Warning signs and the latest treatment options for rosacea

For most people, a flushed face is a typical reaction to emotions ranging from excitement to embarrassment and sometimes even anger. Yet for an estimated 14 million Americans, facial redness and swelling are characteristics of rosacea, a condition that many times goes untreated due to lack of awareness about this common skin disorder.

Speaking at the American Academy of Dermatology’s (Academy) Derm Update 2004, dermatologist Michelle T. Pelle, M.D., clinical associate professor of dermatology, University of California, San Diego, discussed the warning signs and the latest treatment options for rosacea.

“Because it is so noticeable on a person’s face, rosacea can be socially and emotionally distressing,” said Dr. Pelle. “While the cause is unknown, the good news is that this condition can be controlled if people know and look for the symptoms, as well as follow a supervised treatment plan.”

Rosacea is a chronic and often progressive skin disease that causes redness and swelling on the face. Most people affected by the condition are fair-skinned between the ages of 30 and 50. Rosacea often runs in families, with women being affected more than men. Men, however, often get more severe forms of rosacea.

Often incorrectly referred to as “adult acne,” rosacea may begin as a tendency to flush or blush easily, and progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin and nose. As the disease progresses, tiny blood vessels and pimples without blackheads begin to appear on and around the reddened area.

In more advanced cases, a condition called rhinophyma may develop. Less common in women, rhinophyma is characterized by a bulbous, enlarged red nose and puffy cheeks. Thick bumps also can develop on the lower half of the nose and cheeks. Approximately 50 percent of rosacea patients experience eye involvement and have burning and grittiness of the eyes as the result of a condition known as conjunctivitis. Left untreated, this condition can lead to serious eye impairment.

“There is no cure for rosacea and it can become significantly worse without treatment,” advised Dr. Pelle. “The key is to identify the condition early. When the skin doesn’t return to its normal color and when other symptoms such as tiny blood vessels and pimples become visible, it’s time to see a dermatologist for professional treatment.”

The best prevention for rosacea may be to avoid “triggers,” or things that make the face red or flushed. Triggers can vary from person to person, however common ones include hot or spicy foods, alcohol, sun exposure, physical exertion, extremes of emotion, rubbing the face and using irritating topical products and cosmetics. Menopause also has been known to be a trigger for rosacea. In addition, it is important for rosacea patients to care for their skin by using gentle facial products that do not cause excessive dryness or contain additives such as glycolic acid or alcohol that may further irritate the skin.

Rosacea flare-ups also can be minimized by protecting skin from the sun. Dermatologists strongly recommend the daily use of a broad-spectrum (UVA and UVB protective) sunscreen with a Sun Protection Factor (SPF) of 15 or higher, seeking shade when possible and wearing protective clothing such as a long-sleeved shirt and wide-brimmed hat.

Standard medical therapies for rosacea include topical and oral anti-inflammatory and antibiotic medications. Treatment regimens are specific to each patient depending upon the severity of his or her condition. The three main topical medications approved by the Food and Drug Administration (FDA) for rosacea include topical metronidazole, the newer topical azelaic acid, and sodium sulfacetamide and sulfur formulations that include cleansers and lotions for the skin. If symptoms persist, dermatologists may prescribe oral medications in combination with topical therapies to bring rosacea symptoms under control.

“Oral antibiotics such as tetracycline tend to produce faster results than topical medications,” explained Dr. Pelle. “The idea is to use them in conjunction with topical medications to initially bring a patient’s condition under control and then go back to a strictly topical medication for long-term management.” Dr. Pelle advises her rosacea patients to apply an emollient cream in combination with a topical retinoid cream before bedtime to achieve the best outcome.

Newer approaches to rosacea treatment include laser and light therapies that treat persistent redness and dilated blood vessels following initial topical therapy and have been known to achieve longer-lasting improvements. According to a new study published in the October 2004 issue of the Journal of the American Academy Dermatology (JAAD), pulsed dye laser (PDL) therapy in particular was found to be a safe and effective treatment for the symptoms of rosacea and resulted in a significant improvement in facial appearance and quality of life.

Vascular lasers, including PDL, emit specific wavelengths of light that target the tiny visible blood vessels just under the skin. Heat from the laser’s energy builds in the vessels, causing them to collapse. Intense-pulsed light therapy uses multiple wavelengths of light to treat dilated blood vessels in the face. Both vascular laser treatment and intense-pulsed light therapy take approximately 15 to 30 minutes and are performed at six- to 12-week intervals. Patients may require several initial treatments and then return annually for treatment of new blood vessels.

“While newer rosacea treatments are longer-lasting, it is important to remember there is no cure for this condition,” cautioned Dr. Pelle. “However, patients can reduce the incidence of flare-ups by avoiding their personal trigger factors and following through on a dermatologist-supervised treatment regimen.”

For more information about rosacea, visit the Academy’s patient education Web site at www.skincarephysicians.com and select “RosaceaNet.”

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 14,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.