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There are many common skin conditions that affect people around the world, acne being one of the most common ones in dermatology. According to the American Academy of Dermatology, rosacea affects 14 million individuals in the United States or five percent of the population. Rosacea is considered a form of adult acne, and is characterized by acne flare-ups, flushing, facial redness, and prominent facial blood vessels and telangiectasia. There are several different forms of rosacea, some manifesting as traditional redness or pimples, and others affected the eyes and coined ocular rosacea.

Though rosacea a common skin issue for many, a survey from the National Rosacea Society found that 95 percent of rosacea patients barely knew any of the signed or symptoms of rosacea prior to their diagnosis. Though the symptoms of rosacea are usually quite apparent, the underlying triggers and environmental causes can be more complex, and expert treatment is vital when it comes to reducing the cosmetic appearance of rosacea.

If you’re frustrated by the appearance of redness, bumps, or broken blood vessels, board-certified dermatologist Dr. Michele Green is here to help. Dr. Green is an expert in cosmetic dermatology and has treated thousands of patients with acne/rosacea in her private NYC office. For over 25 years, she is consistently voted one of the best dermatologists in New York. She will offer you the best medical treatments for the management of rosacea, through her MGSKINLABs line of skin care products, laser treatments, oral antibiotics, chemical peels, and facials, and help restore your quality of life.

What is Rosacea?

Rosacea is one of the most common skin problems, and chronic skin condition, with more than 3 million new cases diagnosed each year in the United States alone. Rosacea can cause redness, visible bumps or pimples on your skin, and broken blood vessels. The primary sites for rosacea are the cheeks, nose, forehead, chin, and chest. Some patients also complain of a burning and itching sensation. Additionally, rosacea can commonly manifest with redness or irritation of the eyes as ocular rosacea. 

The average age for the development of rosacea is typically 30 to 50 years of age, according to the American Academy of Dermatology. Additionally, female patients outnumber male rosacea patients, and the majority of patients have fair skin tones, according to the NIH. The correct diagnosis of rosacea is important, as many of rosacea cases get diagnosed incorrectly as eczema, psoriasis, or allergic contact dermatitis. Proper, immediate diagnosis by an expert health care professional, such as Dr. Michele Green in NYC, is essential in order to properly treat this skin disease. When you consult with Dr. Green, she’ll be able to assess your skin, review your medical history, analyze possible environmental triggers, and determine which treatments will be best for you.

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Before & After photo: Male VBeam for Rosacea

How do I know if I have Rosacea?

The hallmark of rosacea is persistent redness in the central portion of the face which persists for at least three months. This redness may be associated with flushing, broken capillaries and telangiectasias, and an acne-like skin eruption. However, unlike acne, the skin eruption in rosacea does not typically have any comedones, whiteheads or blackheads.

Patients often find that the first symptom of rosacea is a tendency to flush or blush easily. The condition generally starts in the center of the face and then extends to involve the cheeks, forehead, chin, and nose. Over a long period of time, potentially years, the condition can progress to involve persistent redness with visible blood vessels along with pimples and pustules. With time, the redness can become ruddier and more persistent. In more severe cases, the nose may grow swollen and bumpy, a condition known medically as rhinophyma. (It is believed that W.C. Fields had rosacea which caused a rhinophyma on his nose.)

What are the Symptoms of Rosacea?

Rosacea symptoms may vary widely from patient to patient. For example, some patients may have only redness and flushing, while others may have bumps, pimples, thickened skin, pruritus, burning, or eye involvement. For this reason, Dr. Green always provides a customized treatment plan based upon your individual needs. Facial redness in the hallmark of rosacea. It is defined by persistent redness along the central facial skin, with small blood vessels around the nose, cheeks, and chin. These blood vessels can swell and become more visibly prominent and warrant treatment. Red papule or pustules are similar to acne lesions, can be warm, painful or swollen. In some cases, these pustules become infected and exude pus and require antibiotics to control these outbreaks. Eye problems, called ocular rosacea, are associated with this common skin condition.

Does Rosacea Itch?

Many patients who deal with rosacea also, unfortunately, have some accompanying itchiness. This typically comes in tandem with facial redness, and is described by many patients as a sense of dryness or stinging along the surface of the skin.

Does Rosacea Burn? Hurt?

In severe cases of rosacea, it can cause the skin to burn. This burning sensation is typically accompanied by the characteristic flushing and redness that is commonly classified as subtype 1 rosacea, or erythematotelangiectatic rosacea (ETR). Because of this flushing reaction, many patients experience this as painful and need to treat the rosacea to relieve side effect of the condition.

vbeam laser in use

What causes Rosacea?

Although the cause of rosacea is not known, several factors are known to play a role in its development. For example, the condition is more common in women than in men. In addition, the condition may be inherited, which suggests a genetic component. Evidence also suggests that sun exposure is also a contributing factor in the development of rosacea.

Rosacea is a complex condition whose exact etiology is still unknown. However, there are a few possible explanations for rosacea that are currently being researched:

  • Genetic predisposition: patients with a family history of rosacea have been observed to have an increased risk of rosacea
  • Immune System: Rosacea may be caused by an overactive immune system as well. Testing with a peripheral blood monoclonal proliferation assay, it was discovered that a bacteria, Bacillus oleronius stimulates an immune response in 79 percent of 22 patients with subtype 2 (papulopustular type) rosacea.
  • Microscopic mites on the human face, demodex folliculorum, have been associated with an increased propensity of rosacea. Dr. Michele Green was featured in Web MD discussing this in “Are Mites Causing Your Rosacea?” 
  • Helicobacter pylori (h. pylori) is a type of bacteria which normally lives in the gut.  It is believed that this bacteria can cause rosacea to flare by producing an enzyme which causes facial flushing.

Is Rosacea contagious?

Rosacea and its symptoms are not contagious. Though rosacea affects millions of patients each year, it does not spread from person to person, and each individual patient will have different environmental factors and triggers that aggravate symptoms.

How do you get Rosacea? What are the common triggers for Rosacea?

For many patients, rosacea can be aggravated or triggered by certain dietary, lifestyle, or environmental factors, including:

  • Stress
  • Heat
  • Genetics
  • Diets with hot or spicy foods 
  • Caffeine and caffeinated hot drinks, like coffee
  • Dairy products
  • Spices and seasonings with such ingredients as cayenne pepper or red pepper
  • Foods containing cinnameldahyde, such as citrus fruits, tomatoes, and chocolate
  • Smoking
  • Wind
  • Hot baths
  • Exercise such as hot yoga 
  • Extreme heat or cold weather
  • Steam rooms
  • Intense exercise
  • Sun exposure
  • Wind exposure
  • Alcohol
  • Hormonal or endocrine problems, such as thyroid diseases or menopause
  • Hypertension
  • Medications which dilate the blood vessels, such as certain blood pressure medications such as blood pressure medications
  • Certain skin care or cosmetic products such as Retin-A creams or creams that have fragrance or alcohol based

It is very important to identify these “triggers” which can exacerbate your rosacea and avoid them to keep your rosacea under control and avoid flare-ups.

What is Ocular Rosacea? 

Ocular rosacea is defined by pruritic, dry, irritated, and red eyes. In some cases, the eyes can also be photophobic. Many patients complain of eyelid irritation, also called blepharitis, or eyelid swelling, which can lead to serious vision problems if left untreated. Ocular rosacea can be associated with conjunctivitis, which can cause redness and inflammation of the eye itself. Steroid eye drops, such as Blephamide, may be prescribed. Styes are also a common occurrence with ocular rosacea. Almost half of the patients with rosacea suffer from ocular rosacea.

Rhinophyma

Rhinophyma is characterized by red, large, bumps on the nose, which tend to increase in size and become bulbous. Rhinophyma is a manifestation of severe rosacea, and can often be associated with ocular rosacea. It gradually forms over many years, classical when rosacea is improperly treated or untreated. The large mass that is formed at the end of the nose is a very serious cosmetic concern. 

Rhinophyma tends to occur more commonly in men than women, and the after the onset of disease, gets worse with age. As rhinophyma clinically gets worse, typically you see an increase in facial redness, a thinking of the skin, a rough and waxy appearance to the epidermis, enlarged facial pores, and an increase in the number and size of oil glands. The treatment of rhinophyma is difficult, since typically once it develops, it responds poorly to oral or topical antibiotics. Isotretinoin (Accutane) can be employed to help decrease the increase in sebaceous glands and inflammation.

Surgery is the most effective treatment of rhinophyma, as the overgrowth of blood vessels and tissue classical cause facial disfigurement around the nose. The main restorative surgical approaches to rhinophyma consist of traditional surgery, laser resurfacing with CO2 lasers, cryosurgery, and dermabrasion. Through the use of these surgical and laser modalities, the shape of the nose can be restores and the overgrowth of tissue be improved cosmetically.

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Before & After photo: VBeam laser to treat Rosacea

Rosacea Subtypes

Because rosacea is a complex condition, it has been divided into subtypes, which are determined based on the appearance of the skin. This subdivision helps classify rosacea. However, patients may have symptoms of more than one subtype at the same time.

Subtype 1 – Erythematotelangiectatic Rosacea

Subtype 1 is characterized by persistent facial redness (or erythema). Broken blood vessels, called telangiectasias, may be present, and the skin may feel irritated, sensitive, and uncomfortable, akin to a sunburn.

Subtype 2 – Papulopustular Rosacea

Subtype 2 is characterized by facial redness and acne-like bumps and pimples. Patients with subtype 2 rosacea tend to experience more oily skin texture, as well as raised skin patches.

Subtype 3 – Skin Thickening

Subtype 3 (medically called phymatous rosacea) is characterized by skin thickening and enlargement, especially around the nose. When the nose is involved in this manner, it is referred to as a rhinophyma. It is believed that W.C. Fields had this type of rosacea involving his nose.

Subtype 4 – Ocular Rosacea

Subtype 4 is characterized by the presence of eye symptoms, including watery eyes, red eyes, foreign body sensation, eye burning, dry eyes, styes, and blurred vision. Ocular rosacea should be treated by an ophthalmologist. 

Can Rosacea Go Away?

Unfortunately for those affected by rosacea, it is not a skin condition that tends to go away on its own. Rosacea tends to go into remission, at which point symptoms will not be visible, and then return in the form of a flare-up. For this reason, it’s typically classified as a chronic skin disease, and should be monitored and treated by an expert dermatologist. Dr. Green works with patients who are new to rosacea as well as those who have dealt with flare-ups for years, and will be able to develop a sustainable treatment plan that best fits your current needs.

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VBeam for Rosacea – 4 months

Can you pop rosacea bumps?

If you suffer from red papules or pustules due to rosacea, it is important not to attempt to pop these bumps, as this can further aggravate the affected area. However, there are several topical and in-office treatments that can help to heal these papules or pustules.

How to Treat Facial Rosacea

When it comes to treatment for rosacea, there are a three major goals to consider. The first is to control inflammation and irritation caused by rosacea. The next is to treat the appearance of flushed skin, redness, and/or broken blood vessels in order to improve the look and feel of the skin. Lastly, Dr. Green always wants to leave her patients with healthy and glowing skin. When it comes to rosacea treatment, the best possible care should leave patients feeling and looking even better than before the onset of symptoms.

In order to contain, heal, and reduce the appearance of symptoms due to rosacea, patients typically rely on a combination of medications, photodynamic treatments, and laser treatments. These treatments may include common topical treatments such as antibiotic gels or vitamin-C serums, oral medications, laser treatments such as the VBeam laser, or light therapies such as Red and Blue Light therapy. By combining several skin care modalities, Dr. Green can effectively treat and control every case of rosacea.

Best Topical Skin Care Treatments for Rosacea

The best dermatologists, like Dr. Michele Green in NYC, start by first analyzing your basic skin care regime. Since patients with rosacea have some of the most sensitive skin, Dr. Green will suggest gentle cleansers and toners to clean your skin, and non-comedogenic, oil-free moisturizers, to treat your skin.  Next, she will prescribe some topical medications and antibiotics to treat your rosacea. 

  • Metrogel, or Metronidazole cream, is a classic topical antibiotic cream which both prevents and treats facial rosacea and its accompanying redness.
  • Soolantra (Ivermectin) is an excellent choice to treat the inflammatory component of rosacea as well as the redness.
  • Mirvaso (Brimonidine) gel is a topical cream which reduces the blood vessels from rosacea and is used once a day.
  • Azelaic acid– is a gel that treats the papule, pustules, and inflammatory component of rosacea. 
  • Vitamin C Serum-is an excellent antioxidant serum, reduces facial redness and rejuvenates the face. Dr. Green’s best-selling Vita-C-Serum is available online here.

MGSkinLabs Vita C Serum

Oral treatments/ oral antibiotics for Rosacea

One of the main treatments for rosacea are oral antibiotics, such as doxycycline, minocycline, or tetracycline. Dr. Green traditionally prescribes Doxycycline, or Oracea, or Flagyl (Metronidazole) for facial rosacea and its associated breakouts. The main side effect of chronic oral antibiotic usage are yeast infections, gastrointestinal upset, and photosensitivity. 

In some cases, Dr. Green may recommend the use of isotretinoin (Accutane) in order to treat chronic papules or pustules caused by rosacea. Although isotretinoin is typically used for traditional acne, it can be successfully used to treat rosacea. Ocular rosacea can be treated with oral antibiotics as well as various eye washes and antibiotic drops. In more severe cases of ocular rosacea, Dr. Green will refer you for consultation with a board certified ophthalmologist.

Laser Treatment for Rosacea

V-Beam Pulsed Dye Laser

The V-Beam pulsed dye laser is the gold standard for rosacea treatment. The VBeam laser therapy is extremely effective at removing the redness and visible blood vessels associated with facial rosacea. The V-Beam laser is a pulsed dye laser which selectively absorbs and treats anything “red”. Following the laser pulse, the laser energy is transmitted to the blood vessel wall, which leads to a narrowing of the blood vessel and shrinks the size of the blood vessel. Laser light therapy also reduces the surrounding redness from the rosacea, giving you beautiful and clear skin.

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VBeam, 2 sessions, 2 months before and after

Intense Pulsed Light (IPL) Therapy

Intense Pulsed Light (IPL) is another which Dr. Green treats redness and broken blood vessels for her patients who suffer from Rosacea.  With the Sciton IPL, intense pulsed light is used to reduce redness as well as pigmentation in the same treatment session. 

Red and Blue Light Therapy

Red/Blue Light Therapy in the form of LED light therapy, helps reduce redness and fine lines.  Dr. Green utilizes light therapy as part of a HydraFacial for rosacea with a special treatment with Rozatrol, designed to reduce the redness from rosacea.

Photodynamic Therapy

Photodynamic therapy is an exciting treatment that is commonly used for patients dealing with active acne lesions, rosacea, or psoriasis, among other skin conditions. Photodynamic therapy uses a photosensitizing molecule along with intense blue light in order to heal the skin. Levulan, which is a topical medication is placed on your facial skin for one hour. After one hour, the Levulan solution is removed and you are exposed to the Blue light for 16 minutes. The Blue light will activate the acne/rosacea lesions and help to heal your rosacea and its associated outbreak.

HydraFacials for Rosacea

HydraFacials are a unique way to treat acne rosacea, by a patented skin process, which involves three unique steps. Through vortex technology, the skin is able to be cleaned deeply of impurities, followed by exfoliation, and lastly hydration. Not only do HydraFacials treat acne, rosacea, and facial redness, it also treats discoloration, and facial wrinkles. HydraFacials are recommended as monthly treatments, to improve facial tone, texture, red and brown spots, and reduces enlarged pores.

How to get rid of rosacea permanently? Can rosacea be cured? Does rosacea go away?

Though there is no known cure for rosacea, there are ways to contain, reduce, and eliminate the appearance of rosacea on the surface of the skin. Light therapies and laser treatments are excellent options for patients looking to reduce the likelihood of broken blood vessels and to heal the skin during and after a flare-up. The key to treating rosacea is maintenance, proper skin care, healthy diet and exercise, and avoiding the known triggers for rosacea.

Is Rosacea an autoimmune disease?

Rosacea is not considered a classical autoimmune disease. However, having rosacea makes you twice as likely as being associated with another autoimmune disease. Rosacea is considered an inflammatory condition. However, it shares genetic loci with other autoimmune diseases, such as type 1 diabetes mellitus and celiac disease. Recent studies have also associated rosacea with an increase in thyroid disease. Further studies are needed to understand the true mechanism involved in rosacea.

Is rosacea genetic?

Yes. Rosacea tends to run in families and there appears to be an inherited or genetic component to rosacea.

Does H. pylori aggravate rosacea?

Yes, there are some studies which suggest that an elevated level of H. pylori in one’s gut increases the amount of gastrin produced. It is this increased gastrin production which may cause the flushing seen in facial rosacea.

Is rosacea caused by mites?

Some rosacea is believed to be caused by mites which live on the skin. Demodex folliculorum is the type of mite which lives harmlessly on one’s skin. However, some patients have a sensitive of these mites, which can irritate your skin and cause rosacea.

Does rosacea affect your eyes?

Yes, 50% of patients suffering from rosacea have some aspect of ocular rosacea, affecting their eyes.

How to calm and prevent a rosacea flare-up

  • Proper skin care and the use of gentle products, such as Cetaphil, are essential for patients with rosacea.
  • Daily high-SPF sunscreen that blocks both UVA and UVB rays, as well as a wide-brimmed hat, are important in preventing flare-ups of rosacea.
  • Applying the proper non-comedogenic moisturizers, hydrating creams, and topical medications can control rosacea flares.
  • Proper eye care when needed such as re-wetting eye drops (artificial tears) and special eye rinses with help with ocular rosacea.
  • Avoid spicy foods.
  • Avoid extreme in temperatures, like very hot or very cold temperatures.
  • It’s best to avoid things which exacerbate the effects of rosacea, like sun exposure, irritating make-up, hot beverages, cigarette smoking, and caffeine.
  • Try meditation or yoga as a way to manage stress.

How to help your rosacea today?

If you’re suffering from symptoms of rosacea, there are solutions that can help. Dr. Michele Green has been effectively treating acne/rosacea for over 25 years in her private, discreet, New York office. Dr. Green has the best treatments and innovative lasers to treat acne/rosacea, including the V-Beam laser treatment.  

Her NYC, Upper East Side office, is conveniently located on East 79th Street. Please book a consultation online today or call 212-535-3088 to see how Dr. Green can best help to treat your rosacea. Dr. Green has been consistently voted as one of the best dermatologists in NYC by Castle Connolly, The New York Times, Super Doctors, and New York Magazine. Let Dr. Green’s office help rejuvenate your complexion and give you beautiful, clear skin today.

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