Acne rosacea is an inflammatory skin disorder marked by acne-like eruptions. It is seen most often in fair-skinned individuals of northern European extraction and is more common in women than in men.

Although acne rosacea may look like typical acne, it lacks one of the classic features of acne – comedones (whiteheads and blackheads).

The condition usually appears in middle age or later, it is not primarily a plague of teenagers. It is estimated that as many as 14+ million North Americans have acne rosacea and many don’t know it. The condition is chronic with periods of exacerbation and remissions.

You may have acne rosacea if you have dilated capillaries (also known as telangiectasias) causing redness on your forehead, nose, cheekbones and chin.

Other symptoms include a mild swelling of the face, skin thickening, papules and pustules and persistent redness. People with acne rosacea often have a history of flushing and blushing easily.

Some patients with acne rosacea have the redness, papules and pustules while others have only redness and telangiectasias; and others have a combination of all these features. In its extreme form it gets deep into the many oily follicles of the nose and the inflammation can result in thickening of the end of the nose. In roughly half of all patients with acne rosacea the eye can be affected, with such symptoms as conjunctivitis, soreness, decreased tear production and redness and scaling of the eyelids.

The exact cause of acne rosacea is still a mystery, but it is known that certain conditions can exacerbate it by dilating facial blood vessels. Among the things that can make rosacea worse are:

• Alcohol ingestion – especially red wine, beer, bourbon, gin, vodka or champagne.
• Weather – sun, strong winds, cold, humidity.
• Hot drinks – including hot cider, hot chocolate, coffee or tea.
• Extreme temperature changes – from hot showers, heating, air conditioning, saunas and strenuous exercise.
• Irritating skin treatments or products – including facial peels and alpha hydroxy acid (AHA) products.
• Certain dairy products – including yogurt, sour cream, cheese (except cottage cheese).
• Certain vegetables – eggplant, avocado and spinach.
• Spicy and thermally hot foods – many experts recommend avoiding a wide variety of these.
• Other food and food ingredients – liver, chocolate, vanilla, soy sauce, lobster, yeast extract (bread is ok), vinegar, Broad-leaf beans and pods (including lima, navy or pea), Aspartame and NutraSweet, preservatives, food colorings and MSG.
• Citrus fruits – tomatoes, bananas, red plums, raisins or figs.
• Certain skin care products – containing alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus oil, clove oil and salicylic acid.
• Drugs – especially those that dilate the blood vessels including some blood pressure medications.
• Emotional influences – stress, anxiety.
• Demodex folliculorum – it is also felt that this mite, which lives in the hair follicles, may be part of the cause. In some individuals with acne rosacea, the concentration of such mites is significantly increased.

Treatment guidelines:

• For the milder cases of acne rosacea metronidazole cream has proven effective. For moderate to severe cases oral antibiotics such as tetracycline and other acne medication might be required. These medications are normally used over the longer term to keep the problem under control. Antibiotics and topical treatments, used in combination, are also very popular.
  
  Another topical antibiotic used is sulfacetamide. It is available in several preparations in tinted form to minimize redness. For the most severe cases, isotretinoin is sometimes prescribed.
• Use a full spectrum sun block (against both ultraviolet A and B radiation).
• An anti-inflammatory diet is often effective for those suffering from acne rosacea (sometimes spelled rosacia or roseacea). They are really designed to prevent a rapid rise in blood sugar. Why is this important? Because a rapid rise in blood sugar causes an insulin response in the body which then causes an inflammatory response.
  
  Remember this simple fact: whatever food we consume is converted into sugar as it is digested. Different foods are converted to sugar at varying rates. When you consume foods that are rapidly converted into sugar, that is considered pro-inflammatory. Pro-inflammatory foods cause all kinds of problems in the body resulting from a rapid rise in blood sugar, which in turn sparks a burst of inflammation on a cellular level. As your insulin rises, this triggers more inflammation throughout the body.
  
  So how can we tell which foods are pro-inflammatory and which ones aren’t? The glycemic index was created as a rough index that rates food on a scale from zero to one hundred. Water is zero and table sugar is 100. Foods above 50 should be avoided. The lower the glycemic index rating the less likely it is to be pro-inflammatory. Proteins and fats, for example, rate low, whole sugars and starchy foods rate high.
  
  There is another important factor to consider and that is quantity. Eating too much at one time, even if the food rates low on the index will cause a rise in blood sugar. As always, let common sense prevail.
• Make sure to keep your skin very clean and don’t wash with water alone. Use a gentle but thorough cleanser (preferably containing alpha lipoic acid and not not grainy or abrasive) to remove bacteria in the morning and evening.
  
  Topical alpha lipoic acid can decrease the redness associated with acne rosacea that cannot be improved by prescription medications such as Metronidazole. Rosacea is often treated with antibiotics, although there are many who believe that following an anti-inflammatory diet oftentimes proves this unnecessary.
• To take care of the redness, once the acne rosacea is under control, vascular laser surgery can be quite effective and results in a high degree of patient satisfaction. These lasers emit wavelengths of light that target blood capillaries just under the outer layer of skin ( epidermis).
• For treatment of rhinophyma, re-sculpting the nose with a carbon dioxide laser has resulted in remarkable improvement. Recently developed techniques using intense pulsed light (IPL) sources mimic lasers but generate a carefully defined spectrum of light to treat a broader spectrum of tissue.
• Rosacea of the eyelids may respond well to oral antibiotics, but before that is tried, wiping the eyelid edges daily with Johnson’s Baby Shampoo applied with a Q-tip should help clear up the milder cases of acne rosecea.