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Skin conditions are a major concern. They can cause emotional distress because of their appearance. In this article we will talk about an underrecognized skin disorder - rosacea. Rosacea majorly affects fair-skinned people who tend to blush easily. It is more common in women than in men. 

Rosacea usually affects the face but can also spread to the eyes, chest, neck and back. 


What is Rosacea?

Rosacea is a chronic, inflammatory skin condition that usually affects middle-aged people. It causes redness and visible blood vessels. It primarily affects the face. (1)

What Causes Rosacea?

Rosacea is more common among fair-skinned people. What exactly causes rosacea is not clear. 

Rosacea is often associated with acne. However, this skin condition doesn’t occur due to excess sebum production and oily skin. Rosacea is a different skin condition altogether. 

Inflammatory reactions and abnormal blood vessels trigger this condition. However, the exact cause of rosacea is not clear. 

a. What Can Trigger Flare-ups?

  • Sunlight 
  • Extreme temperatures 
  • Certain type of hair mites 
  • Stress 
  • Genes 
  • Bacteria 

b. Other things that are said to possibly contribute to flare-ups:

  • Alcohol 
  • Spicy food 
  • Cosmetics that irritate your skin
  • Some medications

Types of Rosacea

There are four main types of rosacea:

1. Vascular rosacea: This type causes flushing of the face and visible clusters of blood vessels.
2. Inflammatory (Papulopustular rosacea): This type causes pustules along with redness of the skin.
3. Phymatous rosacea (rhinophyma): This type causes the skin to thicken and commonly results in an enlarged, bulbous nose. 
4. Ocular Rosacea: This type results in inflammation of the eyes and eyelids.

The four types of rosacea

The four types of rosacea

How to Treat Rosacea?

Rosacea does not have any known cure. Symptoms can be reduced by addressing the skin condition. Before consuming/using any of these medicines, consult your dermatologist. 

1. Treatments for Vascular Rosacea

1.1. Brimonidine Tartrate

Mild rosacea (redness and visible blood vessels) can be treated by applying Brimonidine Tartrate. Research shows that it reduces redness and makes blood vessels narrower. 

Brimonidine Tartrate can cause skin irritation and allergic reactions. Conduct a patch test before applying it. (2)

1.2. Laser Treatment

Laser Treatment for Rosacea uses heat to damage small blood vessels. Side effects include swelling that usually goes away after a few days. 

2. Treatments for Inflammatory Rosacea

2.1. Azelaic acid

    Azelaic acid has anti-inflammatory properties that help treat Type 2 rosacea. Studies show that applying Azelaic acid can significantly improve this condition in a few weeks. (3)

    2.2. Metronidazole

      Metronidazole is an antibacterial agent. Oral and topical forms of metronidazole are commonly used to treat rosacea. Topical metronidazole is effective in treating moderate to severe rosacea. People who use metronidazole should avoid too much sun exposure. (4)

      2.3. Doxycycline

        Doxycycline is an antibiotic that is used to treat moderate to severe rosacea. It has antibacterial and anti-inflammatory properties that help reduce symptoms of rosacea. 

        Doxycycline is taken orally. It can cause more severe side effects as compared to topical treatments. Side effects include nausea, diarrhea and sun-sensitivity. (5)

        2.4. Ivermectin

          Ivermectin helps reduce inflammation caused by rosacea. It also fights hair mites that contribute to the skin condition. Ivermectin is said to be effective in treating moderate rosacea. 

          3.Treatments for Phymatous Rosacea

          3.1. Isotretinoin

            Isotretinoin has only been approved as a form of medication to treat severe acne. People with phymatous rosacea often have enlarged oil glands. Isotretinoin helps to shrink  these oil glands. Research has not been conducted on how well Isotreinoin works in treating phymatous rosacea. 

            Isotretinoin can cause a series of adverse effects. These include skin irritation, dryness, mucous membranes and sun-sensitivity.

            3.2. Laser therapy

              Phymatous rosacea can be treated with laser therapy. Laser therapy involves numbing the affected area and removing excess tissue. Laser therapy can help restore the normal shape of the nose. (6)

              4. Treatments for Ocular Rosacea

              Ocular rosacea causes redness, burning and itching of the eyes. It is often one of the first symptoms of facial rosacea. (7)

              Symptoms of ocular rosacea:

              • Dry eyes
              • Burning of the eyes
              • Sensitivity to light
              • Itchy eyes
              • Blurred vision
              • Redness and tiny visible blood vessels on the white part of the eye
              • Swollen eyelids

              Ocular rosacea isn’t curable. However, it can be addressed with proper eye care and medication. 

              4.1. Doxycycline

              A low-dose of doxycycline can be taken to improve symptoms of ocular rosacea. (8) Doxycycline is an antibacterial agent. 

              Side effects of doxycycline:

              • Nausea 
              • Diarrhea
              • Sun-sensitivity
              • Hives

              Severe side-effects of doxycycline

              • Blurry vision/Vision loss
              • Severe headaches
              • Severe diarrhea
              • Anemia
              • Fever
              • Dehydration
              • Changes in tooth color 

              Consume doxycycline only if prescribed by your doctor. If you are pregnant, ask your doctor about the possible side-effects. 

              4.2. Tetracycline

              Studies suggest that tetracycline is effective in controlling the symptoms of ocular rosacea. (9) It is a commonly prescribed drug for the condition.

              Side effects:

              • Nausea
              • White patches in the mouth
              • Tooth discoloration in children
              • Fever
              • Pale skin
              • Vaginal itching

              Note:If you’re pregnant, Tetracycline is not recommended for you. 

              4.3. Eye drops

              Eye drops help relieve dry eyes, itchiness and burning. However, do not use eye drops that treat blood-shot eyes as they can worsen the symptoms of ocular rosacea. (10)

              Steroid eye drops and artificial tears are recommended to provide relief and keep your eyes moist. 

              What to keep in mind before taking eye drops:

              • Read the instructions and use them as recommended
              • Try not to miss the drops while trying to get them into your eyes
              • Consult a doctor to help get you the right eye drops