Rosacea,
Diagnosis and Treatment

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It is very important to distinguish true Rosacea from simple skin redness or flushing. Rosacea is a spectrum of presentations ranging from skin redness and sensitivity to sun, alcohol, spicy foods to true Rosacea, with inflammatory skin lesions (which are not adult Acne) and the appearance of Rhinophyma (large bulbous, red nose … like W.C. Fields). It is very important not to label the former patient with Rosacea, because it carries certain disease oriented stigmata.

Rosacea is more commonly found in patients of Northern European origin, age usually 30 or beyond as presentation, males and females probably have the same disease ratio; although more women seek medical assistance than men. The disease might be genetic but we have no proof of this and further studies are required. Clearly there are “trigger factors.” Sun is number one trigger factor. Rosacea patients should stay out of the sun, period. Sun blocks are helpful, but clearly ineffective as compared to staying out of the sun. The other minor trigger factors to be avoided are alcohol, spicey foods and hot beverages.

Rosacea is a clinical diagnosis, rather than a microscopic or tissue diagnosis like skin cancer. Yes, there are certain changes in the skin which are found in Rosacea patients. These changes are increased number of capillaries, distortion of the capillaries, increased numbers of inflammatory cells as well as certain bacteria and skin mites. Rather the bacteria or skin mites (found in all skin biopsies) have anything to do with Rosacea is one question researchers are trying to answer. The two most prominent theories as to the cause of Rosacea are the infectious theory and the autoimmune theory. The former postulates that Rosacea is caused by bacteria or an inflammation to the skin by skin mites. The latter, autoimmune theory, postulates that the patient develops antibodies to the skin which results in the “redness and pustule cascade.” Researchers are also looking toward certain inflammatory chemicals in the skin (cytokines, interleukins, nitric acid and others) which might be implicated in the redness, pustules and chronic inflammation which sets apart Rosacea from simply flushed skin.

Rosacea does not invariably progress to worsening stages. In fact, anecdotal patient comments indicate that it might even resolve with some treatments. Rosacea patients may need to be treated medically all their adult lives, but they might also get better and not require continued treatment.

The treatment of Rosacea is based on the infectious disease theory and involves the use of topical and oral antibiotics. Topical antibiotics (metronidazole (Flagyl®) and sulfacetimide gels, lotions and creams, are the mainstay of therapy as they reduce the bacterial population of the skin. Oral antibiotics in the tetracycline class (doxycycline, tetracycline, minocycline) or Erythromycin antibiotics are used in more advanced cases. The side effects of Rosacea such as rhinophyma (large bulbous nose) can be successfully treated with laser surgery, whereas the ophthalmologic complications need specialized care with an ophthalmologist (dry eye, conjunctivitis, red eye syndrome).

What about common skin creams that “fight redness,” or treat Rosacea? There is much anecdotal evidence in the patient community that certain products help the redness and flushing of early Rosacea, but really only topical and oral antibiotics and abstinence from the “trigger factors,” are effective for treatment in advanced cases.

I personally believe that some of our skin care products are very helpful early in the course of Rosacea. I believe that Transfer Factor Gel (TF RenewAll Gel) is very helpful for skin erythema (redness) and perhaps assists the skin in immune function. Other products which I recommend for erythema are:

If you have persistent redness, with pustules in the “malar” area of the face, that is the upper cheek and bridge of the nose area, then you will also require topical metronidazole gel and possibly oral antibiotics. We are free to consult with you regarding your skin and the possibility of Rosacea here at GreatSkin®. We would like to view digital images of your face in three views, as Rosacea is a sight diagnosis combined with compatible history, and not a tissue biopsy diagnosis. You may E-mail photographs to info@greatskin.com.