Rosacea

What is Rosacea? 


Rosacea is a common skin condition that usually manifests after age 30. Signs include recurrent episodes of redness/flushing of the cheeks, nose, and or chin. These are usually the early signs of rosacea. Later signs may include eye irritation (ocular rosacea), and/or burning/stinging, papules/pustules, enlarged nose, or spider veins where there is redness or flushing. This is why it is important to treat rosacea early, before the later signs manifest. 


What are common triggers?


Wind

Sun

Alcohol

Hot beverages

Hot temperatures

Intense feelings or anger or embarrassment

Foods containing Capsaicin such as hot sauces, cayenne or red pepper.

Foods containing cinnamaldehyde such as tomatoes, citrus, cinnamon, and chocolate. 


Medications which can make rosacea worse include Calcium channel blockers, sildenafil, nitrates, nicotinic acid and some vitamin B-related medications including niacin. 


Rosacea diet


A diet high in omega-3 fatty acids (eg., flax seeds and salmon) and zinc may help reduce rosacea flares as well as eating a diet high in fiber, prebiotics (known as non-digestible food ingredients that selectively stimulate the growth and/or activity of beneficial GI microbes) and probiotics (live natural microorganisms with health benefits). 

Prebiotic foods include bananas, onions, raw leeks, raw artichokes, raw garlic and kale, while Probiotic foods include yogurt, pickles vegetables or fruit (eg., Kimchi), Kombucha, and sauerkraut. 


Some foods which may trigger a rosacea flare or worsen rosacea include refined sugars, processed meat, red meat, fried foods, preservatives, and gluten.


Treatments:


Rozatrol by ZO. If you would like to go the non-prescription route this cream has been specifically formulated to reduce facial redness for those with sensitive skin. We recommend washing with salicylic acid wash cleanser plus applying Rozatrol cream twice per day for younger clients or those with early signs of Rosacea.  


Metronidazole 0.75% has been shown to reduce redness (erythema), papules and pustules in multiple trials of patients with moderate to severe rosacea. It is usually well tolerated with minimal local adverse effects such as skin irritation. It is applied twice per day for best results.


Azelaic acid (15-20% gel or lotion) is an over-the-counter preparation which has anti-inflammatory, anti-keratinising and antibacterial effects which can be applied once or twice daily. Adverse effects may include skin irritation, but azelaic acid is usually well tolerated and can be used for long periods of time.


Brimonidine is a topical gel (0.33%) which can reduce redness for up to 12 hours through direct cutaneous vasoconstriction. This medication is very useful for some people when not used on a daily basis. 


Intense Pulsated Light (IPL): This treatment congeals the blood contained in the small superficial vessels (telangiectasia) which result from repeated skin flushing or chronic sun exposure. 


Doxycycline 40 mg per day is beneficial for treating acne rosacea. Photosensitivity is the main adverse effect, so daily sun avoidance or sunscreens are required.


*Topical treatments should be given the chance to work for at least 6 weeks. 

*Avoid topical steroids to the affected areas


References:


Rivero, A. L., & Whitfeld, M. (2018). An update on the treatment of rosacea. Australian prescriber, 41(1), 20–24. doi:10.18773/austprescr.2018.004


Weiss, E., & Katta, R. (2017). Diet and rosacea: the role of dietary change in the management of rosacea. Dermatology practical & conceptual, 7(4), 31–37. doi:10.5826/dpc.0704a08


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