Rosacea can be a trying condition under the best of circumstances, but it can be particularly vexing to women during menopause and even their monthly cycle.
Many women report more flushing episodes and increased numbers of bumps and pimples during these times, according to Dr. Wilma Bergfeld, head of the clinical research section of the dermatology department at Cleveland Clinic and former president of the American Academy of Dermatology.
"There is no research regarding hormones and their effect on rosacea," Dr. Bergfeld said. "However, it has been widely observed that rosacea is often aggravated at menopause and sometimes during mid-cycle." She noted that by treating the underlying hormonal fluctuations, the physician may in effect be treating the rosacea as well.
Hot flashes, for example, commonly trigger flushing in women going through menopause. Dr. Bergfeld said gynecologists now have a number of options for treating this condition, including hormone replacement therapy, and that she also often prescribes antihistamines.
"Using an antihistamine may be very helpful because it is basically an anti-inflammatory medication," she said. "If you can reduce the beginnings of the flush, you can reduce its severity."
She added that antidepressants may be used to treat the emotional effects of menopause, which in turn may reduce the potential for stress-induced rosacea flare-ups.
Women who experience rosacea flare-ups from emotional stress associated with premenstrual syndrome (PMS) may also benefit from medical therapy, according to Dr. Bergfeld. "During the third week of the cycle, estrogen plummets," she explained, noting that patients are usually referred to a gynecologist for treatment of this condition. "For some cases low-estrogen birth control pills may be prescribed to help flatten out the hormonal levels."
Patients may also be advised to chart their symptoms on a calendar and use a diuretic the week before they normally would see the onset of premenstrual symptoms.
Pregnancy poses a more difficult dilemma for doctors treating rosacea because "so many medications are off limits," Dr. Bergfeld said. Often, she will recommend that the patient use an antidandruff shampoo containing zinc as a face wash once or twice a week, because the zinc acts as both an anti-inflammatory and antimicrobial agent but does not penetrate the skin barrier.
Studies have found that rosacea is diagnosed three times as often in women, although it is often more severe in men. Dr. Bergfeld said there may be a variety of reasons why more women seek treatment. She noted that women may be more concerned about their facial appearance, while mild cases of rosacea may not be as noticeable in men. "A dark beard can hide a multitude of things," she said.