Rosacea: facial redness, bumps and how to keep it under control

Rosacea is a chronic inflammation of the skin on the face. It often starts with flushing that comes and goes, and over time the redness can stay. It can cause red or pus-filled bumps that look like acne, visible small blood vessels on the cheeks and nose and, in some people, thickened skin on the nose.

It is more common in middle-aged and older adults and in women, though it tends to be more severe in men. The exact cause isn’t known; genes and environment both play a part.

Many people find certain things make it worse: sun, heat, stress, spicy food and alcohol. With Puerto Rico’s sun and heat, sun protection is part of the treatment.

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A first visit for rosacea is a doctor visit, the same price for every age, with no membership. A refill of a treatment you already use is a follow-up visit. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. See all prices.

Rosacea looks different from person to person. The most common signs are:

• Facial redness that comes and goes, or stays, sometimes with burning or stinging
• Red or pus-filled bumps on the nose and cheeks that look like acne
• Visible small red blood vessels on the cheeks and nose
• Thicker or bumpy skin on the nose
• Red, irritated, watery or dry eyes

Rosacea has no cure, but treatment improves how your skin looks and feels. Mild cases start with prescription creams or gels; for moderate or severe cases, the doctor may consider a medicine by mouth. Results take time: it can be 3 months or more.

Topical metronidazole: metronidazole 1% gel is FDA-approved for the inflammatory bumps of rosacea. It is applied to the face as prescribed.

Topical ivermectin: ivermectin 1% cream is FDA-approved for the inflammatory lesions of rosacea and is applied once a day.

Low-dose doxycycline: the 40 mg once-daily doxycycline capsule is FDA-approved for the bumps and pustules of rosacea in adults. This formulation is not meant for treating infections, and it does not improve general redness. It is not used in children under 8, and in pregnancy it can affect the baby’s teeth, which is why the doctor asks whether you are pregnant.

If appropriate, the doctor prescribes one of these options or another and we send your prescription to your pharmacy. Rosacea is not acne and does not improve with over-the-counter acne treatments.

Laser and light treatments for visible blood vessels are done in person at a skin specialist’s office; if you are interested, the doctor can point you in the right direction.

• Use a broad-spectrum sunscreen with SPF 30 or higher every day.
• Wash your face with a gentle cleanser and don’t scrub.
• Keep track of what triggers your redness (sun, heat, spicy food, alcohol, stress) and avoid it.

Rosacea can affect the eyes and, if it isn’t treated, it can harm your eyesight. If your eyes are red, sore, itchy, watery or dry, or your eyelids are swollen, you need an in-person exam with an ophthalmologist (eye doctor); the doctor guides you and refers you. If eye rosacea comes with blurred vision or any change in your sight, don’t wait: you need to be seen in person that same day. For your safety, if you have severe eye pain or changes in your vision, go to the emergency room or call 911.