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Rosacea

Rosacea is a common recurrent eruption that appears on the face or neck. It is usually seen in adults, but may be diagnosed in children. Symptoms may include episodes of facial flushing or blushing (usually after spicy foods, sun, stress or alcohol), swelling, pimples, pustules, “broken” or dilated blood vessels. The central face and nose are the most common areas of involvement.

Jimmy Durante had an extreme end stage type of rosacea, contributing to the size and shape of his distinctive nose. One third of rosacea patients also note that their eyes are red, runny, have a gritty feeling, or are sensitive to sunlight. They have “ocular rosacea”.

Treatment is aimed at avoiding trigger foods, beverages, and conditions. A diary may help you understand what your triggers are. Foods that contain tyramine, monosodium glutamate and certain spices may provoke flushing. Monosodium glutamate is a flavor-enhancer commonly used in Chinese food, fast foods, and in some frozen foods. Tyramine may be found in many cheeses (not cottage or cream cheese), yogurt, sour cream, coffee, tea, non-white vinegar, nuts, citrus, raisins, herrings, chocolate, bananas, soy sauce, vanilla, figs, avocados, and anything fermented, pickled, marinated or smoked. Nitrites are found in processed meats, bacon, pepperoni, sausage, corned beef, and smoked fish. (High intake may be associated with increased pancreatic cancer, stomach cancer and colorectal cancer rates, so it is not a bad thing to cut down on their ingestion.)

Alcoholic beverages often cause facial flushing. Initially, it may be desirable to totally avoid intake of beer, wine, bourbon, gin, vodka, and champagne. After several months, you may find that an occasional alcoholic drink is tolerated.

Emotional and physical stress may aggravate rosacea. Environments where the ambient temperature is high (including after a hot shower), unprotected UV exposure, wind and even intense visible light may cause rosacea to flare.

Treatment may include topical creams to relieve or diminish inflammation and irritation. Long term, low dose doxycycline (brand name Oracea) is a safe way to diminish formation of pimples and often will alleviate eye symptoms. Occasionally, isotretinoin (a high potency vitamin A derivative) may be recommended.

Intense pulsed light (IPL) treatment will often reduce the flushing and unsightly blood vessels of rosacea. Multiple treatments are necessary to get the desired result. These treatments are not covered by insurance companies as they are considered “medically unnecessary”.

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