What is Rosacea?
Rosacea is a chronic skin disease characterized by recurrent redness, burning and sensation of heat usually in the face area. It is most commonly seen on cheeks, nose, forehead and chin. Although it is more prominent especially in fair-skinned people, it can appear in any skin type.
Although the exact cause of the disease is not fully known; genetic predisposition, immune system response, sensitivity of vascular structure in the skin and environmental factors can play a role.
Rosacea is not contagious and is not a condition related to hygiene.
Triggering Factors
The following factors can trigger the disease or cause flare-ups:
- Sunlight: Most common trigger
- Hot drinks: Tea, coffee, hot chocolate
- Spicy foods: Hot pepper, mustard, wasabi
- Alcohol: Especially red wine
- Stress and emotional changes
- Extreme hot or cold weather
- Wind
- Intense exercise
- Hot bath and sauna
- Some cosmetic products: Products containing alcohol, perfumed products
- Some medications: Vasodilators, topical steroids
Types of Rosacea
1. Erythematotelangiectatic Type (ETR)
Most common type. Symptoms:
- Persistent facial redness (especially cheeks and nose)
- Capillary prominence (telangiectasia)
- Sensation of heat and burning in the face
- Dry, sensitive and tight skin
- Sudden flushing attacks
2. Papulopustular Type
Acne-like bumps accompany redness:
- Red, inflamed papules
- Pus-containing pustules
- Acne-like appearance (but no comedones)
- Oily skin appearance
3. Phymatous Type
Rare and advanced stage type:
- Thickening of skin structure especially around the nose
- Irregular surface texture
- Prominence of pores
- Rhinophyma (nose enlargement) - more common in men
4. Ocular Type
Type affecting eyes:
- Redness and itching in eyes
- Stinging and burning sensation
- Dryness and tearing
- Sensitivity to light
- Blurred vision
- Swelling in eyelids (blepharitis)
Diagnosis
Diagnosis is made by dermatological examination. Laboratory test is usually not required. Detailed evaluation can be made with dermoscopy. Acne, lupus, seborrheic dermatitis are considered in differential diagnosis.
Treatment
Treatment is planned individually according to the type and severity of the disease.
Topical Treatments
- Metronidazole: Antibacterial and anti-inflammatory effect. In gel or cream form.
- Azelaic acid: Reduces inflammation and redness.
- Ivermectin: Effective against Demodex mites.
- Brimonidine: Provides temporary redness reduction with vasoconstrictor effect.
- Oxymetazoline: Reduces persistent redness.
Systemic Treatments
- Low dose doxycycline: In subantimicrobial dose for anti-inflammatory effect.
- Oral antibiotics: In severe papulopustular type.
- Isotretinoin: In low dose in resistant cases.
Laser and Light Treatments
- PDL (Pulsed Dye Laser): For capillary prominence and redness.
- IPL (Intense Pulsed Light): Telangiectasia and diffuse redness treatment.
- Nd:YAG laser: For deep veins.
- CO2 laser: In rhinophyma treatment.
Skin Barrier Strengthening Care
- Cleansers formulated for sensitive skin
- Fragrance-, hypoallergenic moisturizers
- Products containing ceramide
- Mineral-based sunscreens (SPF 30+)
Lifestyle Recommendations
- Identify triggers: Identify your personal triggers by keeping a diary.
- Protect from sun: Use wide hat and SPF 30+ physical sunscreen.
- Gentle skin care: Avoid harsh scrubs and abrasive products.
- Use lukewarm water: Avoid washing with very hot or cold water.
- Stress management: Apply relaxation techniques such as meditation, yoga.
- Limit alcohol and spice: Especially during flare-up periods.
Prognosis
Rosacea may not completely go away; however, it can be controlled in the long term with appropriate treatment and lifestyle adjustments. It may show progressive course when left untreated. Regular dermatological follow-up is the most effective approach to protect skin health and comfort.
Summary
Rosacea is a chronic condition, but symptoms can be significantly controlled with correct diagnosis and treatment. Avoiding triggers, appropriate skin care and regular dermatological follow-up are cornerstones of disease management.
