By: Elena Kalabushkina, NP, WNY Medical, PC

Rosacea is a common, chronic inflammatory skin condition predominantly affecting the central face and, in rare cases, can extend to other body parts (i.e., sides of the face, ears, neck, scalp, and chest) (NIH,2021)(Dermnet,2022). This condition is characterized by persistent facial redness/flushing and localized erythema, telangiectasia, papules, and pustules on the nose, cheeks, brow, and chin (Visualdx). The pathogenesis of rosacea is not entirely understood. Still, reports have shown that the cause of this condition can be multifactorial, including abnormalities in the blood vessels of the face, a reaction to microscopic Demodex mites, immune dysfunction, bacteria, and genetics. According to

the National Institute of Health, rosacea is most common among fair skin individuals with Northern European heritage. However, it can still be present in darker-skinned people but is often underdiagnosed because this group can mask facial redness (NIH,2021).

National Rosacea Society

It is essential to advise the public to visit a dermatologist if they present with at least one of the following diagnostic features: persistent facial redness and, although not as common, thickening skin on the face, especially the nose. In simpler terms, if they notice bumps & pimples, flushing of the skin, visible blood vessels, and eye irritation along with the following minor signs and symptoms: burning or stinging sensation, swelling, and dry appearance they should schedule an appointment with a dermatologist.

There are physical and environmental triggers that can trigger or make rosacea worse. Thus, patients must be aware of the following triggers: prolonged exposure to sunlight, stress, strenuous exercise, hot or cold weather, hot drinks, intake of spicy foods, and alcohol.

Thus, it is essential to inform patients of rosacea triggers and provide information about identifying and avoiding triggers. We can control the signs and symptoms with good skincare, prescription drugs, and, most importantly, lifestyle changes (e.g., consuming less alcohol/caffeine, eating less spicy foods, etc.) (Mayo Clinic,2021).

1 The National Society of Rosacea recommends creating a journal to track your flare-ups and see if you can discover what might have triggered them.

a. Alcohol: 

Reduce consumption of alcohol because it dilates blood vessels. If at social events, drink white instead of red wine. Red wine is known to cause 76% of flare-ups, per the National Society of Rosacea). Please limit yourself to 1 or 2 alcoholic beverages and accompany them with a glass of cold water after consuming alcohol.

b. Hot beverages: 

Consuming hot drinks can cause rosacea flare-ups; therefore, patients need to make a few changes in how they consume liquid. Instead of hot coffee, patients can drink iced coffee or tea. If iced drinks are not preferred, patients can allow their hot beverage to cool and drink it once it has reached a warm or lukewarm temperature.

c. Spicy foods: 

Spicy foods can cause a rosacea flare-up. It can be hard to eliminate spicy foods since some cultures depend on them.  If spicy foods cannot be eliminated from patients’ diets, they can try mild versions of spicy foods (instead of hot Buffalo wings, opt for mild wings, or instead of hot salsa, choose mild salsa).

d. Medications: 

Some medications can trigger a rosacea flare-up. It is important for patients to be aware of these medications and inform their medical providers.

e. Exercise: 

Strenuous exercise can cause a rosacea flare-up. Thus, it is recommended that patients engage in lower and medium-intensity workouts. Patients can exercise when it is cool and in the summer in an air-conditioned gym or room.

2. Sunscreen protection: 

Prolonged exposure to the sun can cause uncontrollable flushing and redness in rosacea-prone skin. Therefore, it is recommended that these patients purchase a broad-spectrum physical (mineral) sunscreen that contains zinc oxide and titanium dioxide or both and is fragrance-free. Also, it is recommended that patients with rosacea wear a hat when outdoors during the day and avoid spending a prolonged amount of time outside between 10 AM to 4 PM. SPF of 30 is enough for Buffalo, NY, but if going on vacation (especially when vacationing near the equator), an SPF higher than 30 SPF is preferred.

At WNY Medical’s dermatology office, our preferred sunscreens include Cerave, Cetaphil, Neutrogena, or Supergoop.

3. Practice gentle skin care: 

Avoid rubbing or touching the face too much (no washcloths, facial sponges, or exfoliating) to prevent skin irritation and triggering symptoms of rosacea. Purchase fragrance-free products and avoid products that contain irritants such as alcohol, camphor, urea, fragrance, glycolic acid, lactic acid menthol, and sodium lauryl sulfate (commonly found in toothpaste and shampoos).

We recommend our patients use the following cleansers: Cerave, Cetaphil, and Neutrogena.

4. Makeup: 

Use fragrance-free light and liquid-based foundation that can be easily applied to the skin and set with powder. It is vital to avoid waterproof makeup and heavy foundations on rosacea-prone skin. Avoid using makeup wipes since they can cause skin irritation and flare rosacea. Camouflage makeups with green- or yellow-tinted preparations are helpful in masking underlying redness (Visualdx).

5. Reduce stress: 

It is hard to recommend patients reduce stress since the level of stress depends on individual situations, but one can advise patients to find activities that can relieve stress, such as going on walks, watching movies, and in stressful moments practicing deep breaths and exhaling slowly.

6. Protect skin from weather triggers: 

Windy and cold temperatures can trigger a rosacea flareup. Thus, it is recommended that rosacea patients cover their face with a scarf (silk or acrylic work best) but avoid wool or rough fabrics next to their face since it can trigger a flare-up. Also, wear sunscreen during all seasons (spring, summer, fall, and winter). In the winter, try to spend more time away from fireplaces, heaters, and other heat sources. It is also essential to avoid hot showers; instead, use warm water during the winter months. Lastly, during the warm weather, try to keep cool by taking cool showers and spending time in a fan or air-conditioned room.

In short, people with rosacea may experience feelings of low self-esteem and depression, but it is important to let patients know that although rosacea is a chronic condition that has no cure, it is controllable.