How to address rosacea patients’ toughest in-office questions
Key takeaways:
- With cooperation between doctors, prescriptions and patients, rosacea can almost always be brought under control.
- Rosacea triggers vary from person to person and patients must find their personal triggers.
With April being Rosacea Awareness Month, the National Rosacea Society has brought to light the importance of consistency and patience when treating this chronic, inflammatory skin condition.
Although patients are aware that patience and consistency are important, this knowledge may not mitigate the frustration that they feel when struggling with this incurable disease.
Healio spoke to John E. Wolf Jr., MD, MA, professor and emeritus chair of dermatology at Baylor College of Medicine in Houston, asking him typical patient questions in order to find out how practitioners should respond.
Healio: What is the cause of my rosacea?
Wolf: What you have to say is that there is no specific known cause of rosacea. It is believed to be an inflammatory disease, not an infectious disease, so it’s not caused by bacteria. It is probably caused by your body’s reaction to quite a few different substances. So, the key is that rosacea is inflammatory, not infectious.
Healio: Can my rosacea ever be cured?
Wolf: You must be honest with the patient and say that rosacea is a chronic inflammatory disease that can be controlled but not cured. A combination of treatments and changes in lifestyle will help control the disease; however, it is worth pointing out to the patient that that doesn’t mean it will go away. Sometimes rosacea will go into remission for no reason at all, and sometimes it will clear up without explanation. When it clears, that doesn’t mean it is cured, it just means that whatever was causing the inflammation in the first place has resolved.
Healio: What factors trigger my rosacea?
Wolf: The National Rosacea Society is a great resource that I always share with my patients. According to a survey done by the society, the three most common trigger factors are sunlight, heat and stress. The next two that are listed as “fairly common” are alcohol use and certain foods.
Now, it’s important to tell patients that these triggers vary from person to person. For example, I tell my patients that I have rosacea and wine does not cause it to flare. But, if I take a hot bath or shower, I get a red face. So, some people will find that heat is worse, whereas others may find that alcohol is a major trigger.
When it comes to food, I’ve had many patients suggest over the years that dozens of foods may make their rosacea worse. However, I tell patients that they need to discover what foods don’t work for them specifically and then avoid those foods. The foods that cause my rosacea flares may not be the foods that cause their rosacea flares.
Healio: How can I quickly calm down my rosacea flares?
Wolf: Explain to patients that there are two different types of flares with rosacea, just as there are two different types of rosacea. One common form of rosacea is a red face. Another common form of rosacea is the presence of pimples, papules and bumps.
For a flare of the red face, which is probably the most common flare that a patient will see, the most common triggers are heat and stress. So, I tell my patients that the best thing to do is to get into a calm, comfortable, air-conditioned environment and put a cool compress on their face.
I also tell my patients that they should drink cool liquids because the stimulus for the flushing on the face comes from an organ deep in your throat. So, when they drink cool liquids, put something cool on their face and get into a comfortable environment, it will calm down the flare.
On the other hand, if a patient is having a flare of pimples and bumps, there’s no quick, easy way to deal with that. Tell a patient that that type of flare requires consistently taking their antibiotics as prescribed.
Healio: How can I stop feeling so embarrassed by my rosacea?
Wolf: The first question we should ask ourselves is, should you be embarrassed to have rosacea?
Rosacea is a very common disorder, and a lot of famous people have it. However, while it’s easy to tell a patient that they should not be embarrassed because they have a lot of company, that may not always make them feel better.
With that, the best thing for a patient to do to mitigate their embarrassment is pursue proper treatment and make lifestyle changes. Avoiding their specific trigger factors and knowing what to do when they have a flare is very important.
Healio: I feel like nothing is working, what do I do?
Wolf: This depends on what the patient has already done. If a patient has never seen a dermatologist, they should certainly see one to learn more about their rosacea and treat it.
There are many different treatments for rosacea and it’s very likely that nobody has tried every single treatment. So, just because one treatment may not work for a patient, they cannot give up. It is a chronic disease with unknown cause, but it’s a disease that, with cooperation between doctors, prescriptions and patients, can almost always be brought under control.
Reference:
- Rosacea Awareness Month to highlight importance of consistency and patience when trying new therapies. https://www.rosacea.org/blog/2023/february/rosacea-awareness-month-to-highlight-importance-of-consistency-patience-when-trying-new-therapies#:~:text=The%20National%20Rosacea%20Society%20(NRS,treatments%20enough%20time%20to%20work. Published Feb. 7, 2023. Accessed March 31, 2023.
For more information:
John E. Wolf Jr., MD, MA, can be reached at jwolf@bcm.edu.