#rosacea - symptoms, diagnosis and treatment

Rosacea was known during a long time as "acne rosacea" because it was believed that rosacea was a variant of acne. Today we know that acne and rosacea are different skin diseases, although the exact cause of rosacea is not known yet; all we know is that genetic / hereditary factors are involved.
Rosacea progresses in stages, from mild to severe forms with facial deformities. Usually the first symptom is the "redness" of the face, especially nose and cheeks. Some factors precipitate the redness, like stress, sun exposure, alcohol, pepper and vasodilator drugs. At this stage, there are already dilated blood vessels on the face at the reddish regions.
After a certain time, redness becomes constant, causing discomfort and embarrassment. If untreated, red lumps and hardened nodules arise; over time, these lumps start to agglomerate forming masses and deformities, especially on the nose (rhinophyma). This last stage of rosacea is the most severe and hardest to treat: the patient feels shame and depression can develop. Another complication in advanced stages of rosacea is inflammation of the eyes or blepharitis; symptoms are redness, tearing, itching and irritation of the eyelids.

Once the diagnosis of rosacea is made, treatment must begin. Unfortunately rosacea is a chronic disease and should be monitored closely by a dermatologist, so it does not progress and worsen over time. The first step in treatment is to avoid the precipitating factors, such as excess of  sun exposure, alcohol, pepper, etc. The use of sunscreen is essential . At this stage, cosmetics to disguise the redness of the face may be used: Phyto-Corrective(Skinceuticals) and Anti -Redness (Eucerin), 2 or 3 times a day.
When the redness progresses and becomes persistent and bothersome, drug therapy should be started, primarily with topical antibiotic gel (my preference is metronidazole); it should be applied on the affected areas twice daily for prolonged periods, from 3 to 6 months, until stabilization of the skin. The improvement begins to be noticeable after a month of continuous use. Small vessels on the face, dilated and visible, can be cauterized using Hyfrecator with the proper tip and the minimal power required.

And finally for the most advanced cases of rosacea, treatment options become less effective. But they can somehow prevent the progression of the disease.
For moderate rosacea, represented by the constant redness of face, dilated vessels and inflammatory lumps, I prescribe long cycle of oral antibiotic, preferably doxycycline, erythromycin or azithromycin. The use must be for at least 3 months. If no improvements, I associate oral isotretinoin (Accutane) in low doses, for an average period of 6 months. At this stage, Intense Pulsed Light sessions can be useful.
In the final stage of rosacea (severe rosacea), with facial deformities (rhinophyma), treatment is difficult and costy. Medications are not useful at this stage; only the ablative CO2 laser (average of 3 sessions) may lead to a partial improvement.
So, keep an eye! Noting abnormal redness of the face and small dilated veins, visit your dermatologist...