Rosacea
What Is Rosacea?
Rosacea is a chronic inflammatory skin condition that causes redness on the cheeks, nose, forehead, and other areas of the face. Fine, threadlike blood vessels are sometimes visible to the naked eye within the reddened areas, and it may be accompanied by acne-like red bumps or yellowish pus. It is commonly known as a “red face.”
People with rosacea typically have dry or combination skin with a weakened skin barrier, and they often have sensitive skin that reacts easily to cosmetics.
Types of Rosacea
Erythematotelangiectatic type (Stage 1, erythematous rosacea)
Redness and dilated capillaries appear on the tip of the nose, the cheeks, between the eyebrows, and on the chin. The skin tends to be oily and greasy. You may feel itching or a burning sensation, and the skin can react easily to cosmetics. Symptoms may worsen with temperature changes or alcohol consumption.
Papulopustular type (Stage 2, acne rosacea)
Redness spreads across the entire face, accompanied by acne-like red bumps and white or yellow pustules.
Phymatous type (Stage 3)
The bumps cluster densely together and merge into a lumpy, thickened mass. In particular, when the nose becomes bumpy, swollen, and red, with enlarged pores giving it an orange-peel appearance, this condition is called rhinophyma.
Ocular type
The area around the eyes becomes swollen, leading to conditions such as conjunctivitis and keratitis. This is caused by inflammation of the meibomian glands, a type of sebaceous gland. Eye symptoms sometimes appear before any symptoms develop on the skin.
Causes of Rosacea
The causes of rosacea are not yet fully understood, but it is thought to arise from an underlying genetic predisposition toward allergic reactions, combined with environmental factors that disrupt the immune system and lead to chronic inflammation. Demodex mites (skin parasites also known as follicle mites) are also believed to play a role in its onset. Aggravating factors include temperature changes and extremes, sun exposure, vigorous exercise, psychological stress, pollen, and alcohol consumption. Symptoms may also worsen with the topical use of medications such as steroids or tacrolimus, or with the use of certain cosmetics. In women, symptoms may improve or worsen depending on the menstrual cycle.
Treatments for Rosacea
Topical Rozex® Gel
Rozex Gel, whose main ingredient is metronidazole, is a topical medication strongly recommended even in the guidelines for papulopustular rosacea. It improves papules and pustules mainly through an anti-inflammatory action that suppresses the production of reactive oxygen species (ROS). Rosacea skin is often sensitive to irritation, and a stinging sensation or contact dermatitis can occur at the application site. Also, because metronidazole may affect alcohol metabolism, it is advisable to refrain from drinking alcohol while using it.
Topical Ivermectin Cream (self-pay)
Ivermectin cream is a topical medication that combines action against Demodex mites (follicle mites), considered one of the causes of rosacea, with an anti-inflammatory action. It has shown efficacy for papulopustular rosacea and is considered when Rozex® Gel does not provide a sufficient effect or cannot be used. As a topical medication, it can rarely cause a stinging sensation or contact dermatitis.
Topical Azelaic Acid Cream (self-pay)
In addition to an anti-inflammatory action, azelaic acid is thought to suppress the immune response that is overactive in rosacea skin. It is a topical medication expected to improve not only papules and pustules but also redness (erythema). The 15% azelaic acid formulation is approved in the United States by the U.S. Food and Drug Administration as a treatment for the inflammatory papules and pustules of rosacea, and overseas rosacea treatment guidelines also position it as one of the options for topical treatment. In the early stage of use you may feel a tingling sensation, mild itching, or dryness, but in most cases this gradually eases as you continue to use it.
Oral Tetracycline Antibiotics
Tetracycline antibiotics such as minocycline and doxycycline are thought to have anti-inflammatory effects and are commonly prescribed for rosacea, although current guidelines consider the evidence insufficient. Each carries some side effects, such as dizziness and nausea. They cannot be used by patients taking oral isotretinoin for acne, due to the risk of increased intracranial pressure.
Pulsed Dye Laser (V Beam) Treatment (self-pay)
The V Beam is a laser with a wavelength that is absorbed by hemoglobin. It is effective against the dilated capillaries of rosacea. It is best used as a finishing treatment after the condition has improved with oral or topical medications. It does not reach blood vessels located deep within the skin. When repeated, treatments are spaced at least one to three months apart. Although we do not currently offer it at our clinic, phototherapy with Intense Pulsed Light (IPL) is also a good option.
Skincare
People with rosacea often have both dry and sensitive skin. While moisturizing is important, it is also necessary to choose gentle, low-irritation cosmetics and to avoid applying too much, which can lead to excess oil. Because symptoms often worsen with UV exposure, protecting the skin from the sun with sunscreen and similar measures is also recommended. Our clinic carries cosmetics we recommend for people with rosacea, and we can also advise you on which products are best avoided.
Notice Regarding Unapproved Medications
Some of the medications we use (such as azelaic acid and ivermectin cream) are imported drugs that are not approved as pharmaceuticals in Japan. Under the responsibility of a physician, we import them appropriately through an import agent that serves medical institutions and use them in treatment.
These drugs are widely used overseas as treatments for skin conditions such as rosacea, but because they have not received approval under Japan’s Pharmaceuticals and Medical Devices Act (PMD Act), their efficacy and safety have not been fully confirmed within Japan.
Also, even when a drug containing the same ingredient is approved in Japan, the formulation we use in this treatment may differ in dosage form, concentration, method of use, and so on.
Treatment may cause side effects such as a stinging sensation or contact dermatitis. If you notice anything abnormal, stop using it and consult a doctor.