Many of my patients call to make appointments because a spot on their skin has changed color or because they can't wait to get rid of their brown spots or white bumps. But the color they call most about is red, and it is usually because they've developed a red rash on their body or face.

For many of these patients, the issue is rosacea -- a common condition associated with pimples and redness on the face. Rosacea usually occurs in adults well after any acne has subsided, but it can cause at least as much embarrassment and frustration as acne does for teenagers. Part of the problem for many people is the mistaken stereotype that associates red noses with alcohol consumption. Although alcohol sometimes leads to flushing of the face, it is not the main cause of rosacea, and facial redness does not necessarily indicate an alcohol problem. Redness on the face is also difficult to camouflage, even with make-up.

Rosacea is characterized by pimples on the face (but without the blackheads that are typically found in acne); flushing, or episodes of increased redness, which can be associated with various triggers; and persistent redness, caused by dilation of small blood vessels on the face. In severe cases, rosacea can also be associated with tissue overgrowth that can cause enlargement of the nose or chin, but luckily, this is much rarer than the first three. In addition to the skin, rosacea sometimes affects the eyes, causing redness and dryness.

Various treatments are available for the different aspects of this skin condition. Pimples can be managed with one, or a combination of several, topical medications. These include topical metronidazole or other topical antibiotics (such as erythromycin or clindamycin), azeleic acid (a naturally occurring compound that can often help with acne and rosacea) and sulfur preparations. In more severe cases, or when pimples just don't respond to topical medications, oral antibiotics such as erythromycin or tetracycline can be very helpful. For flushing, it is important for patients to try to identify their triggers. As mentioned, for some patients alcohol makes redness worse. Other common triggers include spicy food, very warm environments, stress, hot foods or beverages, exercise and sun exposure. Some people find it useful to keep a diary of foods and activities to try to identify triggers, in order to avoid them in the future. Even if the flushing is controlled, the baseline redness and dilated blood vessels may still be a problem. In this case, the best treatment is often light therapy to eliminate dilated blood vessels on the nose, cheeks and chin. Both lasers (such as the Aura or VBeam) and IPL can be very effective in treating rosacea. Neither of these treatments can cure the problem, but they can fade redness significantly. When there has been overgrowth of skin associated with rosacea, laser treatment may not be enough, and surgery is sometimes warranted to remove excess tissue. For many patients, a combination of some of these options works best, and most people with rosacea can improve greatly if treated appropriately.