is there a way to take the red out of rosacea?

while there is no cure for rosacea, it is possible to control symptoms through calming skin care, avoiding triggers, and using sun protection.

by dr. rohan bissoondath

apr 21 2022

4 minute read

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is there a way to take the red out of rosacea?

the most common reason that people with rosacea seek medical attention is the chronic and progressive redness of their face. getty

when i get home after spending a day looking at aged faces and see my daughter’s face beaming at me, i marvel at her flawless skin. i remind her to treasure it, protect it, and keep it healthy for a lifetime. unfortunately, at 13-years-old, i get the standard response: “why are you talking to me?” usually followed by a smile, a brief hug and kiss on the cheek, before she runs off to do more important teenage activities.

unfortunately for many of us, that flawless childhood skin changes as we age. in addition to progressive laxity and wrinkles, we also experience changes to the colour of our skin, a condition called dyschromia. instead of an even, glowing skin tone, our skin colour becomes irregular with brown and red patches. and one condition that can cause increased redness this is rosacea.

what is rosacea?

rosacea is a disease of the skin which causes progressive, chronic facial redness often accompanied by the appearance of multiple small blood vessels (telangiectasia). occasionally, bumps which resemble acne are also present. areas of the face involved can include the nose, cheeks, forehead, and chin. the permanent redness is punctuated by acute episodes of facial flushing which can be profound in certain individuals. various triggers can be blamed such as, alcohol consumption, physical exertion, extreme temperature, sunlight, stress or strong emotions, spicy foods, and alcohol.

four types of rosacea

there are four distinct types of rosacea that may exist by themselves, or in combination with the others. the most common type i see in my clinical practice is the exaggerated flushing. we all know people who “blush” easily and are often red-faced at various times in relation to their exposure to specific triggers. a second common type is characterized by small, dilated blood vessels — telangiectasia — that develop on the nose and cheek area. some people with papulopustular rosacea develop papules and pustules — acne-like bumps. and finally, with ocular rosacea, symptoms affect the eyes, causing redness, discomfort, burning, tearing, itching, blurred vision, and light sensitivity.

a significant skin change that can occur with rosacea is phymatosis — an irregular thickening of the skin that most often involves the nose, and, less commonly, the cheeks, chin, and forehead. a famous example of rosacea affecting the nose — called rhinophyma — was the late actor, karl malden , who was known for having a red, bulbous nose.

the onset of rosacea typically occurs after age 30, but can be seen as early as teenage years, and females are affected more often than males. and while there is no test to confirm the diagnosis of rosacea, it is often based on the skin changes that occur, along with the corroborating history of the patient. uncommonly, a skin biopsy may be performed.

the underlying cause of the inflammation that drives rosacea is unknown, though there are several theories including a dysfunctional immune system, microorganisms, and the hyperactivity of blood vessels. there also appears to be a genetic component.

how is rosacea treated?

the most common reason that people with rosacea seek medical attention is the chronic and progressive redness of their face. it is not unusual to discover that these patients are also experiencing eczema, burning or stinging, or swelling of the face — secondary symptoms of rosacea.

once the diagnosis is confirmed, it’s time to explore treatment options. the first step in managing rosacea involves educating the patient on the chronic and inflammatory nature of the disease. at best, we can control and reduce symptoms, but unfortunately, there is no cure. with that in mind, some principles apply to all patients with rosacea: calming skin care, the avoidance of triggers, and appropriate sun protection. a prescription topical preparation of brimonidine (onreltea) can also help induce a short-term constriction of the superficial blood vessels of the face for six to eight hours.

other treatment options include vascular laser sessions to address chronic redness and telangiectasia, topical antibiotics — and sometimes retinoids — which are used to treat papules and pustules. oral antibiotics, which are reserved for moderate to severe cases of papulopustular rosacea. in instances where these treatments do not achieve satisfactory results, the use of isotretinoin (accutane, epuris) may be used.

while there is no curative treatment for rosacea, the key to successfully managing the condition is two-fold: avoiding triggers and seeking appropriate medical care.

dr. rohan bissoondath, md, is the medical director and founder of preventous collaborative health and preventous cosmetic medicine . he is also the president of the canadian association of aesthetic medicine and is certified by the college of family physicians of canada and licensed through the college of physicians and surgeons of alberta.

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is there a way to take the red out of rosacea?