Rosacea, an inflammatory skin disease

Rosacea is an inflammatory skin disease that affects mostly white people. It is more frequent in women in middle age. It is characterized by affecting “sensitive” skins, which have a tendency to redden easily, being typical the intense reddening with temperature changes, when exercising or experiencing emotions.

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 the 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.


  • 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 on the legs.
  • 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.
  • 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.
  • Ocular rosacea, which involves inflammation of the eyelids and conjunctiva, and may generate scars that compromise vision.


There are treatments with variable efficacy depending on the case. There is no definitive cure, but several weapons may be helpful:

  • 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.
  • Topical ivermectin, an antiparasitic that limits the Demodex population, has shown significant improvement in many patients, especially the inflammatory forms.
  • Topical metronidazole, an antibiotic, is also useful in cases with pustules and in ocular rosacea (in eye drops).
  • Oral tetracyclines, a family of antibiotics that have strong anti-inflammatory activity, primarily responsible for the therapeutic effect.
  • Certain mild acids, such as azelaic acid, can help keep the skin in better condition and decrease the frequency or intensity of inflammatory outbreaks.
  • Retinoids, vitamin A derivatives also used in acne, are used in more severe forms (including the ocular form), with favorable results in many cases.
  • 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.
  • Cyclosporine, a potent immunosuppressant, may be necessary in the form of eye drops in ocular rosacea.
  • The carbon dioxide (CO2) laser allows a reshaping that restores the nose to its normal shape, size and texture in cases of phimosis.