A Quick Lesson In Rosacea

Rosacea: such a nice-sounding word, almost like a lovely aromatherapy candle you’d burn on a Sunday evening while indulging in a bubble bath…

But in fact rosacea is one of the most misleading words in the English language. Nice? Hell no.

Anyone who’s ever suffered with this skin disease (and that includes more than 3 million US cases every year) knows rosacea can be extremely life-disruptive. Facial redness, pimples, bumpy breakouts, skin thickening, even dry eyes and blurry vision, rosacea can rear its ugly head in many ways (none of them pleasant) and usually appears some time after age 30.

Not to be confused with sunburn or acne, it’s tricky to define and an even trickier to cure.

This is why April has been designated Rosacea Awareness Month by the National Rosacea Society (NRS), and why we thought we’d turn to someone who knows far more about it than we do. Here, top board-certified dermatologist, veritable skin Godfather and founder of the Bay Area Laser Institute, Dr Vic Narurkar, M.D. dispels the myths about rosacea and lays down the facts.

Q. Can You Briefly Explain What Rosacea Is?

A. “Rosacea has multiple clinical components and one or even all of them can present themselves at any given time,” explains Dr. Narurkar.

“These include the presence of facial redness in the t-zone; distinct capillaries and diffuse redness; red papules in the t-zones and even pustules. More severe forms of rosacea include granulomatous variants which results in hard, yellowish-brown bumps or nodules on the skin, and rhinophyma (otherwise known as ‘WC Fields nose’).”

QWho Is More At Risk Of Developing Rosacea?

A. “Women and men with lighter skin types, especially of Northern European descent are more likely to develop rosacea. It generally has an onset in your 20s and 30s, but can also present itself at a later age. Another variant of rosacea is called perioral dermatitis which generally occurs in young women and appears as an eruption around the mouth with red papules and pustules.”

Q. What’s The Difference Between Rosacea And Acne?

A. “Rosacea is all-too-often mistaken for acne, and exacerbating factors for acne are often confused with the causes of rosacea. This is why they can frequently be misdiagnosed,” reckons Dr. Narurkar.

“Often there can be an overlap, with a patient presenting clinical features of both, which is why a detailed history is important to differentiate between the two, particularly if the primary presentation of rosacea is papules and pustules. Factors that exacerbate rosacea include alcohol, caffeine, certain foods – especially very spicy foods – and extremes of temperature, whereas acne is primarily a disorder of the sebaceous glands. The real cause of rosacea has yet to be identified, but several culprits have been proposed, including the over-presence of Demodex mites in rosacea patients.”

What the bejesus are Demodex mites, we hear you squeal? You and us both: so here are facts. Demodex mites are tiny parasitic mites found in or near hair follicles on the human body. They’re a normal, healthy part of the human biology, but have been found in much greater numbers on the facial skin of rosacea sufferers making them continually in the spotlight for causing the disease. Not so scary after all, right?

Q. What Are The Symptoms Of Rosacea?

A. “Visible symptoms can be divided into three. 1. Facial redness and/or capillaries, 2. papules and 3. pustules.

“Any or all of these components can be present at any one given time, but flushing is the most common. It’s important, however, to differentiate rosacea flushing from that caused by rare conditions such as endocrine disorders. The presence of facial capillaries can also be seen in connective tissue disorders such as lupus, and with prolonged sun exposure to fair skin.”

Q. And The Best Ways To Treat Rosacea?

A. “The primary treatment is prevention which means you should avoid exacerbating factors like caffeine, alcohol, spicy foods, extremes of temperature and stress.

“You can also prevent it with the use of topical prescriptive medications like Finacea (a topical azaelaic acid), Metrolgel (a topical flagyl) and Soolantra (a topical ivermectin), as well as oral antibiotics such as Oracea (low dose doxyclyine). When rosacea is under reasonable control, treatment of the facial capillaries and redness is best achieved by including professional laser procedures and intense pulsed light treatments in your beauty plan. Try VBeam Perfecta or Excel V™.

“Finally, you should avoid harsh skincare products like abrasive exfoliators, aggressive alpha hydroxy acids and retinols.”

Q. Which Skincare Products Would You Recommend For Rosacea?

A. “We always recommend SkinCeuticals C E Ferulic® to rosacea-prone patients because it’s a very safe antioxidant. 

Restorsea Renormalizing Serum is also an effective product, as is SkinMedica Redness Relief CalmPlex. Bear in mind, however, these should always be used in conjunction with prescription medications (as above) for the best results. Sunscreens are also essential and my favorite is SkinMedica Total Defense + Repair Broad Spectrum Sunscreen SPF 34.”

Written by: Georgia Gould