“Acne? Acne? Doc — how could I possibly have acne? I’m 35 years old!”
Acne rosacea, or adult type acne, is a fairly common condition affecting an estimated 13 million unfortunate citizens in the United States. Any ethnicity is at risk, but it is more common in whites. Women are affected more than men. Acne rosacea can significantly affect the quality of life of those afflicted by it.
It starts gradually with symmetric facial flushing, erythema (redness), prominent tiny blood vessels called telangiectasias, papules (raised bumps), pustules (tiny abscesses), thickening of the skin and enlargement of the pores. Eye involvement is common with nearly 60% of rosacea patients showing ocular disease. Symptoms include photophobia, erythema, foreign body sensation, telangiectasias, corneal ulcers, and worse.
“But Doc, are you sure?”
Not everything on the face which looks like rosacea is rosacea. It can mimic other conditions and other conditions can mimic it. Your doctor should consider the possibility of lupus, drug rashes, peri- oral dermatitis, sarcoidosis, photosensitivity reactions, granulomatous skin changes, and polymyositis. If doubt exists, a biopsy may be needed.
So let’s say that the diagnosis is secure. You have acne rosacea. What now? Before (long before) your nose resembles that of W.C.Fields, there are things you can do and medicines you can take to treat it.
Avoid sun exposure. Use your sunscreen. Wear wide-brimmed hats. Skin products containing astringents such as menthol, alcohol, witch hazel, clove, peppermint, or sodium laurel sulfate should also be avoided. Other triggers to be avoided are stress (ha! that’s a good one), wind, strenuous exercise, spicy foods, adult beverages, hot beverages, certain cosmetics, and both indoor and outdoor heat. The preceding list was based on a survey of over 1000 rosacea sufferers. You may have none, one, or more triggers. If you do find a trigger, do your best to avoid it.
After avoiding triggers, both topical and systemic therapies are available. What you choose and use is often a process of trial and error. Working together with your physician, you should be able to find a combination which controls the disease (there is no cure), with a minimum of side effects. Evidence for efficacy of treatment in controlled clinical trials is spotty and inconsistent. Be patient. Most therapies work. They just don’t work immediately and they don’t work all the time in all patients.
Topical agents include benzoyl peroxide, clindamycin, erythromycin, sulfacetamide, azelaic acid, metronidazole, adapalene, permethrin, and tretinoin. They all have their place in the therapy, along with pluses and minuses, benefits and risks, and side effects.
Oral options include doxycycline, tetracycline, minocycline, metronidazole, azithromycin, and isotretinoin. Again, each option has its risks and benefits. Have a thorough discussion with your doctor about the best selection for your particular condition.
Nonpharmacological treatments include lasers, dermabrasion, carbon dioxide laser peel, cold steel excision, electro-surgery, and surgical shave techniques. Obviously, these treatments are reserved for only the most severe recalcitrant cases. Ocular rosacea almost always requires systemic therapy and the help of an ophthalmologist.
OK. So you have acne rosacea. Do not despair. It is annoying but not serious. It is treatable. Find a doctor who is familiar with it and work with him or her to find a treatment regimen which is right for you.
Copyright Timewise Medical 2010
