What is Acne Rosacea?
Acne rosacea is a common skin condition where an individual displays a constant red flushing on their skin, often accompanied by pimple-like lesions known as papules and pustules. This condition is believed to affect 45 million individuals worldwide.
The majority of individuals who have rosacea are Caucasian, very often of Celtic descent and have very fair skin. The major symptoms of rosacea are as follows: small broken blood vessels known as telangiectasias appear on the surface of the skin, red or pinkish blotches on the skin, especially on nose, chin and forehead, and even eyes that are persistently red.
Many people who suffer from rosacea are not even aware that their condition is eminently treatable. These individuals may just think that they blush easily, or get flushed often, or are just hyper-sensitive to the sun.
Although rosacea is a very treatable skin condition, it is considered non-curable, and has periods of flareups and remissions. Unlike the acne present in adolescence, victims of acne rosacea do not outgrow their condition.
If you have acne rosacea, you are in good company. President Bill Clinton has rosacea, and the famous “whiskey-nose” of actor W.C. Fields was also attributable to rosacea.
Rosacea is not spread from person-to-person. Touching or kissing a person with rosacea will not spread rosacea by contact. It may be due to a genetically-triggered auto-immune response that is not well-understood.
Acne rosacea, despite its name, is not the same condition as regular acne, although the two conditions may co-exist. Acne rosacea is sometimes referred to as “adult acne”.
Who Gets Acne Rosacea?
Rosacea primarily affects adults from ages 30-50 years of age. Unlike garden variety acne, typical whiteheads and blackheads are not a feature of acne rosacea. Acne rosacea is characterized by small, hard red bumps that cannot be “popped” or squeezed like a regular pimple would be. If you tried to squeeze a rosacea pimple, nothing but a tiny amount of clear fluid would be expelled from the lesion. Even extraction by a professional will make no difference, as it will not clear up acne rosacea.
Typical sufferers of regular acne do not have the persistent rosiness of the skin present in acne rosacea sufferers.
Acne rosacea can strike both men and women; women are afflicted more frequently, but men are afflicted more severely.
Children rarely have the condition, nor do darker ethnic skin tones.
What are the Causes of Acne Rosacea?
Acne rosacea appears to be somewhat hereditary in nature, but there are many suspected causes. A few of these suspected causes are: A skin mite that lives in the hair follicles called Demodex folliculorum; the same bacteria that causes stomach ulcers, H. pylori; gastrointestinal issues and medications that cause blood vessels to dilate.
Acne rosacea also has some well-known triggers that cause increased flare-ups. Emotional stresses such as anxiety and embarrassment may trigger the flushing response associated with rosacea.
Weather can also be a factor, as rosacea prone-skin responds negatively to cold winds, as well as excessive heat and humidity. Excessive sun exposure is also associated with acne rosacea.
Other documented triggers include alcohol consumption (red wine is particularly bad), spicy foods like chilis, and curries, and even exercise as it dilates the blood vessels.
How is Acne Rosacea Diagnosed?
Usually, there are no invasive tests needed to diagnose acne rosacea; however, a small skin biopsy is occasionally required. Examination under a Wood’s lamp can rule out skin conditions that appear similar on the surface, such as dermatitis. A scraping and culture of the affected individual’s skin cells can reveal other causes of the patient’s skin redness, such as staff infections.
Many times, an experienced dermatologist can diagnose rosacea by examination alone.
Acne Rosacea Treatments
The type of treatment chosen by a physician depends on the severity of the case of acne rosacea. There are a number of physician-prescribed treatments available, including antibiotics, topical creams and gels, laser treatments, and IPL (Intense Pulsed Light) treatments. The condition generally does not improve on its own.
Severe cases may require a multi-pronged approach to bring it under control. For example, a patient with severe acne rosacea may take oral antibiotics as well as be prescribed a topical antibiotic cream in addition to being required to wash twice-daily with a special sulfa-based wash. Treatment with lasers or IPL may also be required in addition to the antibiotic regimen.
Milder acne rosacea can often be controlled with topical creams such as Metrogel (metronidazole) or Finacea (azelaic acid). These are applied once or twice daily after washing. Both of these topical treatments treat the redness and facial bumps present with acne rosacea.
Certain patients have noticed marked improvements after alternating treatment with these medications, using one in the morning and the other in the evening. Klaron lotion (sodium sulfacetamide) can be used in conjunction with these treatments to help control and reduce inflammation.
For those whose acne rosacea has progressed to the moderate level, oral antibiotics often become part of their treatment regimen. The most common antibiotics prescribed for acne rosacea include tetracycline; doxycycline in a lower-dose formulation called Oracea and amoxicillin. Of course, taking antibiotics often come with side-effects such as gastrointestinal upsets and trigger yeast infections.
If the inflammation caused by acne rosacea is severe, a short cycle of a low-dose steroid may be prescribed. The risk with long-term use is that it can actually make acne rosacea symptoms worse.
A seldom-used treatment is Accutane, more commonly prescribed for severe acne. It is a drug of last-resort for acne rosacea, as its side-effects can be severe, and often of little benefit. The side effects from this drug are very serious, as it is a known teratogen (causes horrific birth defects).
It can also cause liver-damage, and constant monitoring by a physician when on Accutane is required. As well, Accutane can cause extreme sensitivity to sun exposure, so careful consideration is needed before beginning this course of treatment.
A newer development in the treatment of acne rosacea is laser and IPL treatments to control redness and diminish the appearance of blood vessels on the skin’s surface. These treatments can often visibly improve the appearance of skin affected by acne rosacea, however they can be uncomfortable, and are seldom covered by insurance. Usually, several treatment sessions are required to see improvement.
It does go without saying that one of the key elements of treating rosacea is sun protection. Daily use of a high SPF sunscreen is imperative to control rosacea flareups.