Acne rosacea is a hereditary condition characterized by flushing and blushing, typically of the central face, persistent central facial redness and progressive nasal thickening.
The typical presentation would be that a patient notes that for several years they have been a flusher and blusher, particularly after a shower, with alcohol, and exercise. The flushing and blushing progresses to persistent central facial redness. Acne can appear before, during, or after the central facial redness. The acne may present either as itchy or painful bumps typically occurring on the face, scalp and trunk. Progressive thickening of the nose, rhinophyma (for example W.C. Fields) is usually heralded by the appearance of enlarging pores and small slowly growing bumps and thickening of the skin. A common under-diagnosis is symptomatic ocular rosacea. Just as the blood vessels in the cheeks become persistent, so does the lining of the eyes. This makes the surface of the eye irregular and the eyes become tired by having to contort to the shape, something like a corrugated road. People typically complain of eye fatigue at the end of the day, dry eyes or teary eyes.
There are two types of therapy in general. One is oral antibiotics which slowly reverse the process with periods of treatment up to six months. These are usually oral antibiotics of the Tetracycline group.
There is a new group of therapies which are topical (that is applied to the skin). These are focused particularly on topical niacinamide or B3. The function of topical niacinamide is to encourage the skin to produce a better quality of material that fills the spaces between each of the cells in the epidermis. We know that part of the abnormality of rosacea is a result of disorder of the surface or epidermal layer.
It is difficult to find Niacinamide in the over-the-counter market and we therefore make it. In essence, we take a topical vitamin, put it in a cream base and present it as an airless pump, which preserves the integrity of the cream (prevents contamination). Half a pump applied twice a day to wet skin usually produces rapid improvement in the surface of the skin. This is particularly useful if you notice that you have “crazy” or hypersensitive skin typical of rosacea. Over a period of weeks, topical niacinamide can prevent the acne, reverse many of the blood vessel changes, and over a period of six months to a year gradually reduces the size of the oil glands. Using topical niacinamide has an inherent appeal in that it avoids all of the issues associated with the long-term use of oral antibiotics. The side effect of treatment is frequently the reversal of premature aging. Dr. Oz calls vitamin B3 (niacinamide) “Botox in a bottle” and labels it as being the hottest cosmetic molecule of 2014.
Of interest, topical niacinamide is often effective in facial eczema. Many people find that they like the niacinamide cream enough that they want to stay on it forever.
Other therapies also include 1% metronidazole and 15% azelaic acid, both of which are used for periods of six months.
Topical B3 or topical Niacinamide cream is available as an over-the-counter treatment from my office. The cream itself is not animal tested, free of all preservatives and paraben free.
I do not tell patients to avoid alcohol or stimulants, which precipitate a vascular reaction. In my experience, it is important to remain as normal as possible and generally therapies are good enough that patients can simply continue their normal life.