Caitlin Whyte (Host): Rosacea is such a frustrating skin condition to have. I know because my mother deals with rosacea and has been trying to manage it for as long as I can remember. So today we are talking all about rosacea myths and lifestyle modifications to help you deal with it on a day-to-day basis. Joining us for this conversation is dermatologist, Dr. Ashley Feneran.

Well, Doctor, so excited to have you here today. To start off our conversation on rosacea, this affects more than 16 million people in the United States. So can you tell us first off, just what is rosacea?

Ashley Feneran,DO: Yes, so rosacea is a fairly common skin condition. It often begins at the beginning of symptoms as just an initial blush or flush of the skin that seems to happen more easily than compared to other people. But it can be more than just redness. There are other signs that you might see with rosacea, but not everyone displays these signs; but they can include getting blood vessels on your facial skin, getting bumpiness on your skin that almost looks like acne.

You can even get changes like thickening of your skin, and then rosacea can even affect the eyes in some individuals, but primarily rosacea is a skin condition that affects the facial skin.

Host: Gotcha. So like you mentioned, rosacea can commonly be misdiagnosed as acne or allergies. So what symptoms should someone look for to help determine if they have rosacea versus just that more common acne or allergies?

Ashley Feneran,DO: Yeah, I think this is a very common question that I get and there are differences between acne and allergies and rosacea, but sometimes it can be difficult and sometimes, to be honest, we can see overlapping features in the same person. But thinking about acne versus rosacea; when you see acne in an individual, they usually have blackheads and whiteheads, but in rosacea, you typically do not see those things.

Usually it's just more big inflamed red bumps or pus bumps.   Also, in acne, you tend to see more redness just around the bump itself, whereas in rosacea, remember that facial flushing or blush, it does typically happen in more of a zone of the skin, usually the middle third of your face. In acne skin, it tends to be more on the oily side, whereas in rosacea, you don't always see that.

And then remember with rosacea too, there are other symptoms, like in some individuals, there might be eye problems as well. So if you think you have acne, but then you're noticing your eyes are bloodshot, or they feel sandpapery or gritty, that may be an indication that you're dealing with rosacea.

So I feel like acne and rosacea do have distinctive features, but like I said in my practice, I do see a lot of people with overlap. And then with allergies versus rosacea, that can be trickier too, because rosacea skin is sensitive skin and in a lot of times more prone to getting allergies, but allergies tend to be itchy.

That's usually the classic finding of someone who has a true allergy to a product, whereas rosacea really shouldn't feel like anything, possibly minor itch or minor tenderness, but primarily it's just a look to the skin, but not symptoms to the skin.

Host: Well, are there any risk factors then for developing rosacea? Can you kind of get it at any age?

Ashley Feneran,DO: Yeah, so you can technically get rosacea at any age, but we definitely see it more commonly between the ages of 30 and 50. When it comes to risk factors for rosacea, genetic predisposition is definitely there. And one thing that I found interesting was when I was in training as a resident in dermatology, we actually would do research studies in a city called Twinsburg, Ohio, where they brought in twins from all over the world.

And it gave us the ability to test rosacea on people who had genetic identical, you know, DNA. So these two say identical twins, one would live in Australia, one would live in Minnesota, and they both have the predisposition to getting rosacea genetically, but one would manifest with symptoms and the other wouldn't.

So I guess we find out, like, why is that the case? And it is an interplay between genetics and environment, which we don't fully understand, but there are certain risk factors for that. And being fair skinned, blue eyes, having that family history of rosacea are all risk factors. And women are actually more likely to get rosacea, but men, when they get it, it does tend to be more severe.

Host: Well, I've heard that things like caffeine, coffee, and alcohol can trigger those rosacea flares. Is any of that true? And what typically causes rosacea, then?

Ashley Feneran,DO: In terms of what causes rosacea and what triggers rosacea, I feel like I want to tease out a little bit of both. So what causes rosacea again is we do understand that there's this genetic predisposition to rosacea, but we also are starting to learn more about the root cause of rosacea, which may involve to some degree, the immune system and a reaction of your body to a bacteria or certain bacterias, but we still don't know if it causes rosacea because everyone has these bacteria in their bodies and on their skin, but not everyone then displays rosacea. So there's a certain mite on the skin, which is another example. It's called the demodex mite. And we have targets for this to treat rosacea that can clear people very well. So we assume it's a cause or one of the causes of rosacea, but again, everyone in the world has demodex mites on their skin, but not everyone gets rosacea.

So the causes, we're still trying to learn more about. I think it's kind of interesting.  When it comes to triggers for rosacea, these are a little clearer cut because this is people's individual experience and over time we've learned that many people have the same triggers and by far and large, sunlight is a major factor of triggering rosacea in a lot of people, as are, I kind of joke around about all the good things in life can trigger rosacea.

So spicy food, chocolate, alcohol, especially red wine, extreme temperatures, so very hot, very cold, exercising can trigger rosacea, which some people may like to hear, but you shouldn't avoid it. Yeah, even hairspray is something that can trigger people's rosacea, and sadly, you know, stress. I always tell my patients that the skin is a window to the body, and a lot of stress can manifest on the skin, and rosacea is one of them.

Host: Well, on that note, what are some misconceptions about rosacea, and then what is the reality? For example, I'd love to know, like, is rosacea contagious, or other things you've heard?

Ashley Feneran,DO: I would say rosacea is absolutely not contagious. So this isn't something that with direct contact of one individual to another, you can pass it on. That's just not the case for rosacea. But if you think, well, why does everyone in my family have it, then it must be contagious, because we all have it and we all live together.

But that's not true. Remember, it's that genetic predisposition. So, thankfully it is not contagious. In terms of some misconceptions about rosacea, there are a few. So, one is that some people believe that rosacea only affects the skin, but remember that's not the case. It can actually affect your eyes as well, so it's important to get that diagnosis so that you can be treated effectively.

Also, another myth is that people will wrongly assume that if someone has a red face or features of rosacea that that means that they drink a lot, and unfortunately this can be very uncomfortable for patients with rosacea, so it might be worth being aware of that if you're in a social setting and you see someone with redness to their cheeks, don't wrongly assume that they must be over drinking.

Rosacea definitely happens in people who have never had alcohol before.   Also, , something I hear in my clinic a lot is if I have this type of rosacea or that blushing pink to my skin, it means that I'm going to get what pictures I see online, which are these thickened,  we call it phymatous change, which is where the nose will get bulbous and thickened and bumpy.

And the good news is, is that is not the case. It does not mean that because you have rosacea, you will then have all the changes associated with rosacea. By far and large, we see a lot of people with just the blush of pink of their cheeks or just a few bumps on their nose and their cheeks.

Host: Fascinating stuff. Thank you for sharing those. Well, I'd love to know then, are there any lifestyle modifications that people can make to help keep rosacea flare ups at bay?

Ashley Feneran,DO: Yes, so. This is one of my favorite questions to address in the office because I really consider this to be a team approach. I can only do so much when it comes to prescriptions, but I tell patients that oftentimes the best way to help yourself and help your rosacea is to actively avoid your triggers and identify those triggers as well.

So sun protection is something we really strongly emphasize, not just for skin cancer prevention, but in people who have rosacea, sun protection can dramatically improve how,  how well controlled your skin looks to the point of it even possibly looking clear. So a lot of rosacea or patients who have rosacea, mention that sunscreens can irritate their skin, so they tend to stay away from sunscreen, and that's understandable, but it's just about finding the right sunscreen.

So, my recommendation is to find something fragrance free, something that contains what's called zinc oxide, so or titanium dioxide. Titanium dioxide and zinc oxide are physical blocker or mineral sunscreens, and they tend to be very well tolerated on sensitive skin like rosacea, and you want to be looking for an SPF 30 or higher.

Other ways to help reduce the triggers and keep your rosacea flare ups controlled would be to try to reduce stress as best as you can. Maybe being actively aware if it seems like you're in a stressful situation and trying to navigate that and manage stress appropriately. Try to avoid overheating as well.

Consider when you're exercising, wearing layers or loose, breathable clothing so that you don't overheat which can cause your rosacea to flare. And other things, it depends on the person, but certain triggers like rethink maybe your hot coffee in the morning or that hot tea, which can dilate your facial blood vessels and give you that blush.

Be aware if alcohol, especially red wine, if that's a trigger for you, just consider the situation you're in and whether you want to possibly expose yourself to the trigger that will cause a flare, and then avoid spicy foods if they're a trigger. Be careful with care products that you select. Really in dermatology, we emphasize that personal care products do not need to be expensive or fancy.

Oftentimes, they just need to be fragrance free and gentle, and that's the best way to go, especially for rosacea.

Host: Great. Well, as we close out here today, Doctor, what are the most common medical treatments for rosacea and is there any total cure?

Ashley Feneran,DO: Yeah, so unfortunately, there is no cure for rosacea, but there are ways to manage it so that your skin can essentially look near or completely clear. So that's, I would say, a good motivation for people who want to have treatment. As I said before, addressing and avoiding triggers are by far and large the most important part of managing rosacea.

But if you were to see a Board Certified Dermatologist or a dermatologist here at Duly Health and Care, we have prescription treatments as well that include both topicals, which means your gels and your creams, even pills, which I can go over, and then some options with our Duly Aesthetics or more cosmetic treatments.

So, topical treatments, we use products like azelaic acid or metronidazole, and these are topicals that can help reduce the acne like breakouts with rosacea. We even use oral antibiotics. One is called tetracycline. It's a class of medicine that also includes doxycycline, minocycline. Now these are pills that at their normal levels do kill bacteria, but they also are very effective at reducing the inflammation that's associated with rosacea and can be an excellent treatment for ocular rosacea, which is the eye involvement.

But what we do a lot in rosacea is drop the dose of the oral antibiotic to what's called sub-antimicrobial, which basically means that it's below the level of affecting bacteria. So, when people get, rightfully so, a little hesitant about being on an oral antibiotic for rosacea, especially long term, I tell them, well, you can tell everyone who's asking, why did my dermatologist give me this antibiotic forever?

You can tell them it's okay because we're using it at a low level that doesn't affect bacteria. It's only addressing rosacea. To address the redness of rosacea, there's a few targeted treatments. One is trying to use green tinted makeup. And makeup that's green tinted doesn't necessarily look green, but it cancels out the red.

So, look for products that say that they have green tint in them. Moving into more the cosmetic realm of rosacea treatment would be addressing specifically the blushing pink of the skin and a very popular procedure for this is a laser treatment or something called BBL or broadband light treatment, which is something that picks up on the redness and helps even out skin tone.

So this is a very popular treatment for rosacea, but it's very important to note this is not typically covered by insurance, this is something that is more cosmetic. There are topical prescriptions for the redness of rosacea. These tend to clamp down on the blood vessels, but it is only temporary. So it lasts about 12 hours, and these products are called brimonidine and oxymetazoline.

So some patients like these for, say, events where for one day, maybe a wedding, or some event where there might be photographs, people want to try and reduce that redness to their skin. And then finally, if there's a skin texture change from rosacea, this does have to be addressed a little differently, oftentimes with sometimes we go so far as to do surgical treatment to help almost re-sculpt areas of thickening, like on the nose. We will use lasers, something called an ablative laser, which can help smooth out and resurface the skin. And in more severe cases, we will utilize a medication called isotretinoin, which can really help reduce the thickening and the active breakouts of rosacea.

Host: Thank you so much for this informative conversation, Dr. Feneran. I know I really enjoyed it and will be sending this episode to my mom, and I'm sure many with rosacea will find it just as helpful. And thank you for listening. If you found this podcast helpful, please share it on your social channels and check out our full podcast library on your favorite app or at dulyhealthandcare.com. This is Duly Noted, a health and care podcast from Duly Health and Care.