Because the flushing and facial redness of subtype 1 (erythematotelangiectatic) rosacea are difficult to treat with medical therapy, other measures may be especially important for successfully controlling this widespread form of rosacea, according to the standard management options for rosacea recently published by the National Rosacea Society (NRS).1
Subtype 1 rosacea is characterized by flushing and persistent redness of the central face, and often occurs before or at the same time as the bumps and pimples of subtype 2 (papulopustular) rosacea. Visible blood vessels may also be present, and in many cases the skin may be irritated and unusually sensitive.
"Identifying and avoiding lifestyle and environmental factors that trigger rosacea symptoms in individual cases can be especially effective in controlling the flushing and redness of subtype 1," said Dr. Jonathan Wilkin, chairman of the NRS medical advisory board and a member of the consensus committee and review panel of 26 experts who developed the new standard options. "Gentle skin care is also important, as well as certain medical options that may be appropriate on a case-by-case basis."
He noted that, unlike with the red bumps and pimples of subtype 2, no drugs have been approved to treat the persistent redness of rosacea -- although such potential therapies have now been reported to be in development, and may become available in the years ahead.
The standard management options suggest patients keep track of common rosacea triggers and match them to any outbreak of signs and symptoms, and the NRS offers a "Rosacea Diary" to help patients with this identification process. In an NRS survey of rosacea patients, some of the most common rosacea triggers -- often related to flushing -- included sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, hot baths, heated beverages and spicy foods.
In addition, visible blood vessels and severe background redness may be effectively treated with laser or intense pulsed light therapy, although several sessions are typically required and later touch-up sessions may be needed as the disorder continues to develop.
The appearance of flushing, redness and visible blood vessels may also be reduced with cosmetics, according to the new management options. Products with a green or yellow tint can counteract visible redness, and cover makeup may be used to conceal visible blood vessels and other signs of rosacea.
The facial discomfort often associated with subtype 1 rosacea may be alleviated through appropriate skin care. Because rosacea patients often have extremely sensitive skin, it is important to select cleansers, moisturizers and other products that do not irritate the skin. Non-soap cleansers may be the best option -- they contain less than 10 percent soap, rinse off easily, and have a neutral pH that is closer to the natural pH of the skin. Washing with lukewarm water and blotting the face dry with a thick cotton towel may also minimize irritation.
"Because sensitivities vary, a good rule of thumb when selecting skin-care products is to avoid anything that burns, irritates or stings your skin," Dr. Wilkin advised. He suggests that before using a product on the face, rosacea patients should first try it on a peripheral area, such as the neck, to ensure that it doesn't cause a reaction.
Although no drugs have been approved by the U.S. Food and Drug Administration to reduce flushing, in specific cases extensive flushing may be reduced somewhat through the use of certain medications. For example, physicians may prescribe aspirin or similar agents, antihistamines and other medications to help reduce flushing from substances that cause the blood vessels to dilate -- such as alcohol, certain drugs, the vitamin niacin or certain of the body's own chemicals such as histamine.
In some cases, Dr. Wilkin said, a beta-blocker may be prescribed to reduce flushing related to emotional stress.
- Odom R, Dahl M, Dover J, et al. Standard management options for rosacea, part 2: options according to subtype. Cutis 2009;84:97-104.