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Today’s post is written by Debra Jaliman, MD, author of Skin Rules:  Trade Secrets from a Top New York Dermatologist.  

Every day I treat rosacea. It’s probably one of the most common skin conditions that dermatologists see. New patients either walk in with bright red faces or with caked-on makeup that still manages to do a poor job of concealment. The good news is that nowadays, nobody has to walk around with a scarlet face, since there is an ever-growing number of effective treatment options.

First, though, a prolonged question-and-answer period with your doctor should take place. The first thing your dermatologist will ask about is your diet. Food and drink are usually the prime triggers in rosacea. Everybody is different and so are rosacea triggers, but here is a list of the most common offenders:

• Spicy foods
• Piping hot beverages — better get used to drinking soups at a cooler temperature.
• Caffeine — coffee, tea and, I’m afraid, chocolate.
• Citrus fruits
• Tomatoes (including ketchup)
• Red wine and beer. White wine appears to be less of a problem.
• Soy sauce and miso
• Steam — saunas and very hot, prolonged showers and baths are not good.
• Excessive niacin (vitamin B3) consumption which leads to skin flushing. Low doses or
  taking the non-flushing type of niacin should not cause problems.
• Sun exposure
• Wind
• Extremes in temperature — very hot weather and very cold weather make rosacea worse, as anybody who has a scarlet nose in winter knows.

As is obvious from the last two items, protecting the skin from the elements is essential. But you have to do it the right way — chemical sunscreens will only make rosacea worse. I recommend sunscreens with zinc oxide, which is both anti-inflammatory and provides good, broad-spectrum protection. Make sure it is SPF 30 or higher and slather it on every single day, even on overcast days.

Skincare products can also exacerbate rosacea. Use the mildest cleanser you can find. Avoid products with glycolic or salicylic acid. Stay away from makeup with silicone-based ingredients, such as dimethicone, which can clog pores and make rosacea bumps worse.

Dermatologists have a wide arsenal of weapons against rosacea. The first line of attack is with topical products. In my practice, I first treat the inflammation and dryness, using creams and serums with resveratrol, green tea and hyaluronic acid. Topical antibiotics, such as metronidazole, kill bacteria on the skin surface and lessen inflammation, as can prescription-strength azelaic acid. With severe cases, oral antibiotics can be used. The FDA recently approved the use of doxycycline in very small doses to treat inflammation in rosacea patients; sometimes the course of low-dose antibiotics can go on for months. Most people seem to tolerate it well, but others will have side effects, in which case topical antibiotics, light therapy and lasers are the fall-back answers.

Light therapy can have amazing results. I use a combination of red, infra-red and blue light, typically in sessions lasting between 30 minutes and an hour. The procedure is completely painless and most patients begin to see an improvement after the first session or two.

The next step is using lasers, which are more expensive than light therapy, but worth it. In my practice I use the Genesis laser to reduce background redness. My patients tell me it feels like warm water is being applied and actually seem to find it relaxing. Skin may look pink right after treatment, but that fades in a few minutes. I usually recommend three to six treatments, although most patients see a big difference by the third treatment.

Broken blood vessels that look like red spider webs are common in rosacea patients. The CoolGlide laser is used to seal off the vessels in one to three treatments, four weeks apart. It’s not the pleasant experience of the Genesis laser, but the discomfort is minimal and any redness from the treatment is gone in twenty minutes.

Once rosacea has been brought under control, most patients report they find it easy to avoid their triggers. “I finally feel in control of my skin,” one of them told me recently.

© 2011 Debra Jaliman, MD, author of Skin Rules: Trade Secrets from a Top New York Dermatologist

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