Rosacea Overview with Dr. R. Thomas

Rosacea: What is it?

Rosacea usually occurs in middle aged individuals. They are most often fair-skinned, and complain of red faces, flushing, so there is a vascular component to this, and the other component is inflammation.

Some individuals will have pimples or pus spots and red inflammatory bumps. It also is associated with irritation of the eyes and the eyelids-occuring about 50% of the time. There are common factors that cause aggravation and increased flushing of the skin.

What causes Rosacea?

I don't think that we really know what causes rosacea at this time. It may well be that there are many causes to rosacea. It does appear that chronic sun damage is an underlying theme that we very often see in rosacea. There are many theories. There is currently some work being done using treatments that inhibit the mites that live in our skin. More work with clinical trials may reveal in the future that these can be the initiating causes of rosacea for many, but not all people.

What kinds of treatments are available for rosacea?

Firstly we have to encourage individuals to avoid the factors that cause them to flush-particularly sun exposure. I think sunshine needs to be explained as a factor that may aggravate rosacea over the years.

We reduce inflammation by applying topical anti-inflammatories and antibiotics such as metronidazole. We also use azelaic acid for its anti-inflammatory effects, as well as topical dapsone in recent years. Tetracycline antibiotics are also used for this purpose. A new development in this area is the use of low dose antibiotic doxycycline which acts as an anti-inflammatory, but maybe does not have its antibacterial effect, which helps bypass the problem of bacterial resistance.

For vascular rosacea, lasers and intense pulsed light is one way of trying to close down these blood vessels to reduce the flushing and reduce the background redness.

What lifestyle changes would you recommend for patients with rosacea?

I think that sun protection-use of broad spectrum sunscreens-is the single most important factor in terms of lifestyle. We know that spicy foods, hot drinks, alcohol, and exertion are all things that tend to increase flushing. But you know, I'm not sure if I had rosacea whether I'd want to give up any of those, except for sunshine.

My approach has always been: Let's see if we can control it with the standard treatments that we offer, and for individuals to carry on doing whatever they like to do. One exception is sun protection; this is very important and I really stress want to stress this point.