Access Dermatology

What is Rosacea?

Rosacea (pronounced “roh-ZAY-sha”) is a common, chronic skin condition that primarily affects the central face. Although rosacea usually begins in adulthood, it could also affect children. Symptoms include periodic flushing or redness on the cheeks, nose, chin and forehead. Over time, the redness becomes more persistent, and visible blood vessels may be seen. Inflammatory bumps (papules) and pimples (pustules) may develop, and in severe cases, usually in men, the nose may become bumpy from excess tissue. In many patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

Individuals with fair skin who tend to flush or blush easily are believed to be at highest risk, but it can affect all skin types. Rosacea is more frequently found in women, but tends to be more severe in men. As with other skin conditions, there is a genetic propensity, but diet and lifestyle play an important role.

Treatment

There are effective and safe treatments for rosacea, but treatment usually takes several weeks to see improvement and must be continued to prevent flares. Treatments include topicals and orals. People with rosacea should apply a moisturizer nightly and a sunscreen daily as maintenance. We also provide our updated Diet and Lifestyle Guidelines pdf with useful recommendations for all initial rosacea consultations.

Topical Treatment

People with rosacea tend to have sensitive skin, and one treatment that is suitable for some may cause skin irritation in others. We try to select the most appropriate topical(s) based on the specific type and symptoms of rosacea that you have, your skin type, and your individual preferences. However, adjustments to your regimen may occasionally be needed based on your individual response and course.

Commonly used topical medications for rosacea include:

metronidazole
clindamycin
retinoids
Finacea (azeleic acid)
sulfur and sulfacetamide
Soolantra (ivermectin)
Mirvaso (brimonidine)
Rhofade (oxymetazoline)
Epsolay (special formulation of benzoyl peroxide for rosacea)

Oral Treatment

Adding an oral treatment can be helpful for more severe cases and when there is eye involvement. Oral options include:

Specific vitamin supplementation.
Oracea (low-dose Doxycycline), which has anti-inflammatory effects, but doesn't kill bacteria, is milder than full-dose antibiotics, with fewer side-effects.
Full-dose antibiotics with Doxycycline, Minocycline, and others, for more severe cases, but may cause stomach and bowel side-effects, and negatively affect the gut microbiome with long-term use.
Accutane (isotretinoin), a Vitamin A derivative, can be used in the most difficult cases. Common side-effects are dry lips, eyes, mouth and skin, although other less common side-effects are possible. It may exacerbate depression and inflammatory bowel disease in people who have a propensity to these conditions, but does not cause them. It can cause severe birth defects while taking it and for 1 month after completion of therapy, and requires monitoring blood tests and monthly visits. An optimized typical course is 6-8 months.

We have extensive experience in using all of these treatment options to maximize clearing and minimize potential side-effects.

ROSACEA

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