Rosacea Treatment

Published: 01/23/18

“A kiss,” said the romantic hero Cyrano de Bergerac, “is a rosy dot.” He was speaking in a tradition that sees rosy cheeks as signs of health and beauty. However, that warm glow can also be a warning of rosacea, a chronic skin condition that causes redness and irritation in the face.

What Is Rosacea?

Rosacea is a fairly common condition, affecting about 16 million Americans from all walks of life, and some 45 million people worldwide.

One famous rosacea sufferer was Rembrandt, who painted self-portraits throughout his entire lifetime. Even at a young age, signs of rosacea appear on his cheeks and nose. Ann Chubb’s book, Royal Fashion and Beauty Secret, reports that the late Princess Diana had it, while her son, Prince William, also has a rosy face prone to occasional flare-ups. Former President Bill Clinton has rosacea that flares up under stress. The movie comedian W.C. Fields had a form of rosacea that gave him his famous red nose, commonly mistaken as a symptom of alcoholism.

Rembrandt at age 24, and 30 years later.

The condition is easy to misdiagnose, especially by people with no medical training. People with rosacea frequently make the mistake of thinking they have acne. Remembering their teenage years, they buy over-the-counter treatments for acne only to find that the product can irritate their skin - or even make the problem worse.

Much like acne, rosacea is a chronic, possibly inflammatory, condition. In fair-skinned people, it produces redness that periodically intensifies (erythema) over the face and various other parts of the body. In dark-skinned people, the coloring may be a darker shade of brown, or even purple.

A second symptom that may appear by itself or with the erythema is a change in the texture, color and thickness of the skin (phymatous changes).

According to guidelines sponsored by the National Institutes of Health (NIH) and released in February, 2017, either of these two symptoms is sufficient to diagnose rosacea. But the condition can have quite the variety of symptoms, ranging from pimples to spider veins to itchy, red eyes. The severity and symptom mix differs with each patient.

The new 2017 NIH guidelines also abolished the following sub-categories of rosacea:

  • Erythematotelangiectatic rosacea: the most common type of rosacea, with a red face that generally includes the cheeks, lower nose and forehead. Spider veins on cheek or nose are also included in this category, although they’re not always found. In its mildest form, the red color may not be striking except during bouts of facial flushing.
  • Papulopustular rosacea: sometimes called acne rosacea because the red skin is accompanied by pimples and/or pustules. The term should be avoided, however, because acne and rosacea do not share causes. Flare ups of this type of rosacea may be accompanied by burning and stinging sensations. This variety of rosacea is often accompanied by flushing flare ups and spider veins of the erythematotelangiectatic type.
  • Ocular rosacea: rosacea may be accompanied by a variety of symptoms affecting the eyes, including blood-shot, watery eyes, itching, the feeling that something is in your eye, sensitivity to light, and blurry vision. If left untreated, the eyes can become permanently damaged.
  • Phymatous rosacea: the skin becomes thicker, marked by irregular nodules and swelling. It’s most commonly observed in the nose, but can also appear on the ears, cheeks or forehead. Deep red coloring and spider veins may also accompany this condition.

Just from reading the descriptions of these variations of rosacea, you can see there is an extensive overlap of symptoms and that not all symptoms need be present in a defining type. Ocular rosacea, for example, may have many symptoms or only a few, while erythematotelangiectatic rosacea is present to some degree in almost every instance of the condition.

The 2017 guidelines are an acknowledgement that the earlier list of types of rosacea (proposed in 2002) was not truly successful in sorting symptoms or causes. The new guidelines recommend treating each case of rosacea according to its own set of observable symptoms.


Your Skin, Layer by Layer

The skin is a large organ that keeps the outside world from invading your body. The top layer or epidermis is the skin we are all familiar with. It’s a waterproof, dustproof barrier punctured by hairs that spring from below the epidermis. There are also openings, or pores, in the skin where sweat glands release perspiration. Different people have different skin types, from dry to oily.

The epidermis also includes cells known as melanocytes that regulate skin pigmentation, ranging from very light to very dark. Melanocytes are not the source of rosy or red colorations.

Living on the surface of the skin epidermis are a variety of microorganisms, almost all of which provide useful services in keeping the skin clear and healthy. Sometimes the dead bodies or byproducts of these tiny creatures can build up inside the pores.

Below the epidermis lies the dermis, a tough, connective tissue that contains the hair follicles and sweat glands.

A third skin layer, the hypodermis, lies below the dermis. It consists of fatty tissue and more connective tissue.The hypodermis is traversed by small blood vessels. Normally, they are too deep in the skin to significantly affect skin color.

These three layers together work to keep the outside out while allowing some of the body’s waste matter to escape. As with any other skin condition, the presence of rosacea means something has gone amiss.


What Causes Rosacea?

Rosacea is a sign of skin damage, although the nature of the damage is uncertain. It is important to realize that this damage is not contagious. Infectious diseases are caused by viruses or bacteria that may pass from one person to another, and there is no evidence whatsoever demonstrating that rosacea is spread in this manner. If you have rosacea, there is no need for friends or acquaintances to worry that they might catch it from you.

It is possible that because of the range of symptoms and the differences in treatment success, rosacea has more than one cause. Despite the uncertainty, there are some suspect causes. Candidates include:

UV Light

Ultraviolet light from the sun can penetrate clouds. Even on an overcast day this light reaches your skin. It is known to cause skin damage, and some medical authorities postulate that the damage brings capillaries in the hypodermis closer to the skin’s surface, even as close as the bottom of the epidermis. This change would explain both the reddened skin and a secondary symptom, small red dots sometimes called spider veins.

Immune System

One popular suspicion is that the body’s immune system may be the cause of the trouble. Normally, the immune system kills and removes alien invaders, but sometimes it overreacts and does damage to the body it is supposed to protect. In this case, the skin itself may be attacked. This account would explain the red coloring as part of an inflammatory response to halt a non-existent invasion. It might also explain why, even after rosacea has been successfully treated, there are periodic flare ups. An overactive immune response might trigger a reaction.

One particularly relevant part of the immune system is the mast cell, a type of white blood cell. Studies of rosacea patients indicate that they have more than the normal amount of mast cells. This could indicate, however, that mast cells resist rosacea rather than cause it.

An interesting study of mice found that if mice with mast cells are injected with material from a patient with rosacea, the mice begin showing symptoms of rosacea. If the mice do not have mast cells, an injection with the same material does not produce any symptoms. With more study, the mechanisms may be better understood and a target for treatment identified.

Genetics

There is some evidence that rosacea runs in families, although no gene or combination of genes has been identified as making the disorder more likely. A genetic effect is often indirect. For example, a hereditary predisposition might make a person more susceptible to skin disorders caused by ultraviolet light. In that case, the rosacea would not be directly inherited, but the greater susceptibility to the disorder would be passed down through the generations.

Alcohol

The three candidate causes above are all offered as possible explanations for the reddish color of the skin. No favorite candidate has emerged for the excess tissue (phymatous) that comprises rosacea’s second primary symptom. There is, however, a popular folk explanation: long-term alcoholism.

The logic is simple: sometimes alcohol causes a person’s face to redden, and eventually the drinker’s face might become stuck in a permanent flush. Alcohol can indeed be one of the triggers of a rosacea flare up, except many alcoholics never get the excess tissue, while non-drinkers occasionally do. As a general rule, refraining from alcohol or drinking in moderation is the most prudent policy, even if phymatous is not a sign of excessive drinking.


What Are Rosacea’s Visible Symptoms?

Rosacea is quite a common skin condition - overall, roughly 10% of American adults are believed to suffer from it.

It is most easily observed on people with white skin. Darker skin can mask the condition’s presence, causing it to be under-reported in those cases. Women more commonly get the periodic intense reddening, while men are more apt to see changes in their skin texture. It may affect people of any age but is most common in middle-age (40-60).

The most common symptom is a red glow to the face (cheeks, forehead, nose and/or chin). From time to time, this rosy hue can flare up into a more intense red. When appearing around the eyelids it is sometimes confused with adult blepharitis or allergic conjunctivitis.

Facial Redness

The whole face, or at least much of it, may turn a bright red. Occasional flushing of the face need not indicate rosacea, but recurring episodes are common in many clinical cases.

Spider Veins (Telangiectasias)

Small connections between arteries (which carry blood away from the heart) and veins (which bring blood back to the heart) can become malformed and visible as a series of small red dots on the surface of the skin. Rosacea’s other symptoms may mask the spider veins so they only become noticeable after the these other symptoms have been successfully treated.

Hard Pimples (Papules)

The appearance of pimples on the face can lead people to think they’ve somehow developed acne, even though they’re well out of their teens and may not even have had acne back when they were teenagers. Although adults can have acne, the pimples associated with rosacea are different from acne pimples. Acne is caused by dead skin cells and oils that build up and clog the pores. Classical acne treatments (topical rubs placed on the skin) can actually make rosacea-based pimples more irritating.

Softer Pimples Containing Pus (Pustules)

These pimples may only be tiny pinpoints but their pus can be alarming. Pimples and pustules may be accompanied by a burning or stinging sensation.

Dry Skin

Almost half of all rosacea patients are believed to have dry skin, although this condition was not included in the 2002 list of rosacea types. Rosacea patients with dry skin should be especially vigilant about applying moisturizer every day. Other skin conditions (e.g., dandruff, oily skin) may also occur with rosacea.

Strawberry Nose (Rhinophyma)

Thickening skin with nodules (phymatous) is another primary symptom of rosacea and often found on the nose. The thickened skin may also appear on the chin, forehead, ears, and/or eyelids.

This condition is often a late development of uncontrolled rosacea with pimples or pustules.

Sensitivity to Facial Makeup

Rosacea can make the skin more sensitive, causing it to react strongly to facial makeups.

Red, Watery Eyes

The eyes may become irritated and watery. Adding to the confusion, some patients may have dry eyes. Other problems with the eyes may include frequent styes or infections, redness and sensitivity to light (photophobia). Sometimes the eye may feel as though it has grit or another foreign body in it.

It is especially important to see a doctor if the rosacea affects your eyes. Persistent rosacea can eventually damage the cornea and even lead to blindness.

Rosacea can also lead to an inflammation of the inner edge of the eyelid (posterior blepharitis). This condition causes irritated, itchy eyes and should be treated by a doctor.

Secondary symptoms

Besides facial redness and excess skin tissue, rosacea is frequently accompanied by other symptoms that may have additional causes.

Demodex

One of the normally beneficial life forms living on the epidermis is a tiny, nearly invisible mite called demodex. Normally, demodex is no cause for alarm, but some studies have found that these microorganisms are unusually plentiful during rosacea flare ups. They may be especially important in producing pimples and pustules that often accompany rosacea, and some treatments are expressly designed to reduce the presence of demodex.

Damaged Blood Vessels

Some of the secondary symptoms associated with rosacea (e.g., spider veins) are known to rise from damage to the vascular system (blood circulation). These symptoms are not always present in rosacea, and may only be contributing factors in certain clinical cases rather than primary causes of the disorder. Blood vessels may swell, making the red visible through the skin.


5 Common Rosacea Triggers

While the causes of rosacea remain uncertain, the triggers that lead to flare-ups of the condition are recognized. Triggers seem to bring blood to the face; drinking wine is one example for many people. Rosacea flare ups can also accompany menopause, or be a symptom of caffeine withdrawal.

The National Rosacea Society has surveyed over 1,000 patients and found a long list of triggers. Most of them were reported by a minority of patients, but the following 5 were common to more than half of the patients surveyed.

The best technique to avoid triggers is to keep a record of your flare-ups, noting the weather, your emotional state, any recent activities and the foods you’ve eaten. If a pattern emerges, you’ll know which triggers to avoid.

1. Weather Conditions

Exposure to the sun is the most commonly reported trigger. It’s recommended patients wear broad-brimmed hats and apply sunscreen regularly. Strong winds and hot weather in general will trigger flare-ups in many cases.

2. Emotional State

Another trigger almost as widely reported as sun exposure is emotional stress. This trigger can be especially upsetting to patients at work where the rosacea flare-up can even increase the stress. It can also complicate an already embarrassing social situation when the rosacea suddenly reddens a face, signalling to everyone just how upset the person is.

3. Lifestyle Factors

While not as common a trigger as sun and stress, lifestyle can also trigger flare-ups. Exercise, alcohol and hot baths can actually intensify rosacea.

Of course, people who find that exercise triggers intense rosacea shouldn’t stop exercising. This activity is simply too important to just be cast aside. Instead, change the exercise program so it becomes less intense. Stay well hydrated by drinking plenty of water, and when the workout is finished be sure to cover the head with a cool, wet cloth.

4. Foods

Many people report how certain foods can trigger a flare-up, but which particular food varies widely from one person to another and no one food triggered a flare-up in the majority of people surveyed. That said, spicy foods were found to be the most common dietary trigger.

5. Medications

Rosacea flare ups can sometimes be a side effect of certain medications. If that happens, don’t stop taking the drug, but speak with your doctor and see if a substitute medication is available.


What Should I Do If I Suspect I Have Rosacea?

See your doctor and describe any flare-ups you may have. There is no blood - or other test for the disorder, but your doctor can diagnose the disease on the basis of the group of symptoms you display.

You should especially seek advice if you notice that a normally rosy complexion has turned a deeper shade of red. This change may indicate that your rosacea has advanced to a more severe stage and other symptoms may develop. Your primary care doctor may not be able to recommend particular treatments or management programs, but can recommend the appropriate specialist.

Mild rosacea with a simple reddening of the cheeks and forehead may seem trivial, but there are good reasons for having a doctor look at it. With time, rosacea tends to become more severe; the rosy color can deepen and other symptoms may appear. It’s never too early to start taking care of your skin.

Another matter is the embarrassment that often comes along with rosacea. A strawberry nose and/or bright red cheeks can embarrass people so they wind up engaging in fewer social activities than they’d otherwise prefer.

A doctor can

  • tell you if you have rosacea or possibly something else
  • warn you if the rosacea is a possible side effect of your medications
  • prescribe a course of treatment
  • alert you to any triggers, like certain foods, that may affect you
  • tell you how long the treatment should take.

Be sure to schedule a follow-up appointment for the doctor to observe the treatment’s progress. It may be that a second course needs to be prescribed.


How Can I Tell If I have Acne or Rosacea?

Although acne is considered a problem for adolescents and rosacea for adults, this stereotype doesn’t always hold true. Teenagers with acne may be told by their doctor that they also have rosacea, or appear to be at special risk of acquiring rosacea later on in life and as such should take precautions now. Adults with rosacea may sometimes have acne is well.

Since the two conditions have different causes and call for different treatments, you’ll definitely need a doctor’s diagnosis to be certain of which disease is afflicting you. Other skin conditions sometimes confused with rosacea include:

  • Eczema: this condition arises from an allergic reaction and can appear on any part of the body.
  • Lupus: there are many forms of this disease, some of which produce red marks on different parts of the body.

RELATED: Zwivel's Complete Guide To Acne Treatments


How Can Rosacea Be Treated?

There is no cure for rosacea, but its symptoms can be minimized and occasionally even permanently eliminated. Once the condition is treated, patients will need to adjust their habits and lifestyle to keep flare-ups to a minimum.

Over the past 20 years a number of successful interventions have been developed.

Treatment depends on the symptoms displayed. If a patient displays pimples or pustules, these should probably be treated first. They can spread and also tend to cause many people the most concern about how they look. Problems with the eye are also an area of concern and call for prompt treatment. If there are changes to the skin - thick, nodules on a rosy skin - those should be examined promptly as well.

The Internet is full of pages devoted to home and herbal remedies for rosacea. Most of them have not been scientifically tested nor approved by the FDA and as such are not listed here. Your doctor, however, may know from clinical experience that a particular remedy often helps in cases like yours and promptly recommend it.

Of course, pregnant women should discuss the safety of any medication with their doctor.

Treating Pimples and Pustules

The principal treatment for the lesions commonly associated with rosacea are ointments that are rubbed on the skin. There are many of these medications, some more effective than others, but a treatment that is effective on one person may not help another. Patients should be prepared to try more than one ointment in case the first one is not effective for them personally.

Medications

  • Azelaic acid (Finacea): In gel form it is used as an anti-inflammatory medication. It can darken skin where it is applied (hyperpigmentation) and should be used cautiously by brown and dark-skinned patients. It should not be used around the eye or mouth. Apply twice daily. For fair-skinned individuals the evidence of benefit is quite good.
  • Benzoyl Peroxide (BenzEFoam, MaxClarity, PanOxyl): A gel used chiefly to treat acne, but one study found that the 5% benzoyl peroxide solution does in fact provide some relief. It should be noted, however, that this product is not a first line of defense when treating rosacea pimples. Another acne treatment, Clindamycin phosphate, was found to provide no relief whatsoever for rosacea.
  • Isotretinoin (Sotret Oral): Ingested orally, this drug was originally introduced to treat acne but has also been found to provide some relief from rosacea.
  • Ivermectin (Soolantra): This cream is an anti-parasitic medication that’s also available orally, however, only the cream should be used to treat rosacea. It’s used to reduce the presence of demodex mites and should not be applied around the eyes. Use 1% Ivermectin cream once daily.
  • Metronidazole (Metrogel): This gel containing a 1% active ingredient has long been the most popular treatment for rosacea pimples and is still considered highly effective. Ivermectin is judged slightly more effective, but is also more expensive. After applying the gel, wait half an hour before putting any cosmetics on your face.

Treating Redness and Spider Veins

The redness - also known as erythema - may result from capillaries carrying blood close to the surface of the skin. Medications can temporarily reduce this activity, but for a longer-lasting solution there is laser surgery. The idea is to seal off the capillaries just below the skin so the deep redness is reduced or possibly even removed.

Medications

  • Brimonidine (Mirvaso): a gel shown effective in reducing mild to severe erythema. Patients typically find that the gel works well, although the effects wear off after 12 hours. A sudden flushing may occur some 3 - 4 hours after application, but tends to be no more common than a typical flare up without the gel.
  • Clarithromycin (Biaxin): This antibiotic has been found to have the side-effect of reducing erythema.
  • Oxymetazoline hydrochloride (Rhofade): a 1% active ingredient cream that showed promise when tested on patients with mild to severe erythema. Use a small dab of the cream, covering the face and forehead while avoiding the eyes and mouth.

Pulse Dye Laser

This treatment is used for both the redness and spider veins associated with rosacea. Pulse lasers produce flashes of light that create a mild, pin pricking sensation on the skin. For redness, the laser is moved across the whole of the affected area, which may be most of the face and forehead, and can require several sessions. For spider veins, the session tends to be shorter as the laser only needs to focus on the affected area.

Recovery takes a few weeks and can include swelling and bruise marks. Patients who are unprepared for these first results can become quite alarmed. After three or four weeks, however, the healing progresses enough for the pleasing, long-term results to be visible. Spider veins disappear and the redness reduced to a pinkish glow.

There are many different types of lasers that can be used in these cases: for example, Intensive Pulse Laser and V Beam Laser. Your surgeon likely has their own personal preferences.

Before and after pulse dye laser treatments. Credits: I.C.L.S.

Treating Red Eyes

If you've been diagnosed with skin rosacea, ask your doctor whether you should undergo periodic eye exams. A specific treatment to help control ocular rosacea may also be required.

Medications

  • Artificial tears (Advanced Eye Relief, Bion Tears, Hypo Tears, Murine Tears, Tears Naturale II): Eye lubricants are available over the counter at most pharmacies. Use as often as necessary throughout the day. For many people, these products serve as the first line of defense in getting rid of red, itchy eyes.
  • Cyclosporine (Restasis): Cyclosporine is available as an eye drop or as a tablet, but one study found that the eye-drop form is more effective in treating rosacea. The product was originally developed to increase the tearing of dry eyes and its use in treating rosacea is still somewhat experimental.
  • Metronidazole (Flagyl): This is the same medication used as a gel on rosacea pimples and pustules, but this time it’s swallowed as a tablet. Alcohol cannot be consumed while taking this medication. Rare but severe side effects (nerve damage, seizures) make it an unlikely first choice.
  • Steroids: Although steroids placed on the eyelid can have beneficial effects, it is a last resort measure only, and must be discontinued as soon as possible. Steroids can do permanent damage to the cornea and increase the erythema on the face.
  • Tetracycline (Oracea): The class of antibiotics containing tetracycline, doxycycline and minocycline are the most common treatment for the eye problems associated with rosacea. (Note: antibiotics are not recommended for treatment of rosacea that is NOT associated with eye symptoms.) It may be surprising to see an antibiotic prescribed, as rosacea is not caused by bacteria, but in this case the drugs have a secondary effect that protects the cornea from damage. The dosage is much lower than that prescribed for antibiotic results. Once the symptoms are cleared up, patients can take an even smaller dose to reduce the chances of a flare up. This minimal dose medication may be taken indefinitely.

Treating Strawberry Nose

A bulbous, red nose is fairly rare, but inspires rumors of alcoholism and as such can be a major source of social discomfort.

Treatment for the nose does not address other symptoms of rosacea, which should be treated once the nose has been restored to a more typical shape and size.

Electrosurgery

There are multiple techniques that use electricity to make removal of tissue easier. The electric current first destroys tissue before the surgeon removes it. When used to treat a nose or other parts of the face with thickened, rosy skin, surgeons use a high-frequency electric current that causes heat damage to the unwanted skin. This technique is especially useful for reducing skin bulk without any causing any significant blood loss.

The surgeon uses an electric loop like a scalpel, drying and scraping off the layers of skin. Thick, bulbous growths can be removed in this manner without shedding much blood. It’s also a relatively painless procedure because medication is used to numb the skin. In cases of very large growths, the procedure may take several sessions, allowing a few weeks between sessions to permit healing. The final result is a shapely nose without scar tissue.

Patients with implanted electrical devices like pacemakers, cochlear implants, etc. should thoroughly discuss this procedure in advance with their surgeon. Electrosurgery may cause problems with their various devices normal functions, which could lead to a potentially dangerous situation.

Carbon Dioxide (CO2) Laser Surgery

This technique is used to treat moderate to severe cases of rhinophyma. It’s similar to electrosurgery in that it removes tissue without much blood loss. A local anesthesia is applied to numb the nose while patients wear blinders to protect their eyes throughout the procedure.The laser is then used to remove skin tissue layer by layer. The skin is vaporized and does not need to be scraped away. A surgical assistant vacuums away the vapor as it emerges. The CO2 laser produces a continuous beam that allows for rapid results. Healing takes several weeks. The treatment does not resolve the erythema.

Dark-skinned patients should take note that even darker points of pigmentation may result from this surgery. That said, normal pigmentation can almost always be restored through bleaching therapy, or by simply waiting 3 - 4 months.

CO2 lasers are excellent tools that provide pleasing results over time. Patients must realize that they will not immediately come off the surgical table and be delighted with what they see in the mirror. Depending on the procedure, the results may appear non-existent - or worse. The dark pigmentation can be especially alarming, while the strange and ugly nose shape after carbon dioxide laser surgery is also disquieting. Patients tell themselves it can only get better, but then two weeks pass and the results are still questionable. Four weeks on, however, the results can suddenly seem miraculous, and after six weeks patients tend to be delighted with the outcome.

Moral of the story: don’t schedule your surgery just before an event where you want to look your best. Wait for at least a month and a half.

RELATED: Rosacea Treatments That Actually Work


How Much Do Treatments Cost?

Insurance should cover the cost (with perhaps a co-pay) of your initial visit to your primary care physician for a diagnosis. Any topical (rub on) medications or tablets prescribed will depend on the details of your pharmaceutical plan. A survey taken by the National Rosacea Society in 2014 found that 72% of those surveyed reported their insurance plans covered the topical and oral medications. This coverage doesn’t mean that the medications are free, mind you, but prices are reduced.

The laser and electrosurgical treatments are both fairly long-lasting but more expensive than other approaches. The survey data was unclear about these procedures because most of those surveyed didn’t know whether their insurance covered them or not.

As a rule, health insurance companies are reluctant to cover surgery they consider cosmetic, but you may be able to make the case that treating a face that is always deep red, or removing the bulbous and pock-marked tissue from the nose is more like treating damaged tissue than a cosmetic improvement. Many patients find their insurance lacking when it comes to covering rosacea treatments.

The surgery usually is performed on an outpatient basis without the need of an anesthesiologist. There will be an assistant whose costs must also be covered. Laser treatments can require several sessions, with each session including a basic, office-use price. The laser surgery itself is in the range of $250 to $600 per session. Note, however, that treating rosacea growths on the nose, ear and other parts of the face costs more.


What Should I Do To Maintain Skin Health?

Once treatment has reduced or eliminated symptoms, patients should develop a daily routine to manage their condition and keep flare ups to a minimum.

Avoid known triggers.

This advice is easier to give than to take. Must you give up alcohol for the rest of your life? Can you really avoid stress forever? Of course not, but you should be aware of the risk and stay in control.

Control your diet.

The idea is to eat healthy, enjoyable foods without triggering a rosacea flare up. Almost every rosacea sufferer has some trigger foods, but these differ from case to case. As a general rule, avoid spicy foods and acidic foods (e.g., citrus fruits, pineapples, grains, and sugar). Avoiding sugar is particularly difficult as it’s included in almost every processed food and serving of so-called fast food. Pay close attention to how much sugar is being slipped into your diet.

Keeping your skin properly hydrated calls for drinking water throughout the day.

Treat your face gently.

Wash with a soft soap. A useful cleanser is Sulfacetamide 10%-Sulfur 5%. Use hypoallergenic cosmetics.

Rub moisturizers into your skin every day. Men should use moisturizers before they shave and shave with an electric razor. If you prefer disposable blades, change the blade every week. Reapply moisturizer when finished shaving.

Guard against sun damage.

Apply sunscreen daily on your skin. The sunscreen must contain zinc oxide to be truly effective, although titanium dioxide is also acceptable. SPF measures blockage of ultraviolet radiation. SPF 30 blocks 97% of the rays, which is good enough for most people.

The noon sun is the most damaging and should be confronted with a brimmed hat, sunglasses, and long sleeves.

Protect your eyes.

Keep your eyes moist and clear. Use eye drops (artificial tears) when first waking up in the morning, as needed during the day, and just before going to bed for the night.

To avoid irritating your eyes, wash your hair with baby shampoo.

Avoid direct sunlight by wearing a hat and sunglasses. The sunglasses should have a label saying they block 100% of ultraviolet light. Wrap around glasses are best for protecting against side exposure.

Adapt your routine to colder weather.

Summer poses an obvious risk with all that sun, but winter carries risks as well. When outdoors in a chill wind, use a scarf to protect your face and don’t forget to keep up with the sunscreen.

Indoor heaters may be tempting in winter, but stay far enough away to avoid triggering a rosacea flare up. Use a humidifier to keep your skin from drying in the heat.

Be careful about hot drinks, which often serve as rosacea triggers.

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