Rosacea

Encyclopedia of Medicine, Apr 06, 2001 by Richard H. Camer

Vitamin A derivatives, called retinoids, also appear useful in the treatment of rosacea. An oral retinoid, called isotretinoin, which is used in severe cases of acne also reduces the pustules and papules in severe cases of rosacea that do not respond to antibiotics. Isotretinoin must be taken with care, however, particularly in women of childbearing age. They must agree to a reliable form of contraception, because the drug is known to cause birth defects.

Topical vitamin A derivatives that are used in the treatment of acne also may have a role in the treatment of rosacea. Accumulating evidence suggests that topical isotretinoin and topical azelaic acid can reduce the redness and pimples. Some patients who use these medications experience skin irritation that tends to resolve with time.

For later stages of the disorder, a surgical procedure may be needed to improve the appearance of the skin. To remove the telangiectasias, a dermatologist may use an electrocautery device to apply a current to the blood vessel in order to destroy it. Special lasers, called tunable dye lasers, can also be adjusted to selectively destroy these tiny blood vessels.

A variety of surgical techniques can be used to improve the shape and appearance of a bulbous nose in the later stages of the disease. Surgeons may use a scalpel or laser to remove excess tissue from the nose and restore a more natural appearance.

Alternative treatments have not been extensively studied in rosacea. Some reports advocate gentle circular massage for several minutes daily to the nose, cheeks, and forehead. Scientifically controlled studies are lacking, however.

Many people are able to avoid outbreaks by reducing things that trigger flushing. Alcoholic beverages, hot beverages, and spicy foods are among the more common factors in the diet that can provoke flushing. Reducing or eliminating these items in the diet can help limit rosacea outbreaks in many people. Exposure to heat, cold, and sunlight are also known triggers of flushing. The specific things that provoke flushing vary considerably from person to person, however. It usually takes some trial and error to figure these out.

A deficiency in hydrochloric acid (HCl) in the stomach may be a cause of rosacea, and supplementation with HCl capsules may bring relief in some cases.

The prognosis for controlling symptoms of rosacea and improving the appearance of the face is good. Many people require life-long treatment and achieve good results. There is no known cure for the disorder.

Rosacea cannot be prevented, but once correctly diagnosed, outbreaks can be treated and repeated episodes can be limited.

Avoiding anything that irritates the skin is a good preventive measure for people with rosacea. Mild soaps and cleansers are recommended. Astringents and alcohol should be avoided.

Reducing factors in the diet and environment that cause flushing of the face is another good preventive strategy. Alcoholic and hot beverages, and spicy foods are among the more common triggers.