What is Acne Rosacea and how to Treat it?

Acne Rosacea is similar in appearance to acne or consists of red, prominent swelling of blood vessels similar to spider webs that are inflamed. This chronic skin condition appears mainly on the nose, cheeks, chin, eyelids or forehead.   Dilation of blood vessels causes tiny papules to burst open on the surface of the skin. There are three classifications of these papules – minor, moderate or severe. Minor lesions are similar to measles outbreak; moderate papules could be the size of a tiny pencil eraser; and severe papules (called pustules) will be coin-sized and filled with pus. 

Causes and Symptoms of Acne Rosacea

There are no specific causes for acne rosacea although it can be associated to skin disorders such as seborrhea, acne vulgaris or eye disorders like keratitis or blepharitis. There are certain groups of people who are likely to develop this skin problem.

  • Fair skinned people who blush easily
  • Women
  • Ages between 30-50 years

Although women are more prone to acne rosacea, the condition in men is more severe.

The following are some symptoms of acne rosacea.

Acne Rosacea

  • Telangiectasia, which is an increase in spidery enlarged blood vessels on the face that are prominent
  • Papules that are primary lesions and are tiny, red bumps
  • Pustules that are mature papules filled with pus

Invariably, pustules and papules come and go but telangiectasia does not disappear. 

Treatment of Acne Rosacea

Diagnosis will be based on symptoms and characteristics and there are no specific diagnostic tests for acne rosacea.

Allopathic treatment for acne rosacea

The objective of all acne rosacea treatment is not to cure but control symptoms. Doctors could advise topical antibiotic creams or lotions such as metronidazole, benzoyl peroxide or azelaic acid creams, lotions or gels. Other treatment options include clindamycin lotion, erythromycin solution or sulfacetamide / sulfur lotion. Most patients require indefinite treatment as acne rosacea is a chronic condition.

Those suffering from ocular acne rosacea or from a large outbreak of pustules or papules could be given oral antibiotics such as tetracycline, and tetracycline derivatives doxycycline or minocycline. For unmanageable cases, doctors could prescribe isotretinoin, although it is not as effective in treating acne rosacea as acne vulgaris

Of the 3 tetracycline derivatives, minocycline is found to be the most effective but also the most expensive. No tetracycline medications should be taken by pregnant or breastfeeding women. Other oral antibiotics that are effective include erythromycin, amoxicillin, clarithromycin and azithromycin. These are second-line treatments when tetracycline does not work or the patient is allergic to it. Oral metronidazole could be prescribed when oral antibiotics do not work.

One medication that is reserved as a last resort is trimethroprim sulfasoxazole (TMZ). This is meant for stubborn rosacea that does not respond to the other antibiotics. TMZ could trigger severe allergic reactions.

Surgical treatment for acne rosacea

Surgical treatment is used for more severe forms of acne rosacea called rhinophyma when the veins are prominent; nose is bulbous and there is swelling of the sebaceous glands. Electrocautery is a way of cauterizing or burning the tiny blood vessels using an electric current.   Needles using low voltage electric current zap the blood vessels along its length and destroy them. Treating acne rosaceatelangiectasias using electrocautery is painless and cost effective too.

Laser treatment shrinks the size of the blood vessels and reduces redness. Both these treatments require more than one sitting but are long-lasting. 

Light Therapies for acne rosacea

Special light treatment called intense pulsed light (IPL) or vascular lasers are now being tried by plastic surgeons and dermatologists to wipe out the red areas of rosacea. Differing light wavelengths are used to penetrate the skin, target blood vessels and make them get heated after which they collapse. These treatments are in the early stages and their effectiveness has still not been proved.

Treating Scars for acne rosacea

In dermabrasion treatment for rosacea, a wheel or brush is attached to motorized handle and moves rapidly over the affected area. This is similar to high-speed sanding and the rosacea scars reduce with this technique. Another treatment for rosacea scars is surgical excision. In this, slightly deep scars could be cut down to the subcutaneous layer and the resultant hole could be covered using a small skin graft from an affected area of the body.

Aromatherapy for acne rosacea

Aromatherapy with its ability to soothe moods and emotions is said to help in the treatment of a range of skin problems including rosacea. Some of the essential oils that help are jasmine, rose, orange and ylang ylang.  

The following is a simple recipe for an aromatherapy toner that could soothe skin affected by acne rosacea or acne vulgaris.

  • 1oz fractional coconut oil or jojoba oil
  • 6 drops of lavender essential oil
  • 5 drops tea tree or manuka essential oil
  • 1 drop of geranium essential oil

These ingredients should be mixed in a clean bottle and then applied gently on the face avoiding the lips, eyes and nostrils. 

Home remedies for acne rosacea

Make sure you wash your face with lukewarm water and pat dry. Do not rub your face vigorously or use an abrasive cleanser. Use only non-comedogenic oil-free makeup. A sunscreen of SPF 8 or more must be used every day to avoid UV rays affecting your face. 

Camouflaging the redness using the right makeup can also help. Green-tinted foundations neutralize redness of rosacea and hide them more effectively than neutral shades. There are also non-prescription products that can cover up rosacea marks. Make sure all these products are safe to use on skin affected by rosacea. 

Addressing psychological symptoms

Acne rosacea makes people feel depressed as it can distort the face. People feel extremely self-conscious and avoid going out too much. Hence psychological help can be given by a counselor to suggest ways of coping with this skin condition. There are support groups who help people suffering from rosacea deal with the change in their appearance. Seeking their help could be beneficial too.

Summary

It is important to treat acne rosacea in the early stages to avoid it developing to rhinophyma, facial rosacea or ocular rosacea. There is no permanent cure for acne rosacea since it is a chronic condition. Most patients have to continue some form of medication throughout their lives to prevent symptoms from worsening.  Avoiding triggers is important to control rosacea symptoms. These include avoiding direct sunlight, reducing stress and avoid spicy foods, hot beverages and alcohol.