Rosacea: Causes and Treatment [Interview] [Transcript]

Dr_Estee_Williams_Rosacea_Causes_and_TreatmentGuest: Dr. Estee Williams
Presenter: Neal Howard
Guest Bio: Estee Williams, M.D., is a board-certified medical, cosmetic and surgical dermatologist, and treats adult and pediatric patients. She is assistant clinical professor in dermatology at Mount Sinai Medical Center. Dr. Williams is the past president of the Dermatology Interest Group Association; a member of the American Academy of Dermatology, the American Society of Dermatologic Surgeons, American Contact Dermatitis Society, and the Dermatologic Society of Greater New York; she is also a reviewer for the International Journal of Dermatology and the International Journal of Women’s Dermatology.

Segment overview: In this segment, Dr. Estee Williams discusses the signs, symptoms, and latest treatments for rosacea as one of the leading dermatologists that specializes in the area of rosacea.

Health Professional Radio – Rosacea

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you for joining us here today. Our guest today is Dr. Estee Williams, Assistant Clinical Professor of Dermatology at Mount Sinai Medical Center. She’s with us today to discuss skin hormones, menopause, and rosacea. Welcome to Health Professional Radio Dr. Williams.

Dr. Estee Williams: Good morning. Great to be here.

N: Thank you for joining us today. You have a special interest in how hormones affect the skin in particular, especially an interest in rosacea. What exactly is it?

W: That’s a great question. Actually, rosacea is a chronic skin condition that affects the face and has two main features. The first is redness and the second is sensitive skin. I often say that when it comes to rosacea, there are 50 shades of red because there’s a spectrum and redness can be anything from rosy cheeks to pimples that are often mistaken as acne.

N: When they’re mistaken as acne, how severe is that misdiagnosis when it comes to treatment? Is this something that you say, “Oh well, this isn’t working”, and then all of a sudden you hit upon the right diagnosis? Or the people go years sometimes thinking it’s one thing when it’s actually another?

W: As a doctor the most important thing is to first have a proper diagnosis before making recommendations for treatments. Specifically in the case of rosacea being misdiagnosed as acne. Fortunately, these aren’t life threatening conditions and generally the treatments for both are safe. However, the treatments for acne and rosacea are completely different and acne treatments can actually aggravate rosacea making patients to continue to suffer with their condition for months if not years. Spending money and time at the doctor or buying products that find at the beauty counter that don’t actually work for them. It is extremely important to have the proper diagnosis if you have rosacea.

N: I’ve heard it said that pretty much everybody is going to experience acne at one point or another in their life. What is it that causes rosacea? Is it the same type of condition as acne as far as what causes it and it’s just more severe? Or are they totally separate entities requiring that different treatment as you spoke of?

W: The reason with acne and rosacea can be confused for one another, is that a sub-type of rosacea called ‘Papulopustular Rosacea’ exhibits pimples. Patients have red bumps on the skin frequently they’re a little bit painful and irritating, and those bumps look exactly like pimples. That’s the reason that they are confused. But the conditions are completely different. What causes rosacea is essentially that the immune system in your skin which we call the ‘local immune system’ is revved up. It’s very, very hyper-reactive. What that means is that, the pathways that are normally turns on let’s say, a bacterial infection or any other kind of attack on the body that’s seen as a foreign attack, are being turned on by every day triggers. For example, sunlight, and stress, and exercise, and even certain foods. Those are turning on the same pathways that your body would turn on if there was a bacterial attack.

N: Do some of this same symptoms present when say one of the poison ivies or … something like that comes in contact? Is that considered an attack and then the rosacea kicks in? Or is that something that happens totally on or within the body?

W: Great question. This sort of hyper-reactive immune system, it’s not technically an allergic reaction in the same way that you got an allergic reaction to poison ivy. It actually the completely different pathway on a molecular level. There are different molecules and the things that we call … involved, and actually different immune cells, different white blood cells. The picture is different and again, as the reaction to poison ivy we consider more in the allergic reaction category, whereas rosacea is not an allergy.

N: You’ve mentioned food being one of the possible triggers for rosacea. Are this food triggers, are they a rarity or do they just occur differently in different patients?

W: That’s a great question. These food triggers can vary from patient to patient. I wouldn’t say that there’s specific food that can trigger rosacea in all rosacea patients. But there is a list, which I have on my Facebook page that was put up at the National Rosacea Society which is It’s a list of about 40 different foods and food groups that are common triggers. These include foods that release histamine. Histamine is what causes redness and we know that those are things like fermented food, wine, certain cheeses and other people eats spicy food. Things that some people say, ‘I’m allergic to that spice’ and all that allergic they have a sensitivity. They’re really is a very long list and things even like nuts and avocados that we consider to be very healthy foods. In some people, it just doesn’t react well.

N: Although I did hear you say that rosacea is not life threatening by any means. Are they different levels of severity and do those treatments differ?

W: There’s actually a sort of doctors, there are 4 different classifications of rosacea that have very long fancy names. But practically, the most basic form would be the rosy cheeks, on the skin between the middle of the face, there’s redness. In close up, sometimes you could see actual little blood vessel and patients will say that during the day they flush and they flush and they blush very easily -that’s one form. And then you have a more … where the skin … is covered in things that look like pimples, they’re actual bumps. As the signs of rosacea become more involved and more severe, the treatment becomes also more involved. For example, a person who has like periodic flushing and blushing, I might recommend a prescription medication that helps cleanse down blood vessels and reduce redness. Whereas someone who has a lot of bumps on their face and like I said, these could be painful may likely be benefits from an oral antibiotic to be taken by mouth so the treatments really do vary based on what the patient looks like.

N: When a person is suffering from rosacea, are there flare-ups and then a period of calm? Or is there any of time when any emergency treatment is necessary because something has triggered in such a way that a person needs to seek ‘right now’ relief, and then maybe seek some relief a couple days later more formally?

W: Most people with rosacea don’t even know they have rosacea. They are looking to seek relief and get better, they’re not even necessarily aware of what things are helpful and what things are not helpful. It is always best because this is a chronic condition to be on a daily regimen and the best person that can help you with it, would be a board certified dermatologist. Being on a daily regimen helps prevent flare-ups and help you peel with the flare-ups and cope with someone they do occur. There are rare forms of rosacea where you can have a very, very sudden flare-up where the skin in the entire face becomes extremely red and warm and painful and thankfully that is a rare sub-type. But I would say that is something that we need to be urgently seen by a doctor. But for the most part, rosacea is a chronic condition that does intend to be problematic and it’s distressing but it’s usually not an emergency.

N: Talking about being problematic and distressing, you treat both adult and pediatric patients. Talk about some of the psychological aspects that you’ve encountered when it comes to rosacea. Sometimes there are things that prevent people from seeking proper help until maybe it’s too late or until they just suffer until they can’t suffer anymore.

W: Exactly, the reason why I call rosacea problematic is because the demographic that’s affected by rosacea namely women in their 30’s, 40’s and 50’s are typically wrestling with the idea of anti-aging and how to stay young forever. The first thing that they are concerned about is the skin on their face. The problem is that many of these use anti-aging products, skin-care products, make-up contain a lot of chemicals and ingredients that are not good for rosacea. It could become stressful for these women who want to use anti-aging products but their skin just can’t tolerate it. It’s not uncommon for me to have a patient come in who for example, I may have diagnosed with rosacea and the patient is begging me to start on certain products that I know won’t be good for their rosacea. Sometimes it can become a little bit frustrating for them.

N: Where can our listeners go online and get some more information about rosacea and maybe a bit of background on what’s happening there at the College of Dermatology at Mount Sinai Medical Center as far is rosacea is concerned? And maybe look for some possible support.

W: I like to post helpful tips for my patients and for the public on social media. You can find me on Facebook, Instagram and Twitter at @dresteewilliams. I also want to point you guys to the National Rosacea Society, their website is and they have a lot of really helpful tips and resources.

N: It’s been a pleasure speaking with you this morning.

W: Thank you.

N: Thank you. And I’m hoping that you’ll come back and speak with us in some future segments.

W: I would love to.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard with Dr. Estee Williams, Assistant Clinical Professor of Dermatology at Mount Sinai School of Medicine. We’ve been talking about rosacea and some of the causes, some of the treatments and some of the psychological impact that often or sometimes this people to seek treatment a little bit later when they could seek it a lot sooner. Transcripts and audio of this program are available at and also at You can subscribe to this podcast on iTunes, listen in and download on SoundCloud.

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