https://en.wikipedia.org/wiki/Rosacea

Rosacea is a long-term skin condition that typically affects the face.^[2][3] It results in redness, pimples, swelling, and small and superficial dilated blood vessels.^[2] Often the nose, cheeks, forehead, and chin are most involved.^[3] A red enlarged nose may occur in severe disease, a condition known as rhinophyma.^[3]

The cause of rosacea is unknown.^[2] Risk factors are believed to include a family history of the condition.^[3] Factors that may potentially worsen the condition include heat, exercise, sunlight, cold, spicy food, alcohol, menopause, psychological stress, or steroid cream on the face.^[3] Diagnosis is based on symptoms.^[2]

While not curable, treatment usually improves symptoms.^[3] Treatment is typically with metronidazole, doxycycline, or tetracycline.^[4] When the eyes are affected azithromycin eye drops may help.^[5] Other treatments with tentative benefit include brimonidine cream, ivermectin cream, and isotretinoin.^[4] Dermabrasion or laser surgery may also be used.^[3] The use of sunscreen is typically recommended.^[3]

Rosacea affects somewhere between one and ten percent of people.^[2] Those affected are most often 30 to 50 years old and female.^[2] Caucasians are more frequently affected.^[2] The condition was described in the Canterbury Tales in the AD 1300s and possibly as early as the 200s BC by Theocritus.^[6][7]

Treatments[edit]

Treating rosacea varies depending on severity and subtypes. A subtype-directed approach to treating rosacea patients is recommended to dermatologists.^[22] Mild cases are often not treated at all, or are simply covered up with normal cosmetics.

Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions, a decrease in the number, duration, and intensity of flares, and concomitant symptoms of itching, burning, and tenderness. The two primary modalities of rosacea treatment are topical and oral antibiotic agents.^[23] Laser therapy has also been classified as a form of treatment.^[23] While medications often produce a temporary remission of redness within a few weeks, the redness typically returns shortly after treatment is suspended. Long-term treatment, usually one to two years, may result in permanent control of the condition for some patients.^[23][24]Lifelong treatment is often necessary, although some cases resolve after a while and go into a permanent remission.^[24] Other cases, left untreated, worsen over time.^{[citation needed]}

Behavior[edit]

Avoiding triggers that worsen the condition can help reduce the onset of rosacea, but alone will not normally lead to remission except in mild cases. Keeping a journal is sometimes recommended to help identify and reduce food and beverage triggers.

Because sunlight is a common trigger, avoiding excessive exposure to the sun is widely recommended. Some people with rosacea benefit from daily use of a sunscreen; others opt for wearing hats with broad brims. Like sunlight, emotional stress can also trigger rosacea. People who develop infections of the eyelids must practice frequent eyelid hygiene.

Managing pretrigger events such as prolonged exposure to cool environments can directly influence warm room flushing.^[25]

Medications[edit]

Medications with good evidence include ivermectin and azelaic acid creams and brimonidine, doxycycline, and isotretinoin by mouth.^[26] Lesser evidence supports metronidazole cream and tetracycline by mouth.^[26]

Metronidazole is thought to act through anti-inflammatory mechanisms, while azelaic acid is thought to decrease cathelicidin production. Oral antibiotics of the tetracycline class such as doxycycline and oxytetracycline are also commonly used and thought to reduce papulopustular lesions through anti-inflammatory actions rather than through their antibacterial capabilities.^[10]

Using alpha-hydroxy acid peels may help relieve redness caused by irritation, and reduce papules and pustules associated with rosacea.^[27] Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed.^[28]

The flushing and blushing that typically accompanies rosacea is typically treated with the topical application of alpha agonists such as brimonidine and less commonly oxymetazolineor xylometazoline.^[10]

Laser[edit]

Laser treatment for rosacea using a V-Beam laser

Dermatological vascular laser (single wavelength) or intense pulsed light (broad spectrum) machines offer one of the treatments for rosacea, in particular the erythema (redness) of the skin.^[29] They use light to penetrate the epidermis to target the capillaries in the dermis layer of the skin. The light is absorbed by oxyhemoglobin, which heats up, causing the capillary walls to heat up to 70 °C (158 °F), damaging them, and causing them to be absorbed by the body's natural defense mechanism. With a sufficient number of treatments, this method may even eliminate the redness altogether, though additional periodic treatments will likely be necessary to remove newly formed capillaries.^[23]

CO₂ lasers can be used to remove excess tissue caused by phymatous rosacea. CO₂ lasers emit a wavelength that is absorbed directly by the skin. The laser beam can be focused into a thin beam and used as a scalpel or defocused and used to vaporize tissue. Low-level light therapies have also been used to treat rosacea. Photorejuvenation can also reportedly be used to improve the appearance of rosacea and reduce the redness associated with it.^[30][31][32]