Rosacea’s Relation to Skin Cancer

Q: I’m a 45-year-old woman who is being treated for rosacea. Although I have no personal or family history of skin cancer, my dermatologist has never suggested even a baseline screening. Your thoughts?

— L.Z., Suffolk County, N.Y.

A: Before responding to your question about screening for skin cancer, I’ll provide some background information on rosacea. It is primarily a disorder of the facial skin, and it affects about 10 million people in the United States. Rosacea typically shows up after age 30 as redness on the cheeks, nose, chin and forehead.

At first symptoms will come and go, but over time the redness deepens and remains. Eventually tiny blood vessels dilate and break under the skin and acne-like pimples appear. In more advanced cases, the nose may become bumpy and enlarged.

Ocular rosacea begins with watery or bloodshot eyes. As it worsens, the symptoms include a gritty feeling, burning, stinging, itching, dryness, and changes in vision. And about one-sixth of people with ocular rosacea will develop scarring.

Symptoms are usually progressive, but early diagnosis and appropriate treatment can reduce discomfort and psychological distress, as well as reduce long-term problems.

The cause of rosacea is unknown, but it’s more likely to occur if a relative has it, and it’s more likely to occur in people with fairer skin, especially those who tend to blush.

Recent research suggests that rosacea may be related to an infection by the bacteria called H. pylori. People with this infection are also much more likely to have heartburn caused by gastroesophageal reflux disease (GERD). Although treatment of the H. pylori infection has shown mixed results on rosacea symptoms, a recent study showed good results.

There’s no absolute cure, but the skin symptoms can be treated directly. Treatment can begin with metronidazole gel (Metrogel) or cream (Metrocream), which have been the topical treatments of choice. The same company that produces these has recently released a cleanser called Rosanil that contains two different sulfur-based topical antibiotics. Tacrolimus, pimecrolimus and 1 percent 4- ethoxybenzaldehyde have all recently been shown to be helpful, especially with decreasing inflammation and redness.

If symptoms get worse, oral antibiotics such as tetracycline and doxycycline are effective. Recent research showed that azithromycin was very effective when taken for 12 weeks, and it typically has fewer side effects.

Ocular rosacea needs to be treated as early as possible with good eye hygiene and topical medications. If it worsens, it needs to be treated more aggressively than skin lesions.

Because rosacea is a life-long problem, these treatments need to be used on a long-term, continuous basis. Because they are placed on the skin and not swallowed, topical preparations are less likely to cause long-term side effects. But they may need to be enhanced with oral antibiotics.

The only satisfactory treatments for someone who has dilated blood vessels are laser surgery or electrocautery (heating with electric currents).

Having rosacea does not increase the risk of skin cancer. But having a baseline examination for skin cancer is a good idea anyway.