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, suppresses the proliferation of Demodex mites and is strongly recommended for papulopustular rosacea. It also helps reduce inflammation, in part by suppressing the production of reactive oxygen species. Because people with rosacea often have inherently sensitive skin, irritation is not uncommon. Since it inhibits alcohol metabolism, it is advisable to avoid drinking alcohol while using it.

Topical Ivermectin Cream (self-pay treatment)

Like metronidazole, ivermectin is a medication that suppresses the proliferation of Demodex mites. It is worth trying when Rozex has proven ineffective or could not be used due to irritation. Ivermectin can also cause irritation in some people.

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.

Microbotox (self-pay)

Microbotox is a treatment in which a botulinum toxin preparation is injected in small amounts into the superficial layers of the skin. In recent years it has been reported to improve the redness and flushing caused by rosacea, drawing attention as a new treatment option for facial redness. By inhibiting the action of the neurotransmitters involved in blood vessel dilation and inflammation, it is expected to reduce redness and flushing. Its sebum-suppressing effect may also help improve enlarged pores and oily shine. Whereas the V Beam acts on the dilated blood vessels themselves, Microbotox targets the excessive reactivity of the blood vessels and sebum production. It can therefore also be combined with the V Beam depending on your symptoms.

Learn more about Microbotox

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.