Dear Alice,

What is wrong with my face? It permanently looks sunburnt across my nose, cheeks and on my chin. Sometimes it appears worse than others. It is hot to touch and often bleeds. Typical rosacea treatments do not improve the redness or pain. I'm overweight but otherwise healthy. Thanks!

Dear Reader,

Dealing with pain or discomfort on a regular basis can certainly be difficult, not to mention the frustration when recommended treatments don’t seem to help. The condition you mentioned in your question, rosacea, is a chronic inflammation of the skin. It's fairly common, affecting about one in ten adults, and in some cases, may last for years. Have you talked with your health care provider about your symptoms? It may prove beneficial to make an appointment if you haven’t already. They may be able to provide a diagnosis or explore other causes such as dermatitis, an allergic reaction, or lupus (more on those later). It’s also worth noting that not all products recommended for the treatment of rosacea have been sufficiently studied. In fact, many over-the-counter skin care products contain ingredients — such as acids, alcohol, or other irritants — that could further irritate your condition.

While your symptoms may in fact be rosacea, you may want ask your health care provider about other causes, including:

  • Seborrheic dermatitis: The condition causes a red rash that may appear oily or dry and scaly.
  • Skin irritation or allergic reaction: This can be caused by skin that comes into contact with an irritant; the reaction may cause different symptoms or affect the skin differently.
  • Atopic dermatitis: Also known as eczema, it causes a sudden rash that feels dry, scaly, and itchy.
  • Psoriasis: With this condition, the body produces skin cells more rapidly causing cells to accumulate, and leading to patchy, red skin.
  • Spider veins: A lack of sun protection may cause these veins to show up on the face.
  • Shingles: This condition causes a painful rash that may appear anywhere on the body, including the face.
  • Lupus: This is an immune system disorder that causes the body’s own defense system to attack it and in some cases, this may cause redness on the face.

List adapted from the American Academy of Dermatology.

If what you're experiencing is caused by rosacea, it's key to know there's no cure, but there is some treatment for symptoms. Rosacea is more common in women and fair-haired and fair-skinned people. It usually starts in people over the age of 20 and causes redness in the face, papules, pustules and patches (red and yellow pimples), edema (swelling) and bumps on the nose, and includes symptoms affecting the eyes. Given the range and phases of symptoms, rosacea is often mistaken for acne or other skin problems. In most people, rosacea is cyclic, so symptoms may flare up and diminish over a period of weeks to months. The symptoms may stay the same for long periods of time or may steadily worsen over time if not treated. There’s no exact cause, but some types seem to run in families. Researchers believe the body could be reacting to a number of factors, including problems with the blood vessels in the skin, sun damage, an abnormal inflammatory reaction, or an adverse effect of some medications.

Current research suggests that there are a number of different treatment options, ranging from topical creams, pills, and light treatments. Some common treatments include the creams and gels with either azelaic acid or the antibiotic metronidazole in them. Generally, when using these products, improvements may take a few weeks to be noticeable. Other therapies for highly resistant rosacea include brimonidine gel and oxymetazoline hydrochloride cream, both of which reduce redness and last for twelve hours. Oral antibiotics may also be used to treat rosacea, mostly due to their anti-inflammatory properties, and tend to work faster than topical treatments. Antibiotics belonging to the group called tetracyclines such as erythromycin or clindamycin are commonly prescribed, and there’s evidence that doxycycline might help relieve skin redness.

In very serious cases of rosacea, the hormone-like substance isotretinoin has been used, but it’s associated with adverse side effects. And for those who have a constantly red face or visible blood vessels, lasers and other light-based treatments have also been recommended. There’s some anecdotal evidence supporting alternative therapies, but there’s no conclusive evidence that they’re effective. Talking with a health care provider may prove to be helpful — they can help you weigh the pros and cons of continuing your current treatment plan and help you navigate alternative therapies until you find one that helps and relieves symptoms. If you’re feeling self-conscious about the redness in your face, cosmetics could help make the problem less obvious, but remember to be careful that they don’t make your symptoms worse. In addition, there are various rosacea support groups online where people share their experiences. If your symptoms makes you red in the face, you may consider checking one of these out for additional support.

While you wait for an appointment, you may want to consider keeping a diary of your symptoms and their potential triggers. These may include different types of foods or alcohol, cosmetics, particular medications, and specific exposures (such as sun, wind, physical activity, and hot water). Consider tracking your daily symptoms and including other details about your day such as the weather, food and drinks consumed, general mood, or cosmetics used for a few weeks. You may find some patterns that’ll help you control your symptoms. Also note how long you've been using your current regimens — some forms of treatment take time to become effective and you may not have been using the product long enough to see its full effects yet. In the meantime, there are a few steps you may want to take to help: protect your face from the sun (with either sunscreen with an sun protection factor (SPF) of at least 30, a hat, or both), avoid touching or rubbing your face, wash problem areas with a gentle cleanser, avoid overheating, and use products that are labeled non-comedogenic, as these won't clog your pores. 

Here’s to hoping you find a way to flush the blush!

Alice!

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