What is rosacea and how can it be controlled?

Rosacea: Understanding and Simple Control Measures

Rosacea is a chronic inflammatory skin disease affecting the central face, characterized primarily by persistent facial redness with periodic intensification and/or phymatous changes, which can be effectively controlled through trigger avoidance, gentle skincare, and appropriate medical treatments. 1

What is Rosacea?

Rosacea is a chronic inflammatory facial skin condition that typically presents with one or more of the following features:

• Diagnostic features (either one alone is sufficient for diagnosis):

  • Persistent centrofacial erythema (redness) with periodic intensification
  • Phymatous changes (skin thickening, especially of the nose)

• Associated features (may be present but not independently diagnostic):

  • Flushing
  • Telangiectasia (visible blood vessels)
  • Inflammatory papules and pustules
  • Ocular manifestations
  • Burning or stinging sensations
  • Facial edema
  • Dry appearance 1

Rosacea affects up to 10% of the world population, particularly fair-skinned individuals aged 35-50, with women being affected more frequently than men. 2

Simple Control Measures for Rosacea

1. Trigger Avoidance

Identifying and avoiding personal triggers is fundamental for rosacea control:

• Sun exposure (use wide-brimmed hats and broad-spectrum sunscreen SPF 30+)
• Hot beverages
• Spicy foods
• Alcohol
• Temperature extremes
• Stress
• Certain skincare products 1

2. Gentle Skincare Routine

• Cleansing: Use mild, non-abrasive cleansers
• Moisturizing: Apply gentle, fragrance-free moisturizers
• Sun protection: Daily broad-spectrum sunscreen (minimum SPF 30)
• Avoid: Harsh scrubs, alcohol-based products, fragranced products 1, 3

3. Medical Treatments Based on Phenotype

For Inflammatory Lesions (papules/pustules):

• First-line topical options:

  • Azelaic acid 15% gel/foam
  • Metronidazole 0.75% or 1% gel/cream
  • Encapsulated benzoyl peroxide 5% (E-BPO 5%) - newest FDA-approved option with excellent tolerability 1

• For moderate to severe cases:

  • Oral antibiotics (subantimicrobial-dose doxycycline) combined with topical agents 3

For Persistent Facial Redness:

• Topical brimonidine or oxymetazoline 3

For Phymatous Changes:

• Laser or light-based therapies 3

4. Important Considerations for Treatment

• When using azelaic acid: Temporary skin irritation (burning, stinging) may occur initially but usually subsides with continued treatment. If irritation persists, reduce application to once daily or discontinue use 4

• Maintenance therapy: After achieving control, continue with topical agents to maintain remission 5

• Treatment duration: Rosacea is chronic with periods of flare-ups and remissions, requiring long-term management 6

Potential Pitfalls and Caveats

1. Misdiagnosis: Rosacea can be mistaken for acne, seborrheic dermatitis, or lupus erythematosus. The key distinguishing feature is persistent centrofacial erythema 1

2. Delayed treatment: Early recognition and treatment prevent progression and potential disfigurement 6

3. Ignoring ocular symptoms: Up to 50% of patients may have ocular involvement requiring specific treatment 3

4. Overuse of steroids: Topical steroids can worsen rosacea and should be avoided 7

5. Inconsistent management: Long-term adherence to both trigger avoidance and medical therapy is essential for effective control 1

By understanding the nature of rosacea and implementing these simple control measures, most patients can effectively manage their condition and improve their quality of life.