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Expert Q and A: Dealing With Rosacea

An interview with Jenny J. Kim, MD, PhD.
By
WebMD Feature
Reviewed by Laura J. Martin, MD

If you're embarrassed by the redness, flushing, and prominent blood vessels that characterize rosacea, you're not alone.

An estimated 14 million Americans, mainly fair-skinned, blue-eyed, blonde men and women between the ages of 30 and 50, suffer from the chronic skin disorder. And nearly three-fourths say that the condition lowers their self-esteem and self-confidence, says Jenny J. Kim, MD, PhD, associate professor of dermatology at the University of California, Los Angeles, David Geffen School of Medicine.

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Fortunately, there are new treatments that can help, she tells WebMD. At the recent meeting of the American Academy of Dermatology in Miami Beach, Fla., Kim discussed the common skin disorder.

What causes rosacea?

That's not fully understood. But a recent study suggests that a small protein called cathelicidin within the skin is processed differently in rosacea patients and induces inflammation that may contribute to rosacea.

If you ask patients, the most common triggering factor is sun, followed by heat, spicy food, alcohol, and stress. Caffeine and citric acid are also known triggers.

How is rosacea treated?

It's very difficult because we don't really know what causes rosacea. We're using some anti-inflammatory and anti-microbial treatments but we're not really sure how much they'll help.

For rhinophyma -- the large, bulb-shaped, ruddy, oily nose that some patients suffer -- surgical treatments are sometimes necessary.

Of course, avoiding the triggering factor is very important.

A few new treatments are available. One recently approved oral treatment is low-dose doxycycline -- it's an anti-inflammatory type of antibiotic. So it only targets inflammation and appears to have few side effects for rosacea patients.

In the last few years, lasers and light therapy have been added to drug therapy. For example, pulsed-dye lasers work well for people with lots of broken blood vessels, and both pulsed-dye laser and intense pulsed-light treatments are effective at treating the redness on the face and flushing associated with rosacea.

Basically the pulsed-light lasers will go down one wavelength and destroy the red cells -- so it makes some of the redness go away. Intense pulsed light is where you don't get one wavelength but you get lots of light to destroy some of pigmentation as well as the redness.

While multiple treatments are usually needed, lasers and light treatments are very effective and produce long-lasting results.

Additionally, a number of topical medications have been introduced to treat rosacea. Two that work well are metronidazole and azelaic acid.

What about skin care?

Use very gentle skin care and don't wash your face more than a couple times a day. Don't traumatize the skin with scrubs or astringents or alcohol-based products, and perhaps wait a little bit before you put on medication after washing if the medication is irritating.

A recent study showed that topical medication works better if you moisturize your skin and repair the skin barrier before applying.

Since sunlight is the most common triggering factor, sun protection is critical. There is a study that shows that rosacea patients had more sunburns than people without the condition. So if children or younger people have a predisposing factor for rosacea, such as being fair-skinned and blue-eyed, it is really important to start sun protection very early on.

Use a sunscreen that contains zinc and titanium, as they have shown to be more effective than chemical sunscreen ingredients.

Reviewed on March 12, 2010

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