When Nikki Chwatt first noticed a patch of red, bumpy skin that spread from her cheeks to her jawline and down to her neck, she had no idea what to make of it. Save the occasional whitehead, the then-26-year old had always had clear skin, so her first thought was that she was finally experiencing some type of acne breakout.
The texture was noticeably different from a crop of pimples, though, so Chwatt quickly concluded it had to be a rash. “I was trying a new sea buckthorn oil on my face and thought I was having a reaction since it was the only new product I'd introduced to my routine,” she recalls. “But I’d also dealt with eczema behind my ears and on my wrists, so I thought it could possibly have spread to my face, too.”
Because the redness was in such highly visible place, Chwatt wanted to do something about it right away. “My birthday was coming up in four days, and I didn’t feel like seeing my friends or celebrating with my face looking this way,” she explains.” So, two days after the rash appeared, she visited her dermatologist and soon learned that it was not a rash at all. Chwatt discovered she was dealing with rosacea, a chronic skin condition marked by small, red, pus-filled bumps that most often affect the face. Thought to be the result of both genetic and environmental factors, rosacea has four different forms and can be triggered or exacerbated by a number of things, but in almost every case, it can have a devastating physical and emotional effect on those who suffer from it.
What is rosacea?
“Rosacea is a chronic skin condition causing facial redness, flushing, and visible blood vessels with or without acne-like bumps,” explains Blair Murphy-Rose, MD, a board-certified dermatologist in New York, NY. “It can also lead to a thickening of skin called rhinophyma or affect the eye area, which is called ocular rosacea.” Affecting more than 415 million people globally, the condition is quite common, yet its exact cause remains unknown. And thought it comes in different forms, rosacea typically develops on the face, though it may spread to the neck and chest.
What causes rosacea?
“Although the exact cause is not fully understood, rosacea is thought to be caused by a combination of genetic, immune, and environmental factors” says Tiffany Libby, MD, a board-certified dermatologist in Providence, Rhode Island. It’s difficult for patients and their doctors to pinpoint what may bring on rosacea, however there are a number of triggers that are thought to cause flare-ups or make the condition worse. “Triggers include sun exposure, temperature changes, exercise, spicy foods, and alcohol,” adds Dr. Libby.
What are the symptoms of rosacea?
There are a few different types of rosacea, but the one thing they all have in common is the symptoms they cause. “These symptoms range from flushing and skin feeling warm, hot or like a burning sensation to acne-like bumps that may be irritating,” Dr. Libby says. “Dry, irritated eyes and dilated blood vessels at the eyelids are also common in rosacea patients.” In some cases, rosacea may cause thickening or swelling of the skin or a dry, scaly effect.
And while rosacea can be physically agonizing, the pain they cause can also extend to mental and emotional health, especially since the area most affected by the condition, the face, is almost impossible to hide. “I was embarrassed about going in public with it, so I tried covering it up with makeup,” Chwatt admits. “Once I realized that makeup only covered up the redness and not the textured bumps, it made me feel even worse about it. I even canceled a date because of it.”
What are the different types of rosacea?
Rosacea is usually grouped into just one category, but there are in fact several types of the skin condition. “The most common type of rosacea is erythematotelangiectatic rosacea, which is characterized by facial redness and dilated blood vessels,” says Dr. Murphy-Rose. “These patients are often flushers and blushers.” Papulopustular rosacea, another type, often appears in the form of redness, swelling, and breakouts, and is often initially mistaken by patients as mere acne. “Phymatous rosacea causes thickening of skin and classically an enlargement of the nose with thickened pores, while ocular rosacea is characterized by eye redness and irritation, also often with dilated blood vessels.”
When should you see a dermatologist about rosacea?
It’s certainly never too soon to see a board-certified dermatologist about rosacea, and some patients may opt for an appointment at the very first sign of a flare-up. Because the skin condition is so common, though, many of those affected by it choose to try some at-home skincare products and solutions first. “If and when over-the counter moisturizers and the avoidance of triggers are not helping resolve rosacea symptoms, it is worth seeing a dermatologist for treatment options, and to ensure accurate diagnosis,” Dr. Libby says. And since rosacea can appear similar to other serious skin conditions, like malar rush of lupus and facial seborrheic dermatitis, it’s never a bad idea to consult a derm.
How is rosacea diagnosed?
When patients are seen by a dermatologist, their rosacea will be diagnosed through clinical examination and a history of their condition. “We ask questions like what makes it worse or better, any associated symptoms, and obtain a medical history including any current medical conditions or medications as well as family history,” Dr. Murphy-Rose explains. “To the trained eye, rosacea can usually be distinguished from other similar appearing conditions, but sometimes, response to therapy may help to guide our diagnosis.”
How is rosacea treated?
When Chwatt’s rosacea was diagnosed by her dermatologist, just a few days after her first breakout appeared, she was told there were two options for treatment. “The doctor said he could write me a prescription for Doxycycline, an oral antibiotic that would probably clear it up the fastest." Chwatt was also given the option to use Metronidazole cream, which she was told can also be effective but typically doesn't work as fast as Doxycycline. “Since I’m not very fond of taking antibiotics unless necessary, I went for the Metronidazole,” she recalls.
And while Chwatt was able to find relief through the prescription cream, others turn to a variety of other treatments. “Patients are usually advised to avoid triggers like UV light, stress, heat, spicy foods, alcohol, and temperature changes,” Dr. Libby notes. “Topical medications like metronidazole, ivermectin, azelaic acid, niacinamide, and sulfur (the latter three of which can be found OTC) can be helpful in treating rosacea. There are also low dose oral antibiotics that demonstrate an anti-inflammatory benefit and help treat rosacea.”
Topical rosacea treatments, like the one Nikki used, are somewhat limited, but oxymetazoline cream 1%, a prescription topical, is a very effective option. Patients may also benefit from laser treatments with pulsed dye laser, which specifically targets the blood vessels and helps minimize and get rid of redness and flushing. These lasers typically require several sessions and have limited to no downtime.
Can rosacea be prevented?
Although rosacea cannot truly be prevented since it’s a genetic condition, there are measures to take in order to reduce symptoms and severity. “Rosacea may be prevented by avoiding known triggers, which often vary from person to person,” Dr. Libby says. “Patients can also avoid irritating skincare ingredients that may trigger inflammation and rosacea flares.” She recommends sticking to gentle, fragrance-free products and using a humidifier to restore moisture to the air to ensure a well-balanced, healthy skin barrier. “Sunscreen is also a mainstay in minimizing exposure to UV, which may trigger flares,” she adds.
Gabby Shacknai
Gabbi Shacknai is a New York-based journalist who covers lifestyle and consumer-facing business, with a particular focus on beauty and wellness. Her work has appeared in Forbes, Fortune, ELLE, Departures, Air Mail, Harper’s Bazaar, and Women’s Health, among other outlets.
