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What is Rosacea?

Rosacea is a very common acne-like facial eruption that is more common in people over thirty and in those of Celtic origin. However, people of any ethnic background can also have it. One component is vascular (red face, blushing, flushing and enlarged capillaries) and one is a breakout that looks like that of acne. There are a variety of triggers that cause the breakouts to be worse. It can also include watery or gritty feeling eyes and in rare cases (but rarely in women), a thickening of the nose called rhinophyma. Some people find that their facial skin burns, stings, or itches, even when they do not have a breakout.

What Causes Rosacea or Triggers an Outbreak?

The cause of Rosacea is the chronic inflammation of the skin caused mostly by the heating of the skin in people prone to develop it. This can be from hot foods or drinks, exposure to heat sources-including the sun!-, flushing and blushing from exercise or emotions, and certain histamine containing foods.

People with rosacea tend to have sensitive skin that irritates easily. They can break out from beauty products that improve other people skin. They suffer from an over-reactivity of the immune cells in their skin; thus we do not ‘cure’ rosacea but rather control it. For some people that control may be nearly perfect with only an occasional pimple but for others it may mean that they may always have a few blemishes and sometimes have a flare of worse symptoms.

What Do You Mean Histamine Containing Foods?

Histamine triggers the immune response and increases the permeability of small blood vessels. Because of these effects, it is thought to make rosacea symptoms worse. Any fermented or aged foods are naturally high in histamine. Histamine containing foods include cheese, sauerkraut, wine, soy sauce, tofu, eggplant, and canned fish. Some foods although not containing histamine, can cause the body to release histamine from mast cells. These are the foods that many people are allergic to, such as bananas, tomatoes, nuts, shellfish and chocolate.Foods high in niacin. Foods high in niacin also tend to cause flushing.

Not every person experiences the effect from every food, fortunately, or we would have nothing left to eat! Keeping a food diary can be helpful to identify food triggers. Other triggers such as overheating from outside sources or emotional stress can be noted in the same diary.

Is Rosacea Adult Acne?

No. Although they can look very similar, they have different causes. Although some treatments can be used on both, some acne treatments can make rosacea worse rather than better. It is important to get an accurate diagnosis so that the correct treatment can be applied. Rosacea can also occur together with aging from the sun or seborrheic dermatitis, and these factors may change what your doctor chooses for treating you.

How is Rosacea Treated? Can It be Cured?

Rosacea cannot be cured, but for many people it is only an occasional problem or it can be well controlled with topical treatment and gentle skin care. Anything that enhances a good barrier function on the skin will calm down its inherent hyper-reactivity. Topical prescriptions from your health care provider may include metronidazole, azelaic acid, sulfacetamide/sulfer, or clindamycin. Some of the newer products include brimonidine, which decreases the rednes of enlarged capillaries, and Soolantra, which fights the demodex mites that live in the skin and seem to cause outbreaks in some people. Oral treatment is very effective and antibiotics at very low “submicrobial” doses work for many people. For those severely affected or those for whom these treatments are not controlling the rosacea, Isotretinoin (previously the brand Accutane) can be used. This drug is usually used for acne; for rosacea it is used at lower doses and is not as reliably effective.

This Is Really Upsetting! Why Me?

The bumps, the redness, the easy flushing, and the sensitive skin can be very upsetting. Many feel embarrassed and frustrated with their irritated looking and broken out skin. A proper diagnosis is important, as there are some other conditions that cause similar looking breakouts. The same triggers do not affect everyone and the same treatments do not work on everyone. Your healthcare provider and you will need to work together to find the best treatment for you.

Everything you can do to preserve a good barrier on your skin will help-mild soap, moisturizers, sunblock, and care with trying new products, especially those marketed as “antiaging”. Reducing stress and anxiety can help—easy to say but sometimes hard to do, I know. A proper diet with anti-inflammatory foods is good for everyone whether they have rosacea or not. If facial redness is the primary sign, laser treatments or green-tinged makeup can help, as well as the brimonidine mentioned above. Effective treatments are varied, and they exist; you and your provider can find the one for you

For advice on choosing skin products and up to date information on rosacea, go to the website of the National Rosacea Society at www.rosacea.org. A website where sufferers share experience and advice is at www.rosacea-support.org

Frequently Asked Questions

What is Rosacea?