What is Rosacea?
Rosacea is a very common dermatologic condition, often a chronic skin condition, with more than 3 million new cases diagnosed each year in the United States and 16 people suffering with rosacea every year in the USA. 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 or a burning and itching sensation and rosacea can commonly manifest in the eyes as well (periocular rosacea). The average age for the development of rosacea is typically 30 to 50 years of age. Women who are fair skin outnumber men and patients with darker colored complexions. The correct diagnosis of rosacea is important as many of these cases get diagnosed incorrectly as eczema or allergic contact dermatitis. Proper immediate diagnosis, by a board certified dermatologist, like Dr. Michele Green, is essential in treating this skin condition and prescribing the correct topical and oral medications for you rosacea treatment.
Dr. Green is an expert in rosacea and one of the best dermatologists in NYC to treat facial rosacea with the proper skin care, oral medications and laser treatments.
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 (medically called telangiectasias), and an acne-like skin eruption. However, unlike acne, the skin eruption in rosacea does not have any 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?
- Facial redness where there is persistent redness in the central face, with small blood vessels around the nose and cheeks which swell and become more visible.
- Red papule or pustules which are similar to acne lesions. These lesions can be warm, painful, swell, and exude pus.
- Ocular rosacea where the eyes are pruritic, dry, irritated, and red, and can be photophobic. Many patients complain of eyelid irritation, also called blepharitis, which can lead to serious vision problems if left untreated.
- Rhinophyma where facial rosacea gets worse on the nose, causing the nose to swell and become bulbous.
Which factors aggravate rosacea or make it flare up?
- Diet such as hot or spicy foods
- Caffeine and caffeinated hot drinks, like coffee
- Exercise such as hot yoga
- Extreme heat or cold
- Steam rooms
- Sun exposure
- Wind exposure
- Hormonal or endocrine problems such as thyroid diseases or menopause
- Medications which dilate the blood vessels
- Certain skin care or cosmetic products
It is very important to identify these “triggers” which can exacerbate your rosacea and avoid them to keep your rosacea under control and avoid flares.
Before & After photo: V-beam laser to treat Rosacea
What are the causes of Rosacea?
Rosacea is a complex condition whose exact etiology is still unknown. There are several possible explanations for rosacea:
- Genetic predisposition: patients with a family history of rosacea have been observed to have an increased risk of rosacea in our NYC, Manhattan, dermatology practice.
- 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?”
- 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.
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 the findings of more than one subtype at the same time.
Subtype 1 – Facial Redness
Subtype 1 (medically called erythematotelangiectatic rosacea) is characterized by persistent facial redness and flushing. Broken capillaries, called telangiectasias, may be present, and the skin may feel irritated, sensitive, and uncomfortable.
Subtype 2 – Bumps and Pimples
Subtype 2 (medically called papulopustular rosacea) is characterized by facial redness and acne-like bumps and pimples.
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 – Eye Irritation
Subtype 4 (medically called ocular rosacea) is characterized by the presence of eye symptoms, including watery eyes, red eyes, foreign body sensation, eye burning, dry eyes, and blurred vision. Ocular rosacea should be treated by an ophthalmologist.
Although the cause of rosacea is not known, several factors are known to play a role in its development. The condition is more common in women than in men. In addition, genetics is also clearly a factor, as the condition may be inherited. Evidence suggests that sun exposure is also a contributing factor in the development 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, or eye involvement. For this reason, our treatment plans are always customized based upon each individual patient’s unique needs.
What are the Treatment Options for Rosacea in NYC?
The goals of rosacea treatment are the following:
- Bring inflammation and irritation from rosacea under control
- Treat the flushing, redness, and broken capillaries to improve the skin appearance
- Leave our patients with healthy and glowing skin
Depending on each patient’s unique needs, these three goals are accomplished by using a combination of mediations, lights, and lasers. Often these treatments work best when used in combination. The good news is that by combining several skin care modalities, including the MGSKINLabs line of products, Dr. Green can effectively treat and control every case of 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 presribe some topical medications and antibiotics to treat your rosacea.
- Metrogel, or Metronidazole, is a classic rosacea antibiotic medication which both prevents and treats facial rosacea and 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 medication which reduces the blood vessels from rosacea and is used once a day.
- Azelic acid– is a gel that treats the papule, pustules, and inflammatory component of rosacea.
- Vitamin C Serum-is an excellent antioxidant and reduces facial redness and rejuvenates the face and is available online here.
Oral Treatments for Rosacea
One of the main treatments for rosacea are oral antibiotics. Dr. Green traditionally prescribes Doxycycline or Oracea for facial rosacea and its associated breakouts. Ocular rosacea can also be treated with oral antibiotics as well as various eye washes and drops. In more severe cases of ocular rosacea, Dr. Green will refer you to one of the best ophthalmologists in Manhattan. The main side effect of chronic oral antibiotic usage are yeast infections.
Laser Treatment for Rosacea
The V-Beam pulsed dye laser is the gold standard for rosacea treatment . The V-Beam 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 clear skin.
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/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.
How to protect your skin from a rosacea flare?
- Proper skin care and using gentle products such as Cetaphil are essential for patients with rosacea.
- Daily sunscreen use, which blocks both UVA and UVB rays, and a wide-brimmed hat are important in preventing flare ups of rosacea.
- Applying the proper non-comedogenic moisturizer and topical medications which can control breakouts.
- Avoid things which exacerbate the effects of rosacea, like sun, hot beverages, cigarette smoking, and heat.
Dr. Michele Green will treat your rosacea with the most effective treatments and best lasers, including the V-Beam laser. Her NYC Upper East Side office is located conveniently for her uptown and midtown patients. Book online today or call 212-535-3088 to learn more about why Dr. Green is the best rated, trusted source for medical dermatology and cosmetic dermatology treatments in New York City.