Don’t have a gray summer next year! The sun has cast its decadent rays and we all enjoyed showing some skin. All this exposure may have seemed worth it at the time but now we may be seeing visible signs of sun damage on the skin that are definitely not helping us look our best!

Have you noticed any redness and/or little red capillaries on the cheeks or nose? How about enlarged pores, oily skin, acne or small nodules just under the skin? These may be signs of the skin condition called rosacea. And sun exposure usually makes it worse.

What is rosacea?

Rosacea is a fairly common condition that causes changes to the skin most often surrounding the cheeks, nose and occasionally the brow and chin. Women between ages 30 and 50 are most commonly affected; however, men tend to experience more severe and permanent skin changes. There are three types of rosacea: “flushing,” “acne” and “nodular.”

• “Flushing,” or erthematotelangiectatic rosacea, appears as facial flushing over 10 minutes duration after various stimuli such as alcohol, emotional stress, spicy foods, exercise, cold or hot weather, or hot baths and showers. During the flushing, a burning and stinging sensation may be felt in the cheeks. Over time the face may develop a purplish hue with prominent blood vessels.

• “Acne,” or papulopustular rosacea, appears as strikingly red skin with acne-like pustules on the cheeks, nose and occasionally brow and chin. Skin quality may be normal to oily and there can be flushing as well; however, flushing is not the main bothersome feature.

• “Nodular,” or glandular rosacea, more frequent in men, manifests as thickening, oily skin with enlarged pores, nodules and cysts on the nose, cheeks and forehead. Women with glandular rosacea tend to develop more nodules on the chin. Growth of the skin on the nose, with increased capillaries and nodules, known as rhinophyma, may develop with this type of rosacea.

What is the cause of rosacea?

Sun exposure, alcohol consumption, caffeine, hot beverages, eating spicy foods, extreme temperatures, harsh wind and emotional stress are all common triggers of rosacea; however, exactly why or how is not completely understood.

There is some correlation with hypochlorhydria (low stomach acid), H. pylori infection (a bacteria that lives in the stomach), and Demodex folliculorum (a mite infection of the skin); however, this has not been proven by research.

So how can I look better naked with rosacea?

Sexy, smooth, and clear skin is paramount to looking good and therefore we treat rosacea in various ways, both topically and internally, with the dual purpose of repair and prevention.

Topical and internal treatments are available

• Antibiotic creams, gels, and oral regimens such as metronidazole, clindamycin, or doxycycline can reduce redness and telangiectasis (tiny broken blood vessels).

• Azelaic acid, found in whole grains, can be used topically in papulopustular rosacea to reduce redness and acne causing bacteria.

• Retinoids may also be used topically and internally to treat sun damage, enlarged pores and telangiectasis.

• Vitamin C serum topically may boost antioxidants, treat sun damage and reduce redness.

• Vitamin B complex, especially Riboflavin, may decrease Demodex mite infection and normalize oil production.

Repair damaged skin

• Intense pulsed light (IPL) – a.k.a. “photofacial - this concentrated visible light filters out the damaging UV rays and concentrates certain wavelengths of light designed to even out color, reduce unwanted brown and red spots, and eliminate telangiectasias. It can have a nice side effect of skin tightening and removal of unwanted hair where desired. Usually there is no downtime after the procedure.

• Laser – this uses one concentrated wavelength of light (whereas IPL uses a range of wavelengths, thereby possibly treating a broader set of issues in one session). Laser resurfacing can treat the lumps and bumps created with “nodular” or glandular rosacea. However, this is a deeper and more penetrating procedure therefore more pain, more down time after the procedure, longer healing and more risk for scarring and discoloration. So potential benefits should always be weighed against risks.

• Hyfrecation – this low-powered electrosurgical device is perfect for decreasing nodules caused by overactive and blocked sebaceous glands commonly seen in rosacea. When done properly the effect fans out into the deeper tissue with minimal damage to the surface tissue leaving your skin smooth and sexy!

Prevention methods

• Avoidance of triggering factors such as alcohol and caffeine consumption, hot beverages, eating spicy foods, extreme temperature exposure, harsh wind and emotional stress.

• Massage. What’s sexier than a massage? Self-nurture daily or recruit a partner and trade gentle face massages. Move your fingertips in a slow circular motion over your entire face and neck to increase lymphatic flow and circulation to the skin.

• Increase antioxidant foods and anti-inflammatory omega 3 fatty acids found in olive oils, fish, nuts, seeds and avocados while decreasing inflammatory omega 6 rich animal protein.

• Use sunscreen! We all know suncreen protects your youthful complexion and it is essential for rosacea. Look for a full spectrum sunscreen with UVA/UVB protection with at least 7% zinc oxide for maximum UVA protection. Zinc also has anti-inflammatory properties, which can reduce redness and flushing. And NO, this is NOT the zinc oxide your dad used to wear on his nose making it white when you all went to the beach as kids. Today’s zinc oxide, in the right product, is micronized or ultra-micronized, such that it rubs in and you don’t see it at all. So yes, you can look good even while wearing sunscreen!

For many more ways to keep your skin looking radiant, contact Dr. Farnesi and Dr. O’Connell at Medical Age Management at (619) 795-6700, their website, Facebook and Twitter.

References

1. Ferrari A, Diehl C. Evaluation of the Efficacy and Tolerance of a Topical Gel With 4% Quassia Extract in the Treatment of Rosacea. J Clin Pharmacol. 2011 Feb 22.

2. James, W., Berger, T. and Elston, D. Andrews’ Disease of the skin clinical Dermatology. Tenth edition. Elseview Inc. 2006.

3. Antal AS, Dombrowski Y, Koglin S, Ruzicka T, Schauber J. Impact of vitamin D3 on cutaneous immunity and antimicrobial peptide expression. Dermatoendocrinol. 2011 Jan;3(1):18-22.

4. To read the full story, click Azelaic acid.

5. To read the full story, click HERE. Clinical Review: Topical Retinoids: Clinical Uses