Asked by JoAnn Allen, Nashville, Georgia
I am a 65-year-old nurse who has developed rosacea. I do not have the redness, only the itchy bumps on my face, which is so embarrassing. I have seen a dermatologist and I am now taking Oracea, which is 40 mg. of doxycycline, and using hydrocortisone cream. Very little is discussed about this, and I desperately need your expert advice. Is there anything more I can do? This is ruining my life. Thank you.
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Dear JoAnn: Thanks for your question and comments.
Rosacea is a skin disorder most commonly found in light-complexioned people of middle age and older. Blood vessels of the face, including the nose, cheeks, eyelids and forehead dilate, giving the skin a red or rosy appearance. Flushing can be provoked by eating hot or spicy foods, drinking alcohol, temperature extremes, or even emotional reactions.
Early rosacea is just redness of the nose and cheeks. In some patients the disease progresses to include burning and stinging with skin cysts and pustular bumps. It is a chronic disease with very active periods and quiet periods. The goal of therapy should be to control it, not to cure it. The cause of rosacea is not known but the hair follicle mites Demodex folliculorum and Demodex brevis are thought to play a role.
It should be diagnosed by someone experienced in skin diseases. It can be mistaken for other skin diseases such as acne vulgaris, lupus erythematosus and seborrheic dermatitis, among others. People who use a lot of steroid creams on their face can get a rash that looks very much like rosacea.
Common treatments include use of mild soaps and skin cleansers and good sunscreens. Benzoyl peroxide and topical antibiotics such as metronidazole gel or cream are mainstays of therapy for mild to moderate rosacea with inflammation. Azelaic acid cream also has some effect, although many find it harsh on the skin. Other useful topical agents include sodium sulfacetamide lotion; clindamycin gel or lotion; and erythromycin solution. Tretinoin cream (a vitamin A analog) has been used to treat pustular lesions that are unresponsive to topical antibiotics.
All the above agents must be used for several weeks to a month before assessing effectiveness. Long-term oral therapy with tetracycline, doxycycline, minocycline, metronidazole or erythromycin is used when topical therapy is ineffective. Those drugs, too, require weeks of therapy before one can say they are ineffective.
Since Demodex mites may have a role in this disease, topical permethrin cream (commonly used to treat lice) has been studied, and there was a questionable benefit. Most experts believe this still requires more study before it can be recommended.
Surgical intervention is appropriate in the most severe cases unresponsive to topical or oral therapy. Options include electrosurgery, surgical steel resculpturing, dermabrasion, or carbon dioxide laser treatment.
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