Derms answer popular Google questions about rosacea – Part 1

We asked our dermatologists to answer the most popular Google questions about rosacea. Here’s what they said:

Dr. Catherine Zip, Calgary dermatologist

Q: Is rosacea inherited?

Our genetics determine if we are predisposed to rosacea. If you have a family history of rosacea, you are more likely to develop the condition.

However, who actually develops rosacea is not only determined by our genes. For example, there are reports of identical twins who do not both develop rosacea.

Environment factors also play a role. Research has shown that previous smoking, alcohol consumption, sun damage and certain microorganisms (such as Demodex) may increase risk of rosacea.

Q: Can rosacea affect the eyes?

Absolutely. In fact, eye involvement, known as ocular rosacea, occurs in up to 70% of patients with rosacea. There are no specific tests for ocular rosacea; the diagnosis is made based on clinical findings. In 20% of patients, eye involvement precedes the skin changes of rosacea, which can make diagnosis of ocular rosacea even more challenging.

Ocular rosacea typically involves both eyes.  Symptoms can include tearing, dryness, foreign body sensation, burning, itching, light sensitivity and blurred vision. Eye findings include redness, inflammation of the eyelid margin (blepharitits) and recurrent styes.

Q: What are treatments for an enlarged red nose?

Treatment of an enlarged red nose is twofold. First, redness is a sign of inflammation. Treatment that suppresses inflammation, including oral antibiotics such as doxycycline and topical agents such as metronidazole or azelaic acid, are used.

Inflammation of the nose can cause swelling, and once the inflammation is successfully treated, the swelling will also subside.

However, if underlying rhinophyma is present, with persistent enlargement of the nose during to thickening of the skin, surgical treatment or laser can be very helpful.

Dr. Benjamin Barankin, Toronto dermatologist

Q: Does rosacea worsen with age?

In some cases it does worsen with age, while in other cases it can actually burn out with age. It is very hard to predict the course of rosacea in any one person.

It is believed that with gentle skin care, great sun protection and avoidance, minimizing of triggers (e.g. alcohol, stress, hot & spicy foods etc), and with good topical prescription therapy from your dermatologist (e.g. ivermectin, metronidazole, azelaic acid), that rosacea can be held nicely in check without worsening over time. Occasionally oral therapy with antibiotics or isotretinoin may be required for significant flare-ups, but with a good maintenance program, this should be infrequent.

Q: What skin care ingredients to avoid if you have rosacea?

There are no hard and fast rules that cover everyone. The answer can depend on how oily or dry your skin is, and that can be both a function of your genetics, as well as the weather. In general, I’d recommend avoiding soap on the face and foaming cleansers as the foaming ingredients (e.g. SLS) can be irritating for many with rosacea.

I’d also avoid acids on the face such as salicylic acid or glycolic acid or vitamin A acid/retinol; that said, if you’re more oily or normal skin, and/or the weather is warmer and more humid, then you can possibly use these ingredients 2-3 times per week for pimple prevention and anti-aging benefits.

Benzoyl peroxide can also be quite irritating and drying in many patients with rosacea, so if using it for pimples, use very sparingly, and perhaps not every day. Another option is to do a face-mask type treatment where you apply the benzoyl peroxide product to the pimply area for 10 minutes, then wash it off with a gentle cleanser, then apply a moisturizer.

Q: Can rosacea be cured?

At present, we don’t have a cure. Rosacea is in fact a complex condition that is influenced by genetics, diet, environment and more. That said, there is a great deal of research into the causes and treatments for rosacea, and the options we have available to us now are already excellent as far as both safety and efficacy, and no doubt with further scientific research, we will do even better for our patients.

Dr. Jason Rivers, Vancouver dermatologist

Q: What causes rosacea?

The underlying cause of rosacea is unknown.  However, we do realize genetic factors are at play because the condition is more likely to occur in people of “Celtic” descent, and the disease may be seen to occur in multiple generations within a family.

On a more basic science level, it is known that in rosacea, the immune system (at least in the skin) is upregulated owing to the production of an antimicrobial chemical called cathelicidin.  Application of cathelicidin to the skin of mice can reproduce a skin condition similar to rosacea.

Further, medications that we routinely prescribe for rosacea have the effect of reducing cathelicidin production.  Other inflammatory mediators that influence both the blood vessels and nerves in the skin also play a role, but our understanding of these elements remains rudimentary.

Q: What are the early signs of rosacea?

Rosacea is a chronic skin condition that is characterized by symmetric central facial redness and flushing in its early stages.  Initially the redness may be intermittent – being triggered by any number of factors including stress, exercise, hot foods or drinks, alcohol and sunlight, to name but a few.

With time, the background redness may persist, and small dilated blood vessels may be seen to appear on the skin surface.  Periodically small inflamed papules (bumps) may also develop in the affected areas, and these spots may be confused with acne.

Q: Does rosacea go away?

Rosacea is a chronic condition that tends to wax and wane in response to various trigger factors.  Although there is no cure for rosacea, we are able to control it in most cases by means of lifestyle changes and the use of various topical and oral agents.

Dr. Jerry Tan, Windsor dermatologist

Q: How do you clear up rosacea?

Current treatments are available to help improve and control but not cure rosacea.  Avoidance of trigger factors, sun protection, and gentle skin care is helpful.

Different treatments are available depending on the features on presentation:

  1. Antimicrobial and anti-inflammatory medications in creams/gels or pills can be helpful for control of the pimples.
  2. For redness and blood vessel marks, other types of gels are available along with device treatments using intense light or lasers.
  3. For persistent skin thickening, surgical therapy may be required.
  4. Eye involvement in milder forms can be managed with lid hygiene and lubricants along with anti-inflammatory pills.

Q: Is rosacea contagious?

Rosacea results from a hereditary tendency and an exaggerated immune response to normal external triggers.  It is not considered catchy or contagious.

Q: Are there different kinds of rosacea?

Rosacea can present in various ways: facial redness, pimples, skin thickening, flushing or eye irritation. People with rosacea can have 1 or multiple of these features over time.

See more About Rosacea here. *Stay tuned for Part 2 of Derms answer popular Google questions on rosacea when another group of our dermatologists have replies for you!

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