Does your skin suffer from rosacea?

Rosacea is an inflammatory skin disease that especially affects white people, although there are also cases in mixed races. It is also more frequent in women in middle age.

It is characterized by affecting “sensitive” skin, which tends to turn red easily, being typical the intense redness when passing between environments with different temperatures, exercising or experiencing emotions. It usually has a chronic course with exacerbations.

The genetic component is very important in its development. Vasodilator stimuli (temperature changes, sun exposure, exercise, alcohol intake, spicy foods, emotions) as well as stress, favor or precipitate outbreaks. Also playing a role is the presence of a common parasite, Demodex folliculorum, which, although present in the skin of many people who do not have rosacea, appears to be more abundant in affected patients. In addition, it has been shown that in many cases, reducing the amount or eradicating Demodex improves rosacea.

There are four main types of rosacea:

1) Cuperosic-telangiectatic, which consists of diffuse redness mainly in the central facial area, with the development of dilated vessels (telangiectasias) visible to the naked eye, similar to varicose veins in the legs.

2) Papulo-pustular rosacea, reminiscent of acne due to the presence of inflammatory lesions and pustules (“pimples”) mainly on the cheeks. When it affects the chin, it is called perioral dermatitis.

3) Phymatous rosacea: consists of excessive thickening of the skin, mainly on the nose, with the development of exuberant sebaceous glands, which can significantly increase the size of the nose. It affects mostly men.

4) Ocular rosacea, which involves inflammation of the eyelids and conjunctiva, and may generate scars that compromise vision.

The Dr. Federico Feltes considers that there are treatments with variable efficacy depending on the case. “There is no definitive cure, but there are several weapons that can be helpful.” These would be:

1) Vascular laser helps to reduce couperose (permanent redness) and telangiectasias. This results in a noticeable aesthetic improvement, and in addition, the outbreaks tend to be less intense. It is also very useful for a rapid improvement of an inflammatory outbreak – papules and pustules.

2) Topical ivermectin, an antiparasitic that limits the Demodex population, has shown significant improvement in many patients, especially the inflammatory forms.

3) Topical metronidazole, an antibiotic, is also useful in cases with pustules and ocular rosacea (in eye drops).

4) Oral tetracyclines, a family of antibiotics that have a strong anti-inflammatory activity, which is fundamentally responsible for the therapeutic effect.

5) Certain mild acids, such as azelaic acid, can help keep the skin in better condition and decrease the frequency or intensity of inflammatory flare-ups.

6) Retinoids, vitamin A derivatives also used in acne, are used in more severe forms (including the ocular form), with favorable results in many cases.

7) Certain topical vasoconstrictors can be used to reduce facial redness for a few hours, although their long-term use may be counterproductive and should therefore be limited to occasional occasions.

8) Cyclosporine, a potent immunosuppressant, may be necessary in the form of eye drops in ocular rosacea.

9) Carbon dioxide (CO2) laser allows reshaping to restore the nose to its normal shape, size and texture in cases of phimosis.

Precipitating factors can be minimized and treated, but as a condition with a strong genetic component, complete avoidance is not possible in predisposed individuals.

We recommend consulting a dermatologist and, if there is ocular involvement, an ophthalmologist to assess the case is essential, as this is a complex pathology, with multiple possible therapeutic approaches. Avoidance of the precipitating agents mentioned here is always the first step.