Latest Update on Rosacea: Advances in Treatment and Promising Therapies
Rosacea is a chronic skin condition, usually localized to the face that is characterized by flare ups and remissions. The condition typically starts when a person is in their 30s, with red areas on the forehead, cheeks, chin, and nose area. The redness can come and go and also affect areas including the neck, upper chest, scalp, or ears. The condition tends to afflict individuals with fair skin and it can be inherited. It’s also more frequently diagnosed in women, but men tend to have more severe symptoms. Currently there’s no cure but there are medical therapies to help limit symptoms and to treat flare ups.
Primary signs of rosacea include:
- Persistent redness
- Bumps and pimples
- Visible blood vessels
The condition can also involve eye irritation, facial burning or stinging, red skin plaques, skin thickening, and swelling. The disease also has different subtypes. Treatment can include oral and topical medications, and then corrective measure like intense pulsed light to remove visible signs. Because the condition is considered to be an innate abnormality of the immune system, successful treatment can sometimes be vexing. At the Dermatology Aesthetic and Clinical Conference in Orlando in 2017, some new and emerging therapies were presented.
Trying to minimize blood vessels that become visibly apparent is one focus of new treatment. A topical vasoconstrictor cream, oxymetazoline 1 percent, showed a statistically significant improvement in redness, compared with standard treatment in a Phase III clinical trial. The promising treatment actually showed improvements in a 12-hour period, once the cream was applied to affected facial skin areas. Additional observations showed continued and cumulative improvement over 52 weeks. The cream was well-tolerated with mild adverse side effects reported by some (dermatitis, itchiness, headache).
Topical minocycline foam is another treatment that shows some improvement of skin symptoms with no major side effects. It is moving into Phase III trial that is examining its efficacy for acne and rosacea. Azelac foam 15 percent (a new formulation) also shows promise.
Another finding presented at the conference was the fact that similar to the link between psoriasis and cardiovascular disease, other inflammatory skin conditions may have a connection to or be involved in the pathogenesis of heart disease. Experts suggest there is reason to explore the possible causal link between rosacea and other inflammatory diseases and cardiovascular disease. One suggestion is to explore the possible benefits of administering a course of tetracycline to patients with rosacea in order to inhibit MMP (metalloproteinases) activity. Lowering MMP activity can lower the risk of developing vascular disease.
Experts also plan to look at the etiology of rosacea — is it primarily genetic or environmental? Based on current science it seems to be half and half. Doctors also warn that despite the prevalence among fair-skinned individuals, you also have to be prepared to diagnose it among other skin color groups. Rosacea is also a quality-of-life issue because of its very prominent facial presentation. So it is crucial to try to help individuals to limit flare ups. Winter can exacerbate rosacea, and so can summer sun. Reducing stress can help and so can certain dietary restrictions. Probiotics may also help to modulate the condition.
Red meat is certainly part of the group of foods considered to be inflammatory in nature. Other foods that have been categorized as “inflammatory” include: refined sugar, foods high in saturated fat and omega-6 fat, refined carbohydrates, foods containing MSG, and consuming gluten if you are gluten-sensitive. Other foods that may trigger rosacea outbreaks in susceptible individuals include: dairy foods, vinegar, eggplant, avocado, spinach, citrus fruits, spicy foods, and foods high in histamine. Alcohol and hot drinks can also instigate flare ups. Certain cosmetics (containing acetone, alcohol, witch hazel) can make you prone to a flare up. Exercise and lifting heavy loads can instigate a flare up as well.
Foods that help to fight inflammation include: tomatoes, olive oil, green leafy vegetables, nuts, fatty fish, seaweed, and fruits. Coffee, because of its phenols, may also help to combat inflammation. Overall, a Mediterranean-style diet may be a good fit for individuals with rosacea.
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