritty eyes). Note that all drug therapy can help redness and inflamed lesions/papules (pimples and red bumps), but is not likely to help telangiectasia (dilated blood vessels) and flushing.

Generally, I start therapy with topical metronidazole, and move to other topicals if this is not effective. I add doxycycline (like tetracycline) for those who don't respond well to topical therapy after a few months. If this fails, I would suggest referral to a dermatologist for consideration of other options (sometimes low-dose Accutane is used).

It is important for you to take control by trying to avoid things that make your rosacea worse. When medicines and avoidance fail, makeup can be an effective aid in rosacea; it will not make it worse, and even some male rosacea sufferers use a bit. A slightly more olive color than usual helps to hide the redness. For some women, hormone replacement pills may be given to reduce menopausal hot flashes