Types, Triggers, and Treatment of Rosacea-Robin Lewallen, M.D.

Rosacea is a common skin condition that affects millions of people worldwide. It is characterized by redness, flushing, and acne-like bumps on the face. This condition can be debilitating, causing embarrassment and anxiety in social situations, and can also lead to eye problems and rhinophyma, a thickening of the skin on the nose. There are four main types of rosacea, each with its own set of triggers and symptoms. Understanding these types and triggers is crucial for managing this condition and reducing its impact on a person’s life.

Erythematotelangiectatic rosacea

This type of rosacea is characterized by redness, flushing, and visible blood vessels. It is often triggered by hot drinks, alcohol, spicy food, and emotional stress. People with this type of rosacea may also experience burning or stinging sensations on the skin.

Papulopustular rosacea

This type of rosacea is characterized by acne-like bumps and pimples on the face. It is often triggered by sun exposure, hot weather, and certain skin products. People with this type of rosacea may also experience redness, flushing, and itching.

Phymatous rosacea

This type of rosacea is characterized by thick, bumpy skin on the nose and chin. It is often triggered by sun exposure. People with this type of rosacea may also experience redness, flushing, and pimples.

Ocular rosacea

This type of rosacea affects the eyes and is characterized by red, watery, and itchy eyes. It can also lead to dry eyes, sensitivity to light, and blurred vision. It is often triggered by sun exposure, wind, and hot or cold temperatures.

The exact cause of rosacea is not known. There are several theories including altered immune function, changes in the neurovascular system and how the nerves and blood vessels change with exposure to triggers and stress, vascular changes that occur with exposure to ultraviolet light (UV sun rays), and changes in the skin microbiome in which there are increased numbers of Demodex folliculorum mites and their associated bacteria Bacillus oleronius.

While there is ongoing research into the cause of rosacea, there are several factors thought to contribute to its development. Some of the most common triggers include:

Genetics: Research suggests that some people may be genetically predisposed to developing rosacea. If you have a family history of the condition, you may be more likely to develop it yourself.  

Environmental Factors: Exposure to sunlight, wind, and extreme temperatures can all trigger rosacea outbreaks. Certain skincare products, such as those that contain alcohol or fragrances, can also cause irritation and trigger symptoms.

Emotional Stress: Emotional stress and anxiety can cause blood vessels in the face to dilate, leading to redness and flushing. This can be a trigger for rosacea outbreaks.

Certain Foods and Beverages: Certain foods and beverages, such as spicy foods, hot drinks, and alcohol, can trigger rosacea outbreaks.

It’s important to keep track of what triggers your rosacea outbreaks and to avoid these triggers as much as possible. By avoiding triggers, many people are able to effectively manage their rosacea symptoms and enjoy clearer, healthier skin. If trigger avoidance isn’t enough there are treatments that can help control its symptoms and prevent it from getting worse. In this blog post, we will explore some of the most common treatments for rosacea and what you can expect from each.

Topical Medications

Topical medications are creams, gels, or lotions that are applied directly to the skin. The most commonly used topical medications for rosacea are metronidazole, azelaic acid, and ivermectin. These medications work by reducing inflammation, redness, and the number of pimple-like bumps. They can also help improve the overall appearance of the skin and prevent new outbreaks.

Oral Antibiotics 

Oral antibiotics are another common treatment for rosacea. They are often prescribed to help control inflammation and prevent new outbreaks. The most commonly used oral antibiotics for rosacea are tetracyclines, such as doxycycline, and macrolides, such as erythromycin. These medications are usually taken for several weeks to several months, depending on the severity of the condition. 

Oral Isotretinoin

Isotretinoin is a prescription medication that is sometimes used as a treatment for rosacea. It is a form of vitamin A that is taken orally and is often used to treat severe cases of acne that have not responded to other treatments. While isotretinoin is not specifically approved by the FDA for the treatment of rosacea, some dermatologists may prescribe it off-label for patients with severe rosacea. Isotretinoin works by reducing the production of oil in the skin and preventing the growth of the bacteria that can contribute to outbreaks. 

Laser and Light Therapies

Laser and light therapies are also used to treat rosacea. These treatments use specific wavelengths of light to target the blood vessels and inflammation associated with rosacea. Some of the most commonly used laser and light therapies for rosacea include intense pulsed light (IPL) and pulsed dye laser (PDL) therapy. These treatments can help reduce redness, improve the appearance of blood vessels, and reduce the number of pimple-like bumps.

Surgery

In rare cases, surgery may be necessary to treat the pimple-like bumps associated with rosacea. This may involve the removal of individual papules or the removal of larger areas of affected skin. It is important to discuss the risks and benefits of surgery with a dermatologist, as there may be scarring or other side effects.

Lifestyle Changes

In addition to medical treatments, lifestyle changes can also help control the symptoms of rosacea. Some of the most effective lifestyle changes include avoiding triggers such as alcohol, spicy foods, and hot beverages, as well as protecting your skin from the sun by wearing a hat and using a daily SPF of at least 30. It’s also important to maintain a gentle skincare routine, avoiding harsh products that can irritate the skin and make symptoms worse.

In conclusion, rosacea is a common skin condition with four main types, each with its own set of triggers and symptoms. Understanding these types and triggers is crucial for managing this condition and reducing its impact on a person’s life. If you suspect that you have rosacea, it’s important to see a doctor for an accurate diagnosis and appropriate treatment plan. They can help you determine whether medication is appropriate for your individual needs and develop a treatment plan that is right for you. With the right care and attention, it’s possible to manage rosacea and lead a healthy and fulfilling life.