Acne rosacea: here are the treatments available

It is a chronic inflammatory disease of the skin, the main symptoms of which are the appearance on the face of redness and burning sensation.

Despite a sweet name, rosacea is an unpleasant inflammation of the skin (to be precise a “dermatosis”), which affects over 3 million people in Italy. “It is a chronic inflammatory disease that mainly affects certain areas of the face and that, in some respects, resembles acne,” explains Antonino Di Pietro, dermatologist, President of Isplad, the International Society of Plastic, Regenerative and Oncological Dermatology, and Director of the Vita Cutis Institute in Milan.

Just its similarity with acne can complicate the diagnosis and lead to managing rosacea incorrectly, risking to promote the worsening rather than the improvement of the appearance of the skin of the face, with all that follows in terms of aesthetic damage and psychological and social impact. For this reason, when a strange redness appears on the face it is important to contact experienced doctors and carefully follow their advice to arrive, if not to the complete healing of this skin disease, at least to a satisfactory control of the symptoms of rosacea.

More common in women

But what causes this annoying chronic inflammatory disease?

“It is due to an altered stimulation of the sebaceous glands of the cheeks, chin, nose and the central part of the forehead, where they are more concentrated, and sometimes also of the back, chest and belly. However – specifies the dermatologist – the triggering causes can be many: family predisposition, circulatory disorders, infections, stress, anxiety and sun exposure».

“Rosacea is due to an altered stimulation of the sebaceous glands at the level of the cheeks, nose and chin, and of the central part of the forehead, where they are more concentrated; Sometimes, it also affects the skin of the back, chest and belly. The exact causes of the disease are not known, but – specifies the dermatologist – the triggering factors can be many: from family predisposition on a genetic basis to circulatory disorders, from infections to stress, from anxiety to exposure to sunlight ».

In addition to redness in the central part of the face, among the main symptoms of rosacea there is a sense of heat and burning, continuous or occasional, especially when there are sudden changes in temperature, which stress the blood vessels. “There may also be dilated and evident capillaries on the surface of the skin of the face, called telangiectasias – continues Professor Di Pietro – as well as red and turgid skin reliefs and pimples similar to acne boils, even if it is a different pathology that requires differentiated treatment”.

Rosacea prefers people with fair complexion and light or red hair (in particular, of Irish or Northern European origin), while those with dark or olive skin rarely suffer from it. In addition, the disease is more common among women, but in men it manifests itself with more severe forms: “The female predisposition depends above all on estrogens, that is, on the hormones that make the walls of blood vessels more elastic. Estrogens protect the circulatory system from problems such as hypertension, but hinder the return of blood from the periphery to the center and, thus, the blood stagnates and exhausts the veins,” explains the dermatologist.

In the most severe forms of rosacea, particularly inflamed papules and pustules (also containing yellowish pus) may appear in various areas of the face, which must not be touched or crushed if you do not want to risk seeing them worsen and that scars remain on the skin of the face. In the more advanced stages of the disease, moreover, the skin can swell and thicken, with marked enlargement of the sebaceous glands. This condition mainly affects the skin of the nasal region and is referred to as “rhinophyma”. More rarely, when swelling and thickening affect the area around the eyes, conjunctivitisblepharitis (intense inflammation of the edge of the eyelids), keratitis (inflammation of the cornea) and vascularization of the cornea may also occur.

How to keep it under control

Unfortunately, rosacea is a chronic skin disease, so it’s hard to get rid of it entirely. “But it can be kept under control, especially if you ask the specialist for help at the first signs, avoiding its worsening,” reassures Professor Di Pietro. The treatment should be set in relation to the severity of the symptoms of rosacea and the presence or absence of complications, for example infectious type at the level of the pustules.

“Depending on the severity of the disease, products for local use that regulate the activity of the sebaceous gland and reduce the amount of mites that live on our skin may be sufficient. These are small germs like Demodex – explains the dermatologist – that normally coexist with us, but that grow abnormally if the sebum is excessive, infecting the gland that produces it and giving way to the appearance of rosacea».

“The advice is to apply on the skin of the face, a couple of times a day, a cream or gel based on metronidazole or azelaic acid, combining them with supplements containing biotin to be taken by mouth, or in more serious cases, with antibiotics or systemic antifungals. An innovative therapy based on ivermectin has also been developed – adds Professor Di Pietro – which has both anti-inflammatory and antiparasitic properties and fewer side effects than traditional azelaic acid. The spots on the face can also be treated with an intervention in Day Hospital with laser or pulsed light: the heat heals the small blood vessels and dilated capillaries and the imperfection can improve a lot». All without leaving scars, even if the skin of the facial area is delicate.

Lifestyle also matters

Lifestyle also counts for prevention and for the improvement and healing of rosacea. The measures that can help, on both fronts, concern different aspects of daily habits.

“Food choices can positively or negatively affect rosacea,” says Antonino Di Pietro. “A diet rich in fresh fruit and vegetables, in fact, helps to combat this skin blemish. On the contrary, peppery or spicy foods worsen the symptom of redness. This happens because chili, pepper, strong paprika, spicy curry etc. stimulate the dilation of blood vessels and, especially in women at the beginning of menopause, facilitate hot flashes.

For similar reasons, it is also good to try to avoid high temperatures and tanning lamps, but also emotional stress and alcoholic beverages. In addition, you must renounce sun exposure, or at least limit it, and always apply a high sunscreen, using total screen products recommended by the dermatologist, to avoid potentially irritating components or able to increase skin sensitivity unfavorably.

Professor Di Pietro continues: «Attention also to cleanliness, because the skin of the face is very delicate: it is good to use small amounts of light, non-foaming detergents, diluting them in warm water, and rinse well after washing to remove any residue. If acne shows signs of irritation, corticosteroid-free soothing and anti-inflammatory products are useful. At the time of drying, you should not rub, but dab with a soft fabric cloth, tapping the towel gently on the face so as not to worsen the irritation ».

Can you wear makeup if you suffer from rosacea? Yes, but it is better to prefer foundation and other make-up products specific for skin with high sensitivity (without irritants, such as menthol, perfumes, alcohol, oily substances, etc.) and always remove make-up carefully at the end of the day, with cleansing milks and micellar waters equally specific, of good quality and hypoallergenic.

The scheme summarizes useful tips to counteract acne rosacea.

Sun Use full screen or high SPF sun protection (≥ 50)

Avoid tanning lamps

Detergents, creams and cosmetics Use non-aggressive and non-foaming, moisturizing and gentle detergents

Avoid cream products containing corticoosteoids

Use foundation and make-up free of irritants, such as menthol, perfumes, alcohol, fatty substances, etc.

Do not rub cheeks and nose, eyes, forehead or chin to dry or remove make-up

Temperature Avoid very hot environments and temperature changes
Feeding Avoid the consumption of alcoholic beverages and spicy foods

Consume fresh vegetables and fruits in abundance

Do not underestimate the psychosomatic aspect

The face is the first thing that is observed of a person and the appearance of the skin of the face plays a decisive role in mediating social interaction. For this reason, any alteration of the epidermis, physiological (such as wrinkles or sunspots) or pathological (such as acne, rosacea or dermatitis localized in the facial area), can greatly affect individual self-esteem and interpersonal relationships. Up to create serious psychological discomfort.

From the Face Value Global Perception Survey, conducted on over 6,800 people with or without rosacea and published in the scientific journal Dermatology & Therapy, it emerged that nine out of ten people are resigned to not seeing their condition improve, over 25% have faced facial skin redness by changing their lifestyle and nutrition and only 14% have decided to seek medical treatment. Although there are many therapies that can greatly improve the problem.

«The skin is the mirror of our experience and theater of emotions», comments Katia Vignoli, psychotherapist. “There is no organ more psychosomatic than the skin: a meeting space between body and mind, two areas that are difficult to separate. Several studies carried out on patients suffering from diseases such as acne rosacea have shown how important the psychological and social implications of these diseases are, which can lead to lower self-esteem, depression, social isolation, anorexia or bulimia, often caused by the belief that they are chronic conditions from which it is difficult, if not impossible to heal ».

Below is a summary table of the differences between rosacea and juvenile acne.

Juvenile
acne
Rosacea
Prevailing age of onset Between 14 and 30 years old After the age of 30
Prevalence by sex Men Women
Typical skin signs Comedones, papules, pustules, cysts, scars

Pronounced seborrhea

Papules or pustules

Telangiectasias

Redness and flushing (sudden redness of the face)

Prevalent localization of lesions Face, neck, shoulders, chest, back Nose, cheeks, chin, forehead
Response to treatment Slow response to antibiotic therapy, local or systemic Rapid response to topical medications, including antibiotics

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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