My face gets flushed and red: Why is it worsening as I age?

Q: My rosacea flare-ups have gotten more intense in my 40s. Why is that, and what can I do about it?

If you have rosacea, you might notice that by the time you reach your 40s or 50s, your symptoms have gotten worse, said Dr Julie C Harper, a dermatologist in Birmingham, Alabama.

Frequent flushing, acne-like breakouts and dilated blood vessels are all symptoms of the condition, which affects millions

Rosacea is most common in women and those with fair skin. While it can be diagnosed at any age, Dr Harper said, many people don’t experience symptoms until after 30.

Scientists aren’t entirely sure what causes rosacea or why it tends to worsen in midlife. There is no cure. But there are ways to “manage it really, really well,” Dr Harper said.

Rosacea tends to run in families and results when the immune system overreacts to environmental triggers. These can include sun exposure, spicy foods, alcohol, cold and hot weather, stress, physical activity and hot drinks, said Dr Marie Leger, a dermatologist in New York City.

Aside from the typical symptoms — including persistent redness, dilated blood vessels and bumps — it may also cause skin dryness, tightness and burning. Rosacea can cause a feeling of grittiness or itchiness in the eyes, and it can thicken the skin on the nose, too, said Dr Dina Elrashidy, a dermatologist at Northwestern Medicine in Chicago.

Symptoms usually “wax and wane” throughout life, as you encounter triggers, Dr Elrashidy said.

You may have flare-ups that can last weeks or longer if it isn’t treated, Leger said.

If you developed rosacea in your 20s or earlier, it often worsens between ages 30 and 50, Dr Harper said.

Scientists don’t know why this happens, exactly. One likely reason is that years of exposure to triggers can result in chronic inflammation, which can weaken the tissue around blood vessels and, over time, cause them to widen and result in worsening flushing and persistent redness, Dr Harper said.

Years of chronic inflammation, along with normal skin ageing and sun damage, can cause collagen fibres to thin and become less elastic, leaving blood vessels “permanently dilated and visible on the skin’s surface,” Dr Harper explained. This may lead to chronic redness, too, she added.

The skin thins and dries with age, often making redness and other symptoms more apparent, Dr Elrashidy said. Leger added that many of her patients in perimenopause and menopause have worsened symptoms; however, Dr Harper said scientists hadn’t established a clear hormonal connection.

Getting a handle on your rosacea often requires a combination of approaches, Dr Leger said.

Simple tricks that could help

— Avoid triggers. Everyone’s triggers are different. Knowing yours and steering clear of them can minimise flare-ups, Dr Harper said. But some triggers, like cold weather, aren’t always avoidable, Dr Leger said. Or, you may decide that some causes — such as sun exposure if you love the outdoors — aren’t worth avoiding.

— Use gentle products. Moisturizing cleansers, like those with glycerin or dimethicone, can help soothe the skin, Dr Harper said. Cleansers and creams with sulfur, which has anti-inflammatory effects, also helps curb symptoms, Dr Elrashidy said. Avoid scrubs and products with fragrance, which can irritate the skin, Leger added.

— Wear sunscreen. The sun is a common rosacea trigger. Wear a broad-spectrum sunscreen with SPF 30 or higher every day, and reapply it every hour or two when you’re outside, Dr Elrashidy said. Mineral sunscreens that contain zinc oxide or titanium dioxide are often gentler on the skin and better tolerated than chemical ones, Leger added.

— Use prescription medications. Medications like brimonidine gel and oxymetazoline cream can narrow blood vessels under the skin to minimise persistent redness. Other topical treatments such as azelaic acid, encapsulated benzoyl peroxide cream 5 per cent, ivermectin cream and metronidazole can help reduce inflammation that causes pimples and bumps.

These topical medications may be used on their own or with low-dose oral antibiotics, Dr Leger said, which can help with inflammation, redness and other symptoms. The antibiotics can be taken intermittently during flare-ups or for longer periods, such as for several months, she added.

— Try laser treatment. Laser therapy uses different wavelengths of light to shrink blood vessels and reduce redness. Patients often start with one to three treatments, each about a month apart, depending on the severity of symptoms. They often repeat the therapy every six months or once a year for maintenance, Leger said. Laser treatment is typically recommended along with prescription topical medications or oral antibiotics, Dr Elrashidy said.

It’s never too early or too late to see a dermatologist about worsening or new rosacea symptoms, Dr Harper said. Doctors can help you identify your triggers and develop a plan to manage your skin, Leger said: “Having a strategy can make patients feel much more in control.”

This article originally appeared in The New York Times.

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