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Diagosed with rosacea. Capillaries visible on face. Is there a way to keep redness under control?

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Hello. I am a 26 year old female (Indian, 5'7", 59 kg). I've had a history with acne eversince I was 15 years. Recently (2 months ago) I was diagnosed with Rosacea. I feel I may have had rosacea for about a year and a half and simply saw it as a manifestation of Acne. I had been using over-the-counter creams for acne (discontinued now) and never visited a dermatologist for its treatment. My rosacea is characterised by underlying redness, XXXXXXX red spots across the cheeks, above the upper lip and the chin. Small capillaries are visible around the nose, above the upper lip and parts of my cheek. I also have slight ocular rosacea in the right eye only (meibomianitis). Apart from that, I get acne/acne like inflammation from time to time (about 3-4 medium sized pustules every couple of days). Apart from acne and rosacea, I do not suffer from any other health problems. My doctor put me on a 42 day course of doxycycline and night time application of Metrogel for rosacea. I also have to apply Nadoxin on any papules. I have also been advised to take many precautions (from the sun, spicy foods, hot beverages, steam and sauna baths, chocolate, coffee, nuts, bathing with hot water etc). During the course of doxycycline, I felt the redness had gone down, however after the course was over I think the redness is sort of coming back. Also, I have started getting some pustules and papules again (but not so many as before). I have the following queries -
a. In my mornings my face is its natural colour (though the spots and capillaries are visible). However as the day progresses the redness comes back. Is there a way to keep the redness under control throughout the day?
b. Rosacea has tremendously affected my psychologically and I find it very hard to interact professionally with people without trying to cover it up. Is it safe to use non-comedogenic concealers etc to cover up the redness or spots? I have been using a formulation made especially for scars, rosacea etc and it claims to be non-comedogenic and I don't particularly think it's making my rosacea/acne any worse but still I'd like your take on that. I am careful about taking it off before going to bed.
c. Is it possible to treat broken capillaries?
d. This is a complicated question and I do realise there are no straight answers - I am pursuing a PhD in field biology and my work almost entirely involves a massive amount of travel (about 100-150 km of travel everyday), working for long hours (8-10 hours/day) in the forests (lots of sunlight, humidity) as well as physical activity (walking several km in forests, mountain climbing etc). And this routine will be followed for 6 days a week atleast for the next 3 years. My question is - would it be "right" for me to continue doing this? At this stage, the effort put in to take all the related precautions is slowing down my work and I'm not sure if this is the best profession for me considering I have rosacea. I am fearful that it may worsen over the next couple of years if I continue my work and since everybody seems to be saying that rosacea can't be cured and that it worsens over time, I am in a huge dilemma as to whether I should continue with this line of work or switch careers.

Thank you
Posted Sat, 5 May 2012 in Acne
Answered by Dr. Rohit Batra 5 hours later

Thanks for your query.

Rosacea as you have mentioned refers to the reddish discoloration of butterfly area of the face and when associated with pustules on face refers to as Pustular Roasacea varient.

a. Sun avoidence is a must, also you can apply Metrogel during morning also to prevent worsening of symptoms during the day.

Options like Tacrolimus etc are also available and show good results along with Metrogel.

b. I agree that it affects your selfesteem but its not a serious disorder except for its visibile nature. You can use concealers to cover up Rosacea if it is non-comedogenic on your skin.

c. Lasers have been used in patients of Rosacea to treat the vasculature (capillaries) and results are encouraging. You can discuss this treatment option with your Dermatologist.

d. As in your case, you have a job involving going out in sun and hence the lesions vanish during night, only to come back in daytime. You can use a barrier sun protection like wearing a cap to minimise sun exposure, apart from sunscreen creams.

I would advise you to be patient and have confidence in your Dermatologist for in most cases an acceptable improvement is easily attained and there is no need for you to think for a change in profession.

Sun exposure, stress and spicy foods increase the symptoms and hence should be avoided.

Hope, this answers your query. Please accept my answer in case you do not have follow up queries.

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