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How To Manage And Treat Rosacea

Rosacea is a skin condition that makes your skin look flushed or red. You may also have small bumps with pus inside. It can look similar to acne or other skin problems.

Symptoms differ based on the color of your skin. Flushing and blushing are often more obvious on light skin, but harder to see on brown or Black skin. This might make it harder for people with darker skin to get the right diagnosis. 

Even if you don't see obvious redness, you may have rosacea if your skin has: 

  • Small red bumps
  • Bumps that contain pus
  • Stinging, burning, and sensitivity
  • Your doctor can suggest medicine and other treatments to manage your symptoms. You can also take steps at home to help yourself get better.

    Who's most likely to have rosacea?

    Rosacea can affect anyone, but some groups are more likely to get the condition, including:

  • Middle-aged and older adults
  • Women
  • Light-skinned people, but doctors may overlook it in people with darker skin because this skin tone can hide discolored skin
  • There are four types of rosacea. But you can have symptoms of more than one type. The types of rosacea are:

  • Erythematotelangiectatic rosacea. With this type, you have long-lasting redness on your face. Small blood vessels under your skin get larger and more visible. Your symptoms often come and go. Without treatment, the redness can get worse or even become permanent.
  • Papulopustular rosacea. This causes pus-filled "whiteheads" as well as swollen red bumps that look a lot like acne. Often, they show up on your forehead, cheeks, and chin, but they can also affect your scalp, chest, or neck. Your face may also be red or flushed. If you have a serious case, these symptoms can take a while to get better.
  • Phymatous rosacea. With this rare type, your skin gets thick and scarred. This form of rosacea most often affects your nose and can make it look swollen, bumpy, and sometimes discolored.   
  • Ocular rosacea. This type of rosacea affects your eyes, causing them to feel irritated and look bloodshot or watery. Your eyes become dry and sensitive, and you may get cysts on your eyelids. 
  • Rosacea on the face

    When rosacea appears on your face, your skin will look more flushed. You may also see broken blood vessels (called spider veins) and pus-filled bumps. Erythematotelangiectatic, papulopustular, and phymatous are all types of rosacea that appear on the face. 

    For people with lighter skin, the main thing you may notice is redness on your cheeks, nose, chin, and forehead. Less often, the color can appear on your neck, head, ears, or chest.

    After a while, broken blood vessels might show through your skin, which can thicken and swell. Up to half of people with rosacea also get eye problems like redness, swelling, and pain.

    Rosacea can look like some other diseases, so it's important to get a diagnosis. The redness is more obvious on lighter skin. If your skin is darker, it might be harder to get the right diagnosis. (Photo credit: iStock/Getty Images)

    Other symptoms you may get no matter what your skin tone include:

  • Stinging and burning of your skin
  • Red or pus-filled bumps that may resemble pimples
  • Patches of rough, dry skin
  • A swollen, bulb-shaped nose
  • Larger pores
  • Broken blood vessels on your eyelids
  • Bumps on your eyelids
  • Problems with your vision
  • Is rosacea itchy?

    This doesn't always happen, but rosacea can sometimes cause an itchy or tight feeling. Rosacea symptoms can come and go. They might flare up for a few weeks, fade, and then come back.

    Treatment for rosacea is a must, so see your doctor. If you don't take care of it, your symptoms can get worse and might become permanent.

    Common triggers for rosacea include:

  • Sun exposure
  • Very hot or very cold weather
  • Alcohol
  • Very hot or spicy foods
  • Intense exercise
  • Stress 
  • Some cosmetic, skin, or hair products
  • In addition, menopause and some drugs may cause flushing. To help identify your triggers, keep a diary of when symptoms appear, what you were doing, the environmental conditions, and what you think may have brought on your symptoms. Discuss this with your doctor.

    Doctors don't know exactly what causes rosacea. A few things that may play a role are:

    Your genes. Rosacea often runs in families.

    Blood vessel trouble. The redness on your skin might be due to problems with blood vessels in your face. Sun damage could make them get wider, which makes it easier for people to see them.

    Mites. They're microscopic insects. A type called Demodex folliculorum normally lives on your skin and usually isn't harmful. Some people, though, are more sensitive to the mites, or more of the mites than usual. Too many mites could irritate your skin.

    Bacteria. A type called H. Pylorinormally lives in your gut. Some studies suggest this germ can raise the amount of a digestive hormone called gastrin, which might cause your skin to look flushed.

    Some things about you may make you more likely to get rosacea. For instance, your chances of getting the skin condition go up if you:

  • Have light skin, blond hair, and blue eyes
  • Are between ages 30 and 50
  • Are female (or were designated as female at birth)
  • Have family members with rosacea
  • Had severe acne
  • Smoke
  • There isn't a cure for rosacea, but treatments can help you manage the redness, bumps, and other symptoms. Your doctor can choose from among several types of medicines to treat it.

    Rosacea creams and other medicines applied to the skin

    Drugs you apply to your skin (called topicals) can help fight acne and inflammation and/or kill bacteria. They include:

  • Azelaic acid,  a gel or foam that clears up bumps, swelling, and redness. It also stops bacteria growth on your skin.
  • Brimonidine (Mirvaso), a gel that tightens blood vessels in the skin to get rid of some of your redness
  • Calcineurin inhibitors such as pimecrolimus and tacrolimus
  • Clindamycin (Cleocin, Clindagel, ClindaMax), an antibiotic that kills bacteria on your skin
  • Erythromycin (Erygel), another antibiotic
  • Ivermectin (Soolantra), which reduces inflammation 
  • Metronidazole (Flagyl) and doxycycline, also antibiotics
  • Oxymetazoline (Rhofade), a cream
  • Sodium sulfacetamide and sulfur (Avar, Sulfacet, Clenia, Plexion), antibiotics
  • Oral medicines

    Isotretinoin (Amnesteem, Claravis, and others) is an acne drug sometimes prescribed for rosacea. Don't use it if you're pregnant because it can cause serious birth defects.

    It can take you a few weeks or months of using one of these medicines for your skin to improve.

    Rosacea laser treatment

    Your doctor can also treat rosacea with a laser that uses intense light to get rid of blood vessels that have gotten bigger. Lasers can also ease skin redness, while laser resurfacing can remove thickened skin.

    Your doctor may also suggest other procedures to treat your rosacea, such as:

  • Dermabrasion, which sands off the top layer of skin
  • Electrocautery, an electric current that zaps damaged blood vessels
  • There's a lot you can do on your own to improve your symptoms. For starters, try to figure out the things that trigger an outbreak, and then avoid them. To help you do this, keep a journal that tracks your activities and your flare-ups.

    Also, follow these self-care tips to protect your skin and help fade redness:

    Put on sunscreen. To avoid symptoms triggered by sunlight, use a sunscreen with broad-spectrum coverage (it blocks UVA and UVB rays) and SPF 30 or higher. Apply it whenever you go outside. Also wear a wide-brimmed hat that covers your face.

    Use only gentle skin care products. Avoid cleansers and creams that have alcohol, fragrance, witch hazel, and other harsh ingredients. After you wash your face, gently blot your skin dry with a soft cloth.

    Use a moisturizer. It's especially helpful in cold weather, when low temps and wind can dry up your skin. Oil-free is best. 

    Be careful with cosmetics.  Use high-quality, oil-free makeup.

    Massage your face. Gently rub your skin in a circular motion. Start in the middle of your face and work your way outward toward your ears.

    Cover up. If you want to cover your skin, use a green-tinted cover-up on your face to hide redness and broken blood vessels.

    Go indoors. Get out of the heat and sun and cool off in an air-conditioned room.

    Care for your eyes. If rosacea has made them red and irritated, use a watered-down baby shampoo or eyelid cleaner to gently clean your eyelids every day. Also put a warm compress on your eyes a few times a day.

    Eating an anti-inflammatory diet, like a Mediterranean diet, seems to help some people who have rosacea.

    It's also important to care for your emotions along with your skin problems. If you feel embarrassed by the way you look, or you think it's starting to affect your self-esteem, talk to your doctor or a counselor. You can also join a support group where you can meet people who know just what you're going through.

    If you have any symptoms of rosacea, especially if they cause discomfort, see your doctor.  They may refer you to a dermatologist for treatment. Timely treatment can keep your condition from getting more serious. 


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    Your Guide To Erythematotelangiectatic Rosacea And Its Treatment

    Erythematotelangiectatic rosacea (ETR) can cause red or discolored and irritated skin, but many treatment options are available to help ease symptoms.

    Rosacea is a chronic skin condition that primarily affects the face. ETR is a type of rosacea characterized by skin redness or discoloration, flushing, and visible blood vessels. It may also cause pain and discomfort.

    Although there's no cure for ETR, the right treatment can help to manage the condition and alleviate its symptoms.

    This article lists the symptoms and causes of ETR and provides information on its diagnosis and treatment.

    According to the American Academy of Dermatology Association, ETR is 1 of 4 subtypes of rosacea.

    Symptoms of ETR may include:

    The U.K. National Health Service outlines some of the symptoms a person may experience when they first develop rosacea. These symptoms include:

  • repeated episodes of skin redness, discoloration, or blushing, lasting several minutes at a time
  • skin that feels hot, warm, or painful
  • burning or stinging sensations when in contact with water or applying skin care products
  • Rosacea is a common skin condition, affecting more than 14 million people in the United States.

    Scientists haven't discovered the exact cause of rosacea, but the following factors likely play a role in its development:

  • Genetics: Many people with rosacea have family members who also have the condition, suggesting a role of genetics.
  • Skin mites: Demodex is a skin mite that lives on the nose and cheeks of all people. Individuals with rosacea tend to have much greater numbers of demodex on their skin, suggesting a possible link to rosacea, but some individuals without rosacea also have large numbers of demodex on their skin.
  • Immune system response: Demodex carries the bacteria called "Bacillus oleronious." People with acne-like rosacea tend to have an overreactive immune response to these bacteria, but it's still not clear whether this reaction causes rosacea.
  • Gastrointestinal (GI) infection: Helicobacter pylori (H. Pylori) are bacteria that infect the GI system. This type of infection is common among people with rosacea, but many people without rosacea also have the infection. Further research is necessary to determine whether H. Pylori plays a role in rosacea.
  • Cathelicidin production: Cathelicidin is a protein that normally protects the skin from infection. People with rosacea may process this protein in a way that causes skin redness or discoloration and swelling.
  • There's no standard medical test for rosacea. Diagnosis involves examining the skin and eyes and carrying out a detailed analysis of a person's symptoms and medical history.

    When diagnosing rosacea, a dermatologist will also want to rule out other conditions that can present with similar symptoms. Similar conditions include:

    Although there's no cure for rosacea, certain strategies can help to manage the condition.

    Rosacea treatment typically involves the following three steps:

    Avoiding triggers

    Rosacea triggers are individual factors that may cause rosacea to flare. Common rosacea triggers include:

  • sunlight
  • heat
  • cold wind
  • stress
  • alcohol
  • spicy foods
  • hairspray
  • The first step in rosacea treatment is to identify your rosacea triggers so that you can try to avoid them in the future.

    The National Rosacea Society provides a form that can help people identify their rosacea triggers. The society recommends completing the form every 2 weeks and checking to see which of the potential triggers coincided with your rosacea flares.

    You may want to try symptoms journaling as well.

    Using gentle skin care products

    A dermatologist can recommend gentle, rosacea-friendly skin care products. They may also outline products to avoid.

    Some potential products to avoid include:

  • astringents and toners
  • waterproof makeup
  • heavy foundations that require makeup remover
  • skin care, hair care, and toothpaste containing the following common rosacea triggers:
  • Treating the condition

    The earlier a person begins treatment for rosacea, the easier it is to manage. For people with ETR, treatment focuses on treating skin's discoloration and flushing.

    Below are some treatment options a doctor or dermatologist may recommend.

    Sun protection

    Sunlight is one of the most common triggers of rosacea, so sun protection is critical for people with this condition.

    Some tips for protecting the skin from the sun include:

  • apply a broad-spectrum sunscreen with an SPF of 30 or higher daily
  • use a mineral sunscreen containing titanium dioxide or zinc oxide, ingredients that are less likely to irritate the skin
  • wear a wide-brimmed hat when outdoors during the day
  • stay in the shade, if possible
  • avoid being outdoors during strong, midday sun
  • Medicated gels, creams, and lotions

    A dermatologist may prescribe topical medications to reduce skin redness or discoloration, such as brimonidine gel and oxymetazoline hydrochloride cream. Both medications are FDA approved for the treatment of rosacea and may reduce redness for up to 12 hours at a time.

    The following side effects may occur but are usually temporary:

  • redness or discoloration and flushing
  • a burning sensation
  • contact dermatitis
  • A 2018 review lists some additional topical treatments for ETR. These treatments include:

  • Metronidazole: Metronidazole is an anti-inflammatory medication that alleviates skin redness or discoloration and acne lesions in moderate to severe rosacea.
  • Azelaic acid: Azelaic acid is an anti-inflammatory and antibacterial medication. It kills bacteria on the skin and decreases the production of keratin — a substance that can lead to acne.
  • Brimonidine: Brimonidine is a medication that constricts dilated blood vessels to reduce the appearance of spider veins and redness or discoloration.
  • Tinted makeup

    Green tinted makeup can help to temporarily camouflage skin redness. Some makeup companies create these products specifically for people with rosacea.

    Light-based treatments

    Laser therapy and other light-based treatments can reduce the appearance of spider veins and skin redness, and the results can last for years. Those considering laser therapy may want to start by talking with a dermatologist who has experience working with their skin type. Darker skin, for example, may respond better to certain types of laser therapy than others.

    Learn more about laser treatment for rosacea.

    ETR is a type of rosacea characterized by skin redness or discoloration, flushing, and visible blood vessels. People who have ETR may also experience skin pain and discomfort, such as stinging, burning, or swelling.

    Although there's no cure for ETR, treatments can help to manage the condition and alleviate its symptoms. Dermatologists typically recommend a three-step approach to treatment, which includes avoiding rosacea triggers, using gentle skin care products, and treating redness or discoloration.

    Daily sun protection is crucial for people living with rosacea. Additional treatment options include medicated topical agents and light-based therapies. Talk with a doctor or dermatologist about your individual treatment options.






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