The first signs of rosacea can vary from person to person, but typically include persistent redness of the cheeks, nose, chin, and forehead. This redness can come and go over time and may be accompanied by visible blood vessels (telangiectasia), small red bumps (papules), or pimples on the face.  This can be accompanied by a feeling of warmth and mild burning or tingling sensation. Over time, the redness in the center of the face becomes permanent.

There are four subtypes of rosacea that have distinct features.

1. Facial redness rosacea is characterized by persistent redness, flushing, and visible broken blood vessels; and swollen, dry and rough skin.
2. Acne rosacea is associated with oily skin, sensitivity, burning, stinging, redness, swelling, visible broken blood vessels and acne-like breakouts. This type typically affects women in middle age.
3. Thickened skin rosacea is an umbrella term that covers several types of skin thickening, irregular surface nodules and enlarged pores. It often affects the nose and is called rhinophyma.  This form of rosacea is rare.
4. Ocular rosacea affects the eyes and causes redness, swelling, dryness and irritation in the eyes, light sensitivity, as well as sties or cysts on the eyelids.

The exact cause of rosacea is unknown, but there may be several factors that contribute to its development. These include the presence of certain bacteria on the skin, genetic predisposition, immune system dysfunction and environmental triggers such as exposure to sunlight or extreme temperatures, stress, drinking alcohol, eating spicy foods and hot beverages, and certain medications.

Rosacea can be difficult to diagnose as it often resembles other conditions such as acne or eczema. A diagnosis of rosacea is usually made based on Dr. Shagalov’s review of the patient’s medical history and physical examination. In some cases, further testing such as skin biopsy may be needed to confirm the diagnosis.

A majority of patients will need combination treatments to address the multiple signs and symptoms of rosacea. Topical therapies and systemic treatment with antibiotics may be necessary to manage rosacea. The goal of treatment is to reduce symptoms and prevent relapse for as long as possible.

• Persistent redness and flushing can be treated with FDA approved topical therapies such as brimonidine gel and oxymetazoline. Intense Pulsed Light (IPL) therapy and pulsed dye laser treatments may be helpful.
• Thickened skin and enlarge pores may benefit from topical retinoids combined with oral medications and laser treatments.
• Pimples and pustules are often treated with topical ivermectin, azelaic acid and metronidazole may be combined with oral antibiotics such as low dose doxycycline and retinoids.
• Visible broken blood vessels can be improved with lPL, pulsed dye laser treatment and topical retinoids.
• Eye symptoms can be treated with antibiotics, artificial tears and daily eyelid and lash cleansing with baby shampoo.
• Lifestyle changes are important to manage flareups. Patients can learn what triggers their flare-ups and how to avoid them including sun exposure which commonly triggers an outbreak. Your skin care routine is important as well. Always wear sun protection and use gentle cleansing products.