If winter’s chill has left you red in the face, you might be among the 16 million American adults with rosacea, a skin condition that can be triggered by extreme temperatures. Rosacea occurs when tiny blood vessels in the face become dilated and inflamed, creating a flushed appearance on the cheeks, chin, forehead, nose or the skin around the mouth. It can also cause red bumps that look similar to acne. In advanced stages, the skin thickens and the nose may become bulbous.
Rosacea can be painful. More than three-quarters of 1,709 rosacea patients surveyed by the National Rosacea Society said their skin had a burning sensation. And up to half of the cases can cause the eyes to become red, itchy, painful or teary, other research has found.
The skin condition often shows up after age 30 and is more common among women and fair-skinned adults. African Americans can develop it too, usually in the form of firm, skin-colored spots.
“Most information on rosacea emphasizes the higher prevalence in people of Northern European ancestry, so patients with darker skin types are often unaware that they also can have rosacea,” says Andrew Alexis, director of the Skin of Color Center at St. Luke’s and Roosevelt Hospitals in New York. He says asking patients if they have sensitivity to skin-care products and hot or cold temperatures, all common among people with rosacea, helps him reach a diagnosis.
Here are other details that can help you determine whether your skin symptoms indicate rosacea.
How do I know it’s rosacea and not acne? Some cases of rosacea can cause bumpy breakouts that look similar to acne. But people with the condition also tend to have facial flushing (caused by the widened blood vessels). And unlike acne, rosacea doesn’t cause blackheads or whiteheads. Over-the-counter acne products containing benzoyl peroxide, such as Clearasil, can irritate people with rosacea.
What causes it? That’s unknown, although some research suggests that rosacea runs in families. But alcohol, exercise, extreme hot and cold, and hot or spicy food can prompt it.
“Patients are the best detectives in identifying their own triggers,” says Bethanee Schlosser, an assistant professor of dermatology at the Northwestern University Feinberg School of Medicine in Chicago. She cites the dry, cold air of winter as a common cause of flare-ups among her patients. Drugs that help open blood vessels, such as niacin, can cause flushing and make rosacea worse. And some recent evidence suggests that microscopic organisms in the skin called Demodex mites might cause abnormal immune reactions in people with rosacea.
What are the best treatments? Topical prescription drugs including azelaic acid (Azelex, Finacea) and metronidazole (MetroGel, Noritate and their generic cousins) can control eruptions, and low-dose oral antibiotics such as doxycycline (Oracea and generic) can reduce inflammation. Topical retinoids such as tretinoin (Retin-A and generic) can also help, but they should be reserved for cases that don’t respond to standard care because they can cause dryness or irritation in some patients and are never to be used during pregnancy or if trying to conceive. Other drug treatments under study but not yet approved for rosacea include a redness-reducing ingredient that’s in eyedrops for glaucoma, a blood-vessel constrictor used in decongestant nasal sprays, and a cream that targets Demodex mites.There’s evidence that laser therapy administered by a dermatologist can help reduce the redness, flushing and visible blood vessels caused by rosacea. Ask whether you’re a candidate for the treatment, which is more expensive than medication and often not covered by insurance.
Is there anything else I can do to relieve symptoms or at least make my face look better? Yes. Washing your face with a gentle skin cleanser and lukewarm water, and wearing sunscreen every day (since sunlight can aggravate the condition) can help alleviate some common symptoms.In addition, there could be an emotional benefit to using special cosmetics to help cover rosacea and similar conditions, according to a review published last November in the Journal of Clinical, Cosmetic and Investigational Dermatology. It found that some types of makeup products can improve a person’s appearance and well-being before medication starts working. Such makeup is sold under brand names including CoverFX, Covermark, Cover Blend and Dermablend Professional. In one study, people who used the makeup for a month reported improved interpersonal and sexual relationships.