Is it acne or rosacea?

Would you give up dining out, shopping or doing other things you enjoy if it meant healthier skin? You might if you are one of the 14 million Americans suffering from a chronic inflammatory skin condition called rosacea. Characterized by persistent facial redness and bumps or pimples and often mistaken for acne or skin allergies, rosacea can be emotionally and physically painful to sufferers, particularly women. We asked expert dermatologist Dr Hillary Baldwin to explain the causes of rosacea and ways to prevent and treat this embarrassing skin disease.


Rosacea saps self-esteem

According to a new survey by the National Rosacea Society (NRS), 58 percent of respondents with rosacea said that they would be willing to modify their lifestyle by giving up shopping or eating out at restaurants for six months or longer, if it were possible to get rid of their rosacea forever.

Why is rosacea so damaging to self-esteem and self-image? Rosacea has two types: papulopustular and vascular. People with papulopustular rosacea get noticable red and pus-filled bumps that resemble acne scattered across the mid-face. Vascular rosacea is characterized by a permanent flushing and redness of the face. Any change in appearance that doesn’t fit with the American ideal can make people feel embarrassed and bad about themselves — and because rosacea occurs on the face, it is a condition that is hard to hide.

The causes of rosacea are elusive

Despite the prevalence of rosacea, the causes of this skin disorder haven’t been determined. Dr Baldwin, associate professor and vice chair, department of dermatology, SUNY Downstate Medical Center, says “It is clearly a chronic inflammatory condition, but why it occurs is unknown. ‘Flares’ of the condition, or worsening, can be triggered by numerous factors unique to the specific patient.”

Common triggers for rosacea

Unlike acne, people don’t outgrow rosacea. Though it may be less noticable at times, it can be triggered by certain foods, weather conditions and hormones. Common food and drink triggers include hot beverages (particularly tea and coffee), alcohol (especially red wine), chili powder, cocoa powder, and hard cheeses. Other triggers include heat or cold, sun, wind, menopause, menstruation and emotions. Medications that increase blood flow or dilate blood vessels can also cause flares of the redness.

Health dangers of rosacea

“There are no components of rosacea or conditions associated with it that are life threatening,” says Dr Baldwin. However, up to 50 percent of patients are thought to have ocular rosacea, which if left untreated can cause decreased visual acuity and even blindness. The leading dermatologist adds, “This would, of course, be the extreme extreme case where no medical care was obtained and the condition was ignored beyond the comprehension of a thoughtful person.”

The best defense against rosacea is prevention

There is no way to avoid getting rosacea (experts say it may be genetic), but you can take preventative measures to avoid flare-ups.

Dr Baldwin recommends the following preventative measures:

  • Be extremely diligent about protecting your skin from the sun (i.e. suncreen, shade, clothing).
  • Avoid triggers that trigger flare-ups (these are unique to each person).
  • See your dermatologist and get on prescription medications early to prevent any further development.

Treatments for rosacea

If left untreated, rosacea can become progressively worse. According to Dr Baldwin, the available rosacea treatments depend on the type of rosacea.

“The form of rosacea known as papulopustular is the easiest to treat…and can be treated with oral medications or topical medications [that] are highly effective,” explains the dermatologist. “The only FDA-approved oral medication for the treatment of rosacea is controlled-release doxycycline (Oracea). Taken once a day, it is very effective in treating all severity of the disease.” There are also FDA-approved topical products, such as metronidazole (MetroGel, Noritate) and azeleic acid (Finacea). “Applied once or twice a day, respectively, they control the bumps in most patients with mild to moderate disease,” Dr Baldwin adds.

The vascular, or red form of rosacea is harder to treat. “Although the products listed above may improve the redness in some patients, we really do not have a pharmacologic treatment for dilated blood vessels, flushing and blushing,” says Dr Baldwin. “There are some products in development that look promising, so stay tuned! Otherwise, treatment for the redness is laser or light treatments. These are highly effective in many patients.”

Side-effects of rosacea treatments

According to Dr Baldwin, all of the medications listed above are very safe and well-tolerated and can be taken for long-term maintenance as well as immediate treatment.

Regular doses of oral tetracycline-type antibiotics are also effective in treating the papulopustular form of rosacea, but can be associated with a higher incidence of side effects including the possibility of long-term antibiotic resistance. The topical products and controlled-release doxycycline are not considered antibiotics at the doses used and actually function as anti-inflammatory drugs. They are not associated with the development of resistant bacteria as seen in regularly prescribed antibiotics.

Laser and light treatments are also very safe, but there is little data in the way of long-term, large-scale studies with these modalities. Dr Baldwin warns that duration of response, for example, has not yet been established, and that cost may be another concern as such treatments are not covered by insurance. “Make sure you visit a dermatologist for such treatments, as ‘laser centers’ and ‘medi-spas’ may be run by individuals who are poorly trained. In some states a licensed physician need not even be present at the facility,” she adds.

For more information on rosacea and tips to prevent and even conceal it, visit