There are many management strategies for rosacea, and these often depend on what subtype of rosacea you have. Often times, treatment involves approaching your rosacea from multiple different angles, and finding a tailored approach specific to your needs. One thing that is important to remember is that not every treatment option works in every patient. Often times with rosacea it takes trial and error to find the right combination of medications for you.
The first step in managing rosacea is to identify and avoid environmental and lifestyle triggers that make your redness and flushing worse. There is a long list of rosacea triggers, and often times keeping a diary of factors can help. The National Rosacea Society has a diary that is free for members.
The appearance of flushing, redness and visible blood vessels may also be concealed with cosmetics, and facial discomfort may benefit from appropriate skin care, both discussed under Skin Care & Cosmetics.
Visible blood vessels and severe background redness may be reduced with lasers or intense pulsed light therapy. Several sessions are typically required for satisfactory results, and touch-up sessions may later be needed as the underlying disease process is still present.
In specific cases, extensive flushing may be moderated somewhat through the use of certain drugs.
Subtype 2: Bumps and Pimples
Subtype 2 (papulopustular) rosacea is characterized by persistent facial redness and acne-like bumps and pimples, and is often seen after or at the same time as subtype 1. Fortunately, however, a number of medications have been extensively studied and approved for this common form of rosacea, and may also be used on a long-term basis to prevent recurrence of symptoms.
In mild to moderate cases, doctors often prescribe oral and topical rosacea therapy to bring the condition under immediate control, followed by long-term use of the topical therapy alone to maintain remission. A version of an oral therapy with less risk of microbial resistance has also been developed specifically for rosacea and has been shown to be safe for long-term use.
Higher doses of oral antibiotics may be prescribed, and other drugs may be used for patients who are unresponsive to conventional treatments.
Subtype 3: Skin Thickening
Subtype 3 (phymatous) rosacea is characterized by skin thickening and enlargement, most frequently around the nose. This condition develops primarily in men. Although mild cases may be treated with medications, moderate to severe manifestations typically require surgery.
A wide range of surgical options is available, including cryosurgery, radiofrequency ablation, electrosurgery tangential excision combined with scissor sculpturing and skin grafting. A surgical laser may be used as a bloodless scalpel to remove excess tissue and recontour the nose, often followed by dermabrasion.
Subtype 4: Eye Irritation
Subtype 4 (ocular) rosacea is characterized by any one of many eye symptoms, including a watery or bloodshot appearance, foreign body sensation, burning or stinging, dryness, itching, light sensitivity and blurred vision. A history of having styes is a strong indication, as well as having "dry eye" or blepharitis.
Treatment for mild to moderate ocular rosacea may include artificial tears, oral antibiotics and the daily cleansing of the eyelashes with baby shampoo on a wet washcloth. More severe cases should be examined by an eye specialist, who may prescribe ophthalmic treatments, as potential corneal complications may involve the loss of visual acuity.
defined as common patterns or groupings of signs and symptoms. These include:
- Subtype 1 (erythematotelangiectatic rosacea), characterized by flushing and persistent redness, and may also include visible blood vessels.
- Subtype 2 (papulopustular rosacea), characterized by persistent redness with transient bumps and pimples.
- Subtype 3 (phymatous rosacea), characterized by skin thickening, often resulting in an enlargement of the nose from excess tissue.
- Subtype 4 (ocular rosacea), characterized by ocular manifestations such as dry eye, tearing and burning, swollen eyelids, recurrent styes and potential vision loss from corneal damage.
Many patients experience characteristics of more than one subtype at the same time, and those often may develop in succession. While rosacea may or may not evolve from one subtype to another, each individual sign or symptom may progress from mild to moderate to severe. Early diagnosis and treatment are therefore recommended.
To view examples of the four subtypes, see Faces of Rosacea
Learn more about rosacea: