This post is focused on a common skin condition called rosacea. There are different types of rosacea. The most common types are “papular” and “erythematotelangiectatic,” with most people having a combination of these two (either simultaneously or at different times). The least common type of rosacea is phymatous, which is characterized by thickening of the nose and facial skin (it often involves the other types as well).
So what is rosacea? I describe rosacea (which I have) as skin that has all or some of the following characteristics:
- Tendency to break out – You wake up with red bumps on your nose.
- Tendency to get red easily – Blushing, flushing, with exercise, wine- pretty much anything.
- Reacts to products easily – Sunscreens, makeup, and really anything
- Your face stays red and you have blood vessels on your cheeks and nose.
Does this sound like your skin on more days than you would like? You might have rosacea.
What causes rosacea? There are many theories – in the simplest terms we think it represents an inability of the skin to react to changes or stressors. Resulting in red bumps and red faces. Luckily we have several treatments for rosacea. Some people are able to avoid triggers (such as sunshine or wine) and control their rosacea, but most people are unable to find a specific trigger or it is difficult to avoid.
Treatments are categorized into topical (creams) and oral (pills) treatments. I find topicals work best on mild rosacea and for maintenance, as they can take several months to get things under control (when used alone).
The most common oral medications are antibiotics. These are generally used in low dose fashion for short time periods (2 weeks to a couple of months) to get flares under control. I usually prescribe doxycycline 50 or 100 mg once per day. Rosacea is not an infection but the antibiotics are used for their anti-inflammatory properties.
There are several different topicals, which I either prescribe with an oral medication or alone. My favorite topicals are Azelaic Acid (brand Azelex or Finacea) and Sulfacetamide (brand Klaron, Clenia, Ovace and others). Other topicals are Metrocream and Metrogel, which we often use first as they work well for some people and cost much less than brand name medications. There is a newer topical called Soolantra, which is topical ivermectin. Some people will have great results with this medication, as there is a theory that rosacea can be triggered (in some people) by a kind of mite that lives on the skin (sounds gross but it’s normal). Soolantra targets these mites called demodex.
The most common treatment in my practice is a short course of an oral antibiotic (clearing flare) combined with a topical (maintenance). This will get you clear quickly, but in order to stay clear it is necessary to continue the topical treatment (sometimes indefinitely). For people with very severe rosacea (such as phymatous), isotretinoin (accutane) can be very effective.
I also recommend using products by EltaMD (this can be considered a natural approach too) as they are formulated for rosacea prone skin. The EltaMD moisturizers (AM and PM) and some sunscreen (UV Clear) have niacinamide.
I encourage you to see your doctor if you think you might have rosacea. It is an annoying and even painful/itchy condition that can be treated. Additionally, untreated rosacea can lead to a persistently red face (because of dilated blood vessels) or an enlarged nose (phymatous rosacea). I welcome any comments or questions!
Seattle Skin MD 
How do folks with rosacea handle exfoliation? I often find flakes of dry skin on my nose in the winter but I am not sure what to use to exfoliate. I also used to use masks but I am guessing they are a bad idea now.
That is a great question. Exfoliating can be tough for people with rosacea (and anyone with sensitive skin). Exfoliating scrubs can cause irritation and increase redness. Retin A and retinol creams (which provide a slow exfoliation) can do the same. I have trouble with all but the most gentle retinol. The way I exfoliate my sensitive and rosacea prone skin is to perform a peel every 2-3 months. This does cause 3-5 days of redness and peeling, but it gives a great and lasting rssult, so I don’t need to exfoliate more often (and cause more frequent peeling and redness). I also recommend a gentle procedure such as Dermasweep- which uses a vacuum and suction to remove dead skin. Dermasweep doesn’t cause redness or peeling.
Hi, I just heard about Mirasol for rosacea. Do you have any opinions about it?
Mirvaso is a new medication used to combat redness of rosacea. It is actually a medication that has been in use for another purpose for many years- and we have used that medication for skin redness. The problems that I have had with mirvaso are rebound redness and compensatory redness. Mirvaso decreases redness temporarily and some people experience worsening of the redness when it wears off. The other problem reported by my patients is redness in areas where the mirvaso was not applied (such as the upper forehead, neck or chin). For those reasons (and the high cost of the medication) I don’t prescribe mirvaso very often (only if someone requests the medication). Hope this answered your question.