Understanding Rosacea: Symptoms, Causes, and Management Strategies

Rosacea affects more than 14 million people in the United States, with symptoms often worsening as individuals reach their 40s and 50s. According to Dr. Julie C. Harper, a dermatologist based in Birmingham, Alabama, the condition is characterized by frequent flushing, acne-like breakouts, and dilated blood vessels. While rosacea can be diagnosed at any age, many individuals do not experience noticeable symptoms until after age 30.

The underlying causes of rosacea are still not fully understood. Dr. Harper notes that the condition typically results when the immune system overreacts to various environmental triggers. These triggers may include sun exposure, spicy foods, alcohol, extreme temperatures, stress, and physical exertion, according to Dr. Marie Leger, a dermatologist in New York City. In addition to the common signs of rosacea, such as persistent redness and bumps, the condition can lead to skin dryness, tightness, and even burning sensations. Dr. Dina Elrashidy from Northwestern Medicine in Chicago explains that rosacea may also affect the eyes, causing itchiness or a gritty feeling.

Why Rosacea Symptoms May Worsen with Age

Rosacea symptoms often “wax and wane” throughout a person’s life, frequently flaring up after exposure to triggers. Dr. Harper points out that those who develop rosacea in their 20s or earlier may notice a deterioration in their symptoms between the ages of 30 and 50. Chronic inflammation from years of exposure to triggers can weaken the tissue around blood vessels. This process may cause the blood vessels to widen, resulting in increased flushing and persistent redness.

Normal skin aging, combined with sun damage, can further contribute to the thinning and drying of the skin. Dr. Harper elaborates that over time, collagen fibers lose elasticity, which can leave blood vessels permanently dilated and visible on the skin’s surface. Dr. Elrashidy adds that as skin thins with age, it often makes signs of rosacea more apparent. Many patients in perimenopause and menopause report worsened symptoms, although researchers have not established a clear hormonal connection.

Effective Management Strategies for Rosacea

Managing rosacea often requires a multifaceted approach. Dr. Leger emphasizes the importance of identifying and avoiding personal triggers, as these can differ from person to person. For example, while some individuals may need to steer clear of alcohol or spicy foods, others may find it challenging to avoid triggers like cold weather.

Gentle skincare products can also make a significant difference. Moisturizing cleansers that contain glycerin or dimethicone can soothe irritated skin. Dr. Elrashidy recommends products containing sulfur for their anti-inflammatory properties, while Dr. Leger advises against using scrubs or fragrances that may irritate sensitive skin.

Sunscreen plays a crucial role in rosacea management. As sun exposure is a common trigger, Dr. Elrashidy suggests using a broad-spectrum sunscreen with an SPF of 30 or higher every day, reapplying every hour or two when outdoors. Mineral sunscreens containing zinc oxide or titanium dioxide are often gentler on the skin.

Prescription medications can also be beneficial. Treatments like brimonidine gel and oxymetazoline cream can help narrow blood vessels and reduce persistent redness. Other topical options, such as azelaic acid, ivermectin cream, and metronidazole, target inflammation and bumps. Dr. Leger notes that these medications can be used alone or in conjunction with low-dose oral antibiotics, which can help manage inflammation and redness during flare-ups.

For those seeking additional treatment, laser therapy may be an option. This technique uses specific wavelengths of light to diminish blood vessels and reduce redness. Patients typically undergo one to three treatments spaced a month apart, with maintenance sessions every six months to a year, depending on symptom severity.

Dr. Harper emphasizes that it is essential to consult a dermatologist for worsening or new symptoms of rosacea. Identifying triggers and developing a tailored management plan can empower patients, allowing them to feel more in control of their condition.