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Rosacea: Managing Summer Flare

Posted on: July 6th, 2017 by California Skin Institute

Dr. Anhalt Offers Tips for Managing and Treating Rosacea

Summer is an enjoyable time of the year filled with sunshine, warm weather, and outdoor activities with friends and family, but for people with rosacea, it can present challenges to keeping cool and managing facial flare-ups. Dr. Todd Anhalt discusses common concerns for patients with the condition and offers tips for treating rosacea without sacrificing your plans for summer fun.

What is rosacea?

Dr. Anhalt: Rosacea is a very common skin condition that presents as a red rash, swelling, pain, and in some cases pustules or thickening of the skin depending on the type. Rosacea is generally seen in adults, although it does affect some teenagers as well.

What is rosacea caused by?

Dr. Anhalt: Rosacea is thought to be genetically pre-programmed. The latest theories of what rosacea is caused by include an abnormal trigger for the release of proteins into the skin that would normally only be secreted to fight off an infection. For rosacea sufferers, these chemicals are released into the skin for abnormal triggers and the excess of these proteins causes inflammation, redness, swelling, and pain.

What abnormal triggers cause redness or flare-ups in individuals with rosacea?

Dr. Anhalt: Triggers vary among individuals, but some common triggers include:

  • Sunlight
  • Alcohol (particularly red wine)
  • Spicy foods and thermally hot foods
  • Exercise
  • Emotions that lead to flushing or blushing

What are the different types of rosacea?

Dr. Anhalt: There are four distinct kinds of rosacea. They can be broken down into the following types:

  • Erythematotelangiectatic rosacea: This form is flat and red with dilated blood vessels.
  • Papulopustular rosacea: Not quite as common, but a bit more severe is papulopustular rosacea, which is characterized by baseline redness and a lot of bumps and pustules.
  • Rosacea blepharitis: Patients with this form experience red, swollen eyelids.
  • Phymatous rosacea: This form is characterized by redness and thickening of the skin on the nose.

How does one go about treating rosacea?

Dr. Anhalt: Treatments vary based on the different types of rosacea. Typically, we start by figuring out what patients’ triggers are and then we work to manage them.

  • Prescription topicals: Some prescription topicals for managing rosacea include metronidazole, azelaic acid, Elidel, and Soolantra.

There is a theory that patients especially those with papulopustular rosacea (the one characterized by bumps and pustules) may actually have their skin tweaked by Demodex, which are tiny mites that live normally on our face. These Demodex may cause a rash that is indistinguishable from rosacea. Topicals such as Soolantra can be used to kill the mites.

  • Prescribed pills: Your dermatologist may prescribe a very low dose of anti-inflammatory drugs such as doxycycline for some patients.

It’s also important to note that once patients with rosacea have been prescribed medication from their dermatologist, they should not stop using the medication unless advised by their doctor, in order to reduce chances of a recurrence.

  • Intense Pulsed Light (IPL): IPL is a good adjunct treatment for rosacea sufferers. IPL is a light-based treatment that can be used in combination with other treatments to improve the complexion of patients that have rosacea, but I typically do not advise patients depend on IPL as a monotherapy (a singular course of treatment) for this skin condition.

If left untreated, the condition will typically worsen. For example, the skin of a phymatous nose can become thicker and thicker until proper treatment is received.

Are there any misconceptions that people should know about rosacea?

Dr. Anhalt: Rosacea cannot be cured completely although it can be controlled for a vast majority of patients.
Rosacea is not contagious. It is not an infectious condition. It is believed to be genetic, but it does not spread from individual to individual in an infectious manner.

Is rosacea occasionally confused with other conditions?

Dr. Anhalt: Yes, differential diagnoses include acne or perioral dermatitis. There are things on the face that may look like rosacea, but could actually be more serious, such as lupus or contact dermatitis.

There’s a lot of different conditions that could look like rosacea which is why it’s very important to see a dermatologist for rosacea because an internist or primary care physician won’t always know what to do or how best to handle the condition.

How does the weather (particularly warm weather) affect rosacea?

Dr. Anhalt: Rosacea affects people year-round, but there are some peaks related to heat in the summer and wind and the chill of winter, which cause people with rosacea to flush. For the most part, rosacea can be managed year-round as long as patients do not stop taking their medications or prescribed treatments.

Are there any quick fixes for making rosacea-related redness go away?

Dr. Anhalt: Unfortunately, there is no over-the-counter medication to treat rosacea. During the summer, patients can manage their rosacea by avoiding their known triggers, staying cool and using their prescribed medications.

Cold compresses can also help flare-ups to go down, but beyond managing rosacea with prescription medication and avoiding triggers, there is little you can do to treat rosacea at home.

Can people with Rosacea still enjoy spending time at the beach, swimming, and other summer social activities? How can they do it while minimizing flare-ups?

Dr. Anhalt: Absolutely, we’re not going to tell people to stop doing what they like to do, but a lot of heat and sunlight can make rosacea worse. Sunscreen does offer protection from UV rays, but not from infrared rays which are what really irritate the skin in rosacea patients.

To enjoy summer activities I advise using a sunblock, taking their prescribed medications, avoiding other known triggers and also using a cool compress or prescription topical cream to help manage and ease inflammation.

Rhofade is a new prescription cream that has been proven to be very effective at taking the red out.

Mirvaso is another prescription topical cream. However, some patients will experience a rebound phenomenon with Mirvaso where after using it for a few days, they will stop using it and the condition will flare up even worse than before.

Do you suggest any specific sunscreen products for patients with rosacea?

Dr. Anhalt: I absolutely encourage sunscreen because many people with rosacea have a lighter complexion and are prone to sunburn. Not wearing a sunscreen also increases their probability of getting skin cancer. For rosacea patients, I recommend using a sunblock with titanium and/or zinc that does not irritate the skin. Regular sunscreens contain more chemicals in them and should be avoided for most people with rosacea.

If you think you may have rosacea, schedule an appointment with CSI to receive proper diagnosis and treatment.

Dr. Todd Anhalt is a Board Certified dermatologist who has been helping patients treat stress-related skin issues and many other skin conditions for over 20 years. In addition to healing patients, Dr. Anhalt also serves as a Clinical Professor Emeritus of Dermatology at Stanford.