Identifying your rosacea triggers helps lessen its impact

Q. I read your column on adult acne with great interest. For years, I thought I had adult acne, but when I finally saw a doctor, she diagnosed me with rosacea. I'd like to learn more about this condition.

A. Rosacea is a long-lasting skin condition that causes inflammation and redness of the face. Remember the comic W.C. Fields — and what his nose looked like? He had rosacea.

Rosacea tends to begin in adults over the age of 30, although it can affect younger adults and kids. Rosacea is sometimes confused with acne, but acne usually starts in childhood and affects more of the skin of the face than rosacea does. Rosacea also has different causes than acne.

Rosacea usually affects fair-skinned people. It is progressive. Most often it affects the cheeks and nose. It starts with redness that looks like sunburn or blush. At first, the redness is intermittent. Gradually, it becomes more noticeable and doesn't go away. It spreads to other areas of the face.

Over time, small, solid red bumps or pus-filled “pimples” appear on the face. (This explains why rosacea is often mistaken for adult acne.) Visible blood vessels appear on the surface of the skin.

Doctors are not sure what causes rosacea, but one theory is supported by scientific studies. Certain bacteria that live on the skin seem to trigger an unusual immune response in some people. Immune system cells release chemicals to help attack the bacteria. Unfortunately, the chemical attack also causes collateral damage that causes the skin to redden and get bumpy.

Eventually, thin red lines appear on the face, especially on the cheeks. Left untreated, rosacea can create small, knobby bumps on the nose, as it did with W.C. Fields.

Fortunately, once rosacea is correctly diagnosed, it is very treatable. Depending on your symptoms, your doctor may prescribe:

• Antibiotics: Metronidazole cream or gel (MetroCream, MetroGel) is the most frequently prescribed therapy. Prescription antibiotics, taken by mouth, are also an option.

• Azelaic Acid (Finacea): This drug, which you apply to your skin, is used for the inflammatory pimples of mild to moderate rosacea.

• Beta-blockers and Alpha Antagonists: These medications may reduce flushing through their effect on blood vessels. They are not approved by the Food and Drug Administration (FDA) to treat rosacea, but many doctors prescribe them anyway.

• Estrogen: This female hormone is used when rosacea is aggravated by the hot flashes of menopause.

• Laser treatment: This is used to get rid of dilated blood vessels or to remove excess nose tissue.

• Surgical procedures: Surgical shaving or scraping can also be used to remove excess nose tissue.

You can't prevent rosacea, but you can control symptoms, which are often triggered by things that make your face flush. Once you identify your particular triggers, you can modify or avoid them. Common triggers include hot drinks, alcohol, spicy foods, stress, sunlight and extreme heat or cold.

Also, use sunscreens and sun blockers regularly and liberally to protect your face.

• Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: AskDoctorK.com.