Inflammatory papules on the face and near confluent erythema of the nose and cheeks is typical of rosacea.

ROSACEA

Rosacea is a papular inflammatory eruption of the face in adults. It is not acne and this author prefers to avoid the term "acne rosacea." Red, inflamed papules and pustules develop on the nose and cheeks. Often there is a background of redness, superficial blood vessels (telangiectasias) and flushing. Hot foods or liquids, sun, and wind may trigger the flushing. Redness or blood vessels alone, without papules and pustules, is not rosacea.

• Rosacea seems to represent a mild surface infection or overgrowth by normal flora--particularly Demodex.
  
• Fair-skinned adults are preferentially affected.
• Patients with rosacea often have sensitive skin.
  
• Mask wearing aggravates all aspects of rosacea in the covered areas.
  
• Ocular rosacea may accompany rosacea. Signs include red or dry eyes. Symptoms include burning, stinging, light sensitivity, and foreign-body sensation.
  
• Woman with rosacea are more likely to have migraines.
• Chronic topical steroid use on the face may induce a rosacea-like eruption, so called steroid-rosacea.
  

General Measures

• Use a gentle skin care routine with unscented cleansers and moisturizers (e.g., Cetaphil, Dove Sensitive Skin, Cerave)
• Avoid cleansers with abrasive or exfoliating agents, alcohol, acetone, and scents.
• Allow skin to dry before applying any medication (or moisturizer).
• Always apply any prescription medication first, before any moisturizer or makeup.
• A green-tinted makeup can help reduce the appearance of redness.
• If flushing is a problem, triggers (e.g. hot foods or liquids) should be avoided as much as possible.

Treatment

There are many approaches to the treatment of rosacea. I sometimes utilize the following in combination. After good control is achieved, the doxycycline is tapered to off and the triple cream continued for maintenance.

• Doxycycline (an oral antibiotic) 40-100 mg twice a day plus
• Triple Cream for Rosacea (ivermectin, azelaic acid and metronidazole) applied daily. Available thru Skin Medicinals.

Once papules and pustules of rosacea have been controlled, laser (e.g. pulsed dye laser) can be excellent for any residual redness and/or surface blood vessels (telangiectasias). As always, let your doctor know of any problems, side effects of the medications, or if the rosacea fails to improve.

This is not rosacea, but surface blood vessels (telangiectasias). The pulsed-dye laser (e.g. Vbeam) can be excellent for these.

RegionalDerm

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