Acne Rosacea (Adult Acne)
Patient Information Sheet
Acne rosacea is adult acne. Yes, I know. There seems to be no escaping it for some people. It is different from teenage acne in that teenage acne is dominated by blackheads and whiteheads. These are little plugs of dead skin that plug up the openings of hair follicles and induce pimples. In adult acne, blackheads and whiteheads play a smaller role. Pustules, cysts, and areas of redness predominate in acne rosacea. Adult acne is mostly limited to the face.
Sometimes acne rosacea can be very subtle. It may appear only as a mild redness of the cheeks and across the nose. It can be mistaken for sunburn; irritation from soaps, cosmetics, and medicines; infection; and lupus erythematosus.
Some medicines such as strong topical cortisones and cortisone pills can aggravate acne rosacea. There is actually a category of acne rosacea called "steroid rosacea."
The cause of acne rosacea is unknown. It is inherited. Sunlight often aggravates the redness and dilated blood vessels, but sunlight does not cause acne rosacea. It is not due to a vitamin deficiency or an allergy to foods.
Evidence presented in 1989 by Michael J. Tapert, M.D., suggests that acne rosacea can involve the eye. It is called "ocular rosacea." It appears as redness of the white part of the eye and stiff crusting of the eyelid margins at the base of the eyelashes. The blood vessels are dilated. In 20% of rosacea patients, the involvement of the eye precedes the skin involvement. In 27% of rosacea patients, the eye involvement occurs at the same time as the skin manifestations. My experience has been different from Dr. Taper's data. I do not see much ocular rosacea. But, it is good to be on the alert for it.
Ocular rosacea can be accompanied by dryness of the eyes due to decreased tear production, sty's, and rarely, vision threatening corneal inflammation. The hard dry crust scrapes the cornea when you blink. If allowed to go on for a long time, the scraping of the cornea can damage the cornea and interfere with vision. If you develop such problems, you must see an ophthalmologist, a doctor of medicine specializing in eye diseases. Don't let it get that bad.
I have been treating rosacea since 1972. I have tried a variety of ways of treating it. I keep coming back to the use of tetracycline or minocycline pills as the most effective treatment. Sometimes, taking one tetracycline capsule a day for 4 to 6 months will get it under control. Sometimes, it is necessary to take tetracycline for years. One of my goals is to reduce the dilation of the blood vessels, to reduce the redness. If 4 to 6 months of tetracycline therapy will reduce the severity of dilated blood vessels, the acne rosacea will often improve.
Initially, I viewed rosacea as a variation on the acne theme. I still think that, but I am more and more impressed by the redness. If you can reduce the redness, usually the acne rosacea improves. Sunlight aggravates the dilation of these blood vessels. So, it may help to use a sunscreen.
Sometimes it is very hard to treat. I have tried 14 treatments on one patient, and nothing worked. The only thing that helped her was laser treatment to reduce the redness.
An alternative medication is erythromycin pills taken one a day. For people who cannot take tetracycline, minocycline or erythromycin, the topical use of metronidazole (Flagyl) in the form of MetroGel twice a day, or Noritate once a day may help.
Here is a list of treatments I have used:
- Tetracycline, minocycline- generally the best treatments.
- Doxycycline- a pill, effective but may cause sunlight sensitivity.
- Metronidazole- MetroCream, MetroGel, Noritate- Not as effective, but sometimes it helps after 2 months of daily use. Advantages- topical cream and not a pill.
- Klaron, Novacet- sulfa based creams
- Bactrim- a sulfa pill
- Capitrol Shampoo
- Topical Indomethacin
- Benzamycin, BenzaClin, Duac, Azelex, Retin A- acne creams
- Topical 1% alpha-lipoic acid in MetroGel
- Elidel cream
- Accutane- a strong oral medicine that is a treatment of last resort for rosacea. Unpredictable results.
- Laser- sometimes this will reduce redness when nothing else will work
Some people report that avoiding foods that dilate blood vessels will help: alcohol, spicy foods, hot coffee, hot tea, vinegar, caffeine, pork (I don't know how pork would fit in.) I have not been too impressed by the role of diet, but avoiding problem foods could not hurt.
One of my patients with ocular rosacea did well with ivermectin, a deworming medicine. It may be working for her by killing microscopic mites called Demodex that live in the oil glands of hair follicles. She uses a short course of the pills about every 6 months.
Acne rosacea is very common, and we need to learn more about it. The National Rosacea Society has a helpful newsletter, which you can subscribe to online or by mail at National Rosacea Society, 800 South Northwest Highway, Suite 200, Barrington, IL 60010
Rev. Jan. 26, 2010 copyright Dr. Tkach
Read more at the National Rosacea Society web site.
The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.