According to Dr. Alina Sholar; How to Know if You Have Rosacea and What You Can Do About It

Rosacea is a skin condition that affects over 14 million Americans. It is a condition that causes redness, as well as visible blood vessels to appear on your face. Rosacea refers to a range of symptoms that generally begin with some blushing or modest redness on the cheeks, nose, forehead and chin. As the condition progresses, symptoms typically worsen to include persistent redness of the nose and cheeks. Small blood vessels begin to grow (Telangiectasia), particularly on the nose, and become increasingly visible. Diffused redness may become permanent, often worsening after exercise, consumption of coffee or alcohol or other factors (see below). Redness is also an indicator of collagen loss, which leads to thin skin density and weakened support of the capillary network. Additionally, vesicles (pustules or papules) may develop in these later stages; a factor which has led to the misdiagnosis of rosacea as “adult acne”.

Dr. Alina Sholar is a plastic surgeon and entrepreneur from Austin, Texas. Too often, she has seen rosacea misdiagnosed as acne, mild skin irritation, sun exposure, or even insect bites. Knowing what the causes and symptoms of rosacea are is critical to treating it. Dr. Sholar delves into all things rosacea, including how to know if you have it and what you can do about it.

What is Rosacea?

As previously mentioned, rosacea is a skin condition that presents itself in the form of redness and visible blood vessels, most commonly on the face. Rosacea is a very common condition and one that can affect anyone, regardless of gender or age. However, according to Dr. Alina Sholar, it is most common in middle aged women with light skin. It is also a fickle condition, which is what so often leads to its misdiagnosis. It is not uncommon for the condition to flare up for weeks or months at a time and then go away entirely. While there is no cure for rosacea, there are a number of treatment options that can help both reduce and control the symptoms of it. The typical characteristics of rosacea include:

  • Permanent diffused redness

  • Flushing

  • Inflammation

  • Rhinophyma

  • Ocular lesions

  • Papules and pustules

  • Visible blood vessels (telangiectasia)

Causes of Rosacea

The direct causes of rosacea are unknown; however, studies have shown that a combination of genetic, physiologic, and environmental factors can make someone more prone to it. Dr. Alina Sholar can say that rosacea is not caused simply by poor hygiene, so there is no need to worry about that. In addition, while the exact causes are not yet known, doctors have narrowed down a variety of factors that can trigger flare ups in people with rosacea. These triggers include eating spicy foods, drinking hot beverages, red wine, or other alcoholic beverages, increased exposure to the sun or wind, exposure to extreme temperatures such as harsh winter conditions, exercising, applying certain cosmetic products to the skin, feeling emotional, and taking drugs that dilate blood vessels, such as certain types of blood pressure medications. Further, Dr. Alina Sholar claims there are other risk factors at play that make certain people more prone to suffering from rosacea. Current research indicates that women are more likely to develop rosacea by a ratio of 3:1 when compared to men. Other factors that put you at risk are being over the age of 30, smoking, having light skin, and having a family history of rosacea.

Signs of Rosacea

With any skin condition, there are several signs or symptoms that may appear when you are experiencing a rosacea flare up. While these signs might be annoying and even painful, they can ultimately help you detect and identify the condition, which in turn, can help you treat it most effectively. Dr. Alina Sholar states that the most common signs of rosacea include facial redness, typically on the center of your face, like your nose and cheeks. In addition to redness, small red blood vessels may swell and become visible on these areas of the face. Further, rosacea can lead to swollen, red bumps that often contain pus and feel swollen and tender to the touch. These bumps are what leads to rosacea being mistaken for acne. Less common symptoms of rosacea include dry, irritated, red, or swollen eyes and eyelids (a condition known as ocular rosacea), and an enlarged nose, whereby the skin on the nose has become thicker (a condition known as rhinophyma that is more common in men than women). Ultimately, if you experience persistent redness on your face, consider visiting your doctor or dermatologist so that it can be diagnosed and you can receive proper treatment In all cases, the inflammation characteristic of this disorder indicates poor skin barrier health.

Dr. Alina Sholar on Treatments for Rosacea

Consistent daily use of correct skin care and treatments to help manage symptoms is critical for long-term management. While there is currently no cure per se for rosacea, its symptoms can be managed quite effectively if the patient is consistently compliant with the prescribed treatment.. Cellular health is very important to improving the condition. In addition to the ingredients outlined below, a dietary intake of essential fatty acids such as Omega 3 & 6 is beneficial.

Before your doctor recommends treatment, they will first confirm that you do in fact have rosacea. While there is no specific test that will tell you if you have it, your doctor will likely ask about your family history and rule out other common skin conditions, such as psoriasis or eczema. Once diagnosed, Dr. Alina Sholar asserts that the treatment plans usually focus on signs and symptoms, as there is no known cure. Based on genetics and the subtype of rosacea, we know events that trigger a reaction are different in each person. Therefore, when considering a skin care product, a one-size-fits-all approach is often inappropriate. The most common treatments involve a combination of dermal barrier-restoring skin care and anti-bacterial medications, some of which are topical and some of which are oral. The customization and blending of Dermaviduals bio-identical moisturizers, gels and anti-inflammatory serums, help fortify and strengthen the barrier system leading to a reduction in redness, dryness, pustules and papules. Corneotherapeutic treatments aim to stabilize the disordered skin barrier over the course of the long term. The skin barrier, when strong and intact, can largely stop external rosacea triggers such as environmental stress, chemicals and germs.

As the skin barrier is stabilized, the likelihood of inflammatory processes in the deeper skin layers recurring decreases. Instead, they will gradually regress and you will notice visible improvements to the condition. This treatment is called the “outside-in” strategy. In summary, a stronger skin with intact lipid bilayers will be better able to prepare itself to utilize anti-oxidants to scavenge free radicals.  In short, it can obviate all that rosacea can throw at it.

The skin care products you use should be free of perfumes, preservatives, emulsifiers, mineral oils and silicones, as these substances have the ability to further aggravate a sensitive, inflamed skin condition such as rosacea. Fatty acids, ceramides and phytosterols in combination with saturated phosphatidylcholine and triglycerides, allow skin-identical physical structures and displays excellent tolerance properties

The water used for cleansing should be lukewarm and free from hardening components such as calcium and magnesium ions in order to prevent a salt precipitation of the fatty acids of the skin barrier, which can further destabilize the barrier.

Cleansing products should be free from preservatives (sensitizing potential) and re-fattening substances in the form of silicones or surface-active compounds. Appropriate preparations are gels with pH values up to a maximum of 7, without lauryl sulfate or lauryl ether sulfate (due to their irritating potential). Sugar tensides, for instance, are recommended as alternate cleansing substances. Alternatively, tensides or emulsifier-free cleansing milks can be used.

The length of the treatment will vary person to person as it depends on the severity of your case. If you are prescribed a topical drug, it will usually be in the form of a cream or gel, like brimonidine or oxymetazoline, which work to reduce redness by constricting blood vessels. This is only a temporary fix that usually lasts about 12 hours, so you will need to reapply frequently. While some topical drugs are aimed at the redness associated with rosacea, others are aimed at the red bumps that form. That is why acne medication is sometimes prescribed for rosacea, such as azelaic acid or metronidazole. Other medications you might be prescribed include oral antibiotics or oral acne drugs like isotretinoin. Beyond medication, various therapies may be recommended by your doctor. Laser or light-based therapies have been known to reduce redness, like Celluma LED, Laser Genesis and LimeLight Photofacials. The weakened blood vessels associated with rosacea can be treated with the use of dermal microneedling by stimulating epidermal growth factors and increasing the density of the epidermis, which lessens the appearance of vessels beneath the skin and reduces overall redness. It will also strengthen collagen in both vessel walls and the connective tissue that support the vessels. However, in all cases, it’s worth noting that all forms of therapy will likely involve repeat appointments for rosacea patients and you should consult with a doctor to discuss options for you. Other non-medical treatments that Dr. Alina Sholar recommends include Dermaviduals treatment masks and regular SkinWave facials.