Expert's Opinion

Effective Management of Rosacea

By Aanand N. Geria, MD | November 5, 2009

Dr. Aanand N. Geria on the causes and treatments of this skin malady.

Rosacea is a chronic inflammatory disorder of the face characterized by flare-ups and remissions. The most affected sites include the forehead, nose, cheeks, chin and sometimes eyes.Rosacea is among the most common dermatologic problems, affecting nearly 14 million Americans.1 At highest risk are fair-skinned individuals of Celtic, northern or eastern European descent. Onset typically occurs anytime after age 30. It is more frequently diagnosed in women, but men are more likely to develop advanced disease, perhaps due to a delay in seeking medical care.

The major clinical features of rosacea include flushing, persistent redness, bumps and pimples, and tiny visible blood vessels. The earliest manifestation of rosacea may be episodic flushing elicited by a variety of stimuli.Such “triggers” include hot beverages, spicy food, alcohol, temperature extremes, sun exposure, stress, anxiety, and irritating skin products.2 Over time, flushing may evolve into a persistent facial redness. Bumps, pimples, and visible blood vessels may appear if left untreated, however, this depends on the particular subtype of rosacea present.In severe cases, soft tissue swelling of the nose may occur resulting in a bulbous deformity known as a rhinophyma.

The cause of rosacea is not entirely understood, however, current theories focus on the role of microbes, vascular abnormalities, and connective tissue disease.2Unfortunately, there is no cure for rosacea.Instead, the focus of treatment is symptom control so that patients with rosacea need not suffer. Early recognition and avoidance of known triggers is extremely important and forms the backbone behind any treatment regimen.In addition, protecting oneself from the sun using sunscreen is encouraged.

Topical preparations of metronidazole or azelaic acid are often used as initial therapy for mild to moderate disease. It may take up to six weeks to see improvement with topical agents. Oral antibiotics are often used in combination with topical therapy to initially control symptoms and are eventually tapered off completely or to the lowest effective dose possible to maintain remission. Laser surgery may be needed to correct rhinophyma and visible blood vessels.For many sufferers, cosmetic camouflage is an effective way to cover-up redness, bumps, and pimples once the correct blend of cosmetics has been chosen.Below are some cosmetic options to effectively camouflage rosacea.3

Moisturizers: Choose a water-based product.

Pre-foundation: Try a color-protecting pre-foundation base in shades of yellow or green to counter redness.

Foundation: Match foundation with skin tone, choosing an oil-free product with moderate to heavy coverage. Avoid makeup with pink or orange hues.

Products to Avoid: Never use products that cause irritation or redness.Avoid ingredients such as alcohol, menthol, peppermint, eucalyptus oil, clove oil, witch hazel, or products with heavy fragrances.

1. The National Rosacea Society: Information For Patients. Available at:
2. Geria AN, Culp B , Scheinfeld NS. Rosacea: A Review. Kosmetische Medizin 2008; 29:14-9.
3. Gupta AK , Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol 2005;19:273-85.

About the Author
Aanand N. Geria, M.D. is currently a transitional resident at Lehigh Valley Health Network in Allentown, PA.He graduated from UMDNJ – New Jersey Medical School with a passion for diseases of the skin.He plans to complete his training in dermatology at Howard University Hospital in Washington DC.Dr. Geria is an active member of the American College of Physicians and Alpha Omega Alpha, honor medical society.