10 Things About… Rosacea

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📖 5 min read

By Ahmed Abdullah, M.D., F.A.C.S., F.I.C.S.

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For the 45 million people worldwide who suffer from rosacea, the disorder can be a constant source of frustration and embarrassment. Because symptoms often mimic those of other skin conditions, improper diagnoses and treatment protocols are common, leading to a continuation and, often, a worsening of symptoms.

What is more, rosacea flare-ups can be triggered by various and unpredictable stimuli, making it difficult to control. Despite these challenges, rosacea can, indeed, be successfully managed and treated with proper intervention. Additionally, significant research dollars have been dedicated to investigating this disorder, leading to promising new treatments and a better understanding of rosacea’s potential causes.

1. Rosacea and the Northern European connection. Rosacea typically is associated with individuals of Northern European ancestry, including light-complexioned individuals with Irish or Norwegian roots. However, a 2009 study suggested that rosacea is more prevalent in India than previously thought, a fact that flies in the face of long-held assumptions about who is at risk of the condition.

2. Rosacea typically gets worse with age. Initially, the disorder presents with severe reoccurring facial flushing between the ages of 30 and 60. Over time, however, symptoms can expand to include spider veins, dryness, scaling, papules, pustules (that resemble acne breakouts), thickened skin, and worse. Early intervention is key to preventing long-term skin damage. However, because symptoms can occur intermittently, those with rosacea often fail to seek medical intervention when it is in its early stages.

3. Rosacea cannot be cured. The good news is that today’s treatments often allow those with rosacea to live nearly symptom-free.

4. Know rosacea sub-types. To properly treat rosacea, medical professionals must classify the patient’s subtype.
• Subtype 1 – Erythematotelangiectatic rosacea is characterized by persistent redness in the center of the face.
• Subtype 2 – Papulopustular rosacea is characterized by oily skin and breakouts that resemble acne.
• Subtype 3 – Phymatous rosacea is characterized by thickening of the facial skin. Thickening that causes enlargement of the nose is called ‘rhinophyma.’
• Subtype 4 – Ocular rosacea is characterized by inflammation of the eyes and eyelids. This type of rosacea can cause a burning, itching, and gritty sensation in the eye.

5. Understand common triggers. Research has demonstrated that those who suffer from rosacea have greater nerve, blood vessel, and sweating responses when exposed to heat or stress than those without the disorder. This research helps explain why hot drinks, spicy foods, alcohol, saunas, exercise, warm temperatures, sunlight, anxiety, and more can trigger a rosacea flare-up. Those with the condition often report that cold compresses can help calm a flare-up.

6. Consider the gut. Rosacea often occurs in combination with gastrointestinal disorders, which reinforces the known link between the gut and the skin. Studies have demonstrated that those with rosacea have small intestinal bacterial overgrowth (SIBO) that, when controlled, results in a dramatic improvement in rosacea symptoms. To control SIBO, those with rosacea should cut out processed and starchy foods and replace them with whole foods that are nutritionally dense.

7. Rosacea is on the rise. Twenty-five years ago, rosacea was a rare skin condition. Today, however, 16 million Americans are believed to suffer from it. Researchers are unsure if this is due to an increase in the age and size of our population, genetic and/or environmental factors, or medical professionals’ increased understanding of the condition and, therefore, an increase in the frequency with which it is diagnosed.

8. Treatment options are more sophisticated. Today, clients who have been diagnosed with rosacea have more treatment options than ever before. Prescription options include antibiotics, tretinoin, topical therapies, and more. Additionally, IPL and laser therapy are often used to treat redness and telangiectasia, while skin peels are effective in the treatment of papulopustular rosacea. Those with phymatous rosacea have shown improvement with drugs directed at sebaceous gland hypertrophy. Advances in the treatment of rosacea are becoming common. In fact, within the past few months, the FDA approved a promising new prescription cream, Ivermectin 1%, for the treatment of papulopustular rosacea.

9. Proper skin care. Clients with rosacea must take care to ensure their skin care regimen is gentle and does not encourage inflammation. Look for products that are free of irritating ingredients, like alcohol, excess fragrance, witch hazel, or peppermint, and cut toners and scrubs out of their regimen. Retinoids and products with alpha or beta hydroxy acids should be used with care and under the guidance of a medical professional. Some rosacea sufferers have experienced an improvement in symptoms through the use of products that combine alpha hydroxy acids with an anti-inflammatory ingredient, like pharmaceutical-grade aloe vera. In this scenario, alpha hydroxy acid works to thicken the skin’s dermis layer, while the anti-inflammatory ingredients calm redness.

10. Avoid stress. There is a documented connection between the mind and the skin, so much so that the field of psychodermatology is growing in prominence. When it comes to rosacea, stress is a known trigger. For that reason, many people have found that yoga, meditation, psychotherapy, and even hypnosis are helpful in keeping flare-ups at bay.

References
National Rosacea Society. (2013, Spring). New Study Shows Heat Increases Nerve Activity.
Parodi A, Paolino S, Greco A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clinical Gastroenterology and Heratology. 2008; 6 (7): 759-64.
Wollina U, Verma S.B. Rosacea and rhinophyma: not curse of the Celts but Indo Eurasians. Journal of Cosmetic Dermatology. 2009; 8: 234-235.

Ahmed Abdullah, M.D., F.A.C.S., F.I.C.S. is author of the forthcoming book, Simple Skincare, Beautiful Skin: A Back-to-Basics Approach, CEO and founder of Lexli International, Inc., and formulator of the company’s Lexli® line of professional skin care products. A board-certified plastic/reconstructive surgeon and a leading aloe researcher, Abdullah travels the world, educating licensed professionals and consumers alike about the proper ways to utilize aloe in skin care applications, the essential steps to ensuring the skin’s basic needs are met, and setting the record straight on prevalent skin care myths. He regularly sees patients at his practices in Fargo, N.D. and Dubai, United Arab Emirates. www.lexli.com