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For years, this skin condition was simply referred to as "acne rosacea." Unfortunately, pustules (pimples) and papules (red, raised bumps) are often present, which makes rosacea look like acne. Rosacea is rarely, if ever, accompanied by blackheads and many sufferers deal with persistent dryness (flaking) over the affected areas. These polar opposite symptoms can be extremely confusing because the dry, flaky skin responds minimally to moisturizers and the bumps and whiteheads do not respond to typical acne treatments. Further complicating matters, when doctors misdiagnose rosacea, the medications prescribed usually make matters worse. Fortunately, due to a new classification system of four rosacea subtypes, more physicians are becoming familiar with how to recognize and properly diagnose rosacea (Source: www.rosacea.org
Keep in mind that when rosacea first develops, it may appear, disappear, and then reappear a short time later. This series of visible problems and spontaneous remissions also make a precise diagnosis difficult. Despite its mysterious nature, the condition rarely reverses itself and almost always becomes worse without treatment. Rosacea most often starts with skin that stays persistently red and doesn't return to its normal color. Other symptoms, such as enlarged blood vessels, flaky patches, oily skin, skin sensitivity, and breakouts, become more and more visible. As rosacea progresses, pimples appear on the face in the form of small, solid red and pus-filled bumps. In more advanced cases of rosacea, a bulbous, enlarged red nose and puffy cheeks (rhinophyma) may develop. However, rhinophyma, for some reason, rarely occurs in women.
The treatments for rosacea are varied and all these options are to be considered because what works for you may not be the same as for someone else. But finding one that does work for you is critical to keeping this problem at bay and reducing (or potentially eliminating) all symptoms. Unfortunately, all of the topical treatments for controlling rosacea are only available by prescription. They include:
MetroGel, MetroCream, MetroLotion, and Noritate (active ingredient metronidazole)
Azelaic acid (Azelex, a cream, or Finacea, a gel)
Topical sulfur preparations (Klaron, Plexion)
Benzoyl peroxide with erythromycin applied topically
Oral antibiotics (tetracycline) prescribed in combination with topical treatments.*
(Sources: Cutis, March 2005, 13-16; Journal of Drugs in Dermatology, May-June 2004, pages 251-266; and www.emedmag.com/html/pre/cov/covers/121503.asp
It should be noted that some patients cannot tolerate metronidazole. If you cannot tolerate it, don’t despair: research has shown an alternate treatment consisting of the disinfectant benzoyl peroxide with topical antibiotic erythromycin can be a very effective alternative (Source: The Journal of Dermatology, August 2004, pages 610-617). Another study compared results of 0.75% topical metronidazole (MetroLotion) to 15% azelaic acid (Finacea) and the 251 patients who completed a 15-week treatment regimen found success with both options, though azelaic acid had a slight edge (Source: Archives of Dermatology, October 2004, pages 1282-1283).
If the inflammation and redness of rosacea is accompanied by numerous papules and pustules, there is research showing that the topical prescription Differin (active ingredient adapalene) can be of significant help. However, Differin doesn’t have an effect on facial redness, so for best results, it is used in combination with metronidazole (Source: International Journal of Dermatology, Volume 44, Issue 3, March 2005, pages 252-255). Some dermatologists may also prescribe tretinoin (Retin-A, Renova) though most rosacea patients find the side effects of this vitamin A medication intolerable (Source: www.drnase.com/Prescipt_ions.htm
For extremely stubborn or unresponsive cases of rosacea, the powerful oral medication isotretinoin (isotretinoin, also available as a generic) may be worth considering. It has been shown in several studies to be effective for those with treatment-resistant rosacea, and it is effective in an extremely low dose. No one is quite sure how or why isotretinoin works for rosacea, but the success rate is positive, and after treatment, the swelling and distortion of the oil glands are often resolved (Source: Archives of Dermatology, July 1998, pages 884–885; and Total Skin, David J. Leffell, M.D., Hyperion, 2000, page 337).
In conjunction with topical and oral prescription medicines, non-ablative laser and Intense Pulsed Light (IPL) treatments have shown great promise in helping to restore rosacea-afflicted skin to its natural, non-reddened coloring and healthy appearance. Whereas prescriptions such as MetroCream or Azelex work to control the theoretical cause of rosacea and minimize symptoms, they are not all-encompassing solutions. For example, facial flushing and telangiectasias are typically not affected by topical rosacea treatments (Sources: Journal of Drugs in Dermatology, September-October 2004, pages 12-22; Journal of the American Academy of Dermatology, October 2004, pages 592-599; British Journal of Plastic Surgery, June 2004, pages 303-310; and Journal of Drugs in Dermatology, June 2003, pages 254-259). Although laser and light-emitting procedures hold much promise, keep your expectations realistic and remember that you will most likely see a reduction (not elimination) of bothersome facial redness. In addition, keep in mind that upwards of six treatments are generally required to produce satisfactory results.