Rosacea is a common, but chronic, inflammatory skin condition that mainly affects the central areas of the face. Rosacea can develop at any age, but is mostly diagnosed after the age of 30 and most commonly appears between the ages of 40-60 years old. Around 1 in 10 people in the UK are thought to be affected by rosacea. Whilst rosacea is more commonly found in women, men usually present with worse symptoms. The cause of rosacea is not fully understood and it is thought to be influenced by genetics, environmental factors and immune system problems. The theory that rosacea is caused by bacteria on the surface of the skin or in the gut is thought to be incorrect despite antibiotics improving symptoms, this is believed to be due to their anti-inflammatory effect.
Rosacea is characterised by redness that appears on the face when the factors that trigger the condition cause the blood vessels in the skin to dilate. In the early stages of the condition this may look like blushing across the cheeks, nose, chin or forehead. During later stages it will become persistent redness that resembles sunburn. The redness may also be accompanied by:
Small bumps or pus-filled spots which look similar to acne. In some cases the papules and pustules may come or go but most of the time they will remain long-term unless they are treated.
Eye symptoms (known as ocular rosacea) occurs in approximately half of the cases. It may feel like there is something stuck in the eye or could be a burning/stinging sensation, itching, dryness, sensitivity to light or affect the eyelids causing inflammation, cysts or styes.
Thickening of the skin can occur, but this is mainly found in men. The nose is most commonly affected (known as rhinophyma) and this happens when there is overgrowth of the oil secreting glands.
Visible blood vessels on the surface of the skin known as telangiectasia which can sometimes become quite prominent.
Occasionally, there may be some swelling of the facial skin, known as lymphoedema, most commonly around the eyes.
Skin on other parts of the head can be affected and rarely, skin on the arms or back. Rosacea isn’t usually painful or itchy, but some patients report a burning sensation in the affected areas. The prime complaint about rosacea is that it’s unsightly and emotionally distressing.
There are several factors thought to influence the emergence or ‘flare up’ of rosacea but none have been proven to be an exact cause. There is a belief that it may be caused by abnormal or ‘leaky’ blood vessels under the surface of the skin. Another school of thought involves a mite called demodex folliculorum which is commonly found on the skin and is completely harmless, but has been found in higher numbers on the skin of rosacea patients. Sun damage is also believed to contribute to the cause/worsening of rosacea. Rosacea can appear to run in families, therefore, genetics could play a part in developing the condition. Finally abnormal immune responses have been linked to the development of rosacea. Rosacea is not contagious and therefore, cannot be spread between people.
The rate of development and the severity of symptoms can vary greatly from person to person. The National Rosacea Society conducted a survey which showed that around 45% of patients waited until the condition reached the mid-stages before seeking medical review. 23% of respondents reported that early symptoms advanced to moderate symptoms within one year, whilst almost half stated that it took several years for the condition to progress to this stage.
Protecting the skin from the sun helps to lessen redness. SPF 50 should be applied every day and will need to be re-applied when outdoors for an extended period of time.
Rubbing or scrubbing the face when washing or cleansing can make the redness more pronounced.
It is recommended to use an emollient to wash the face and avoid perfumed products completely to reduce irritation. Use an emollient cream to moisturise regularly, particularly if dry skin is problematic as well as rosacea.
Keep a diary of possible triggers of rosacea flare ups. Anything which appears to trigger bouts of flushing or make it worse should be avoided.
Spicy Food
Vegetables
Oil-Based/Waterproof Makeup
Some Sunscreens/Insect Repellants
Acetone
Alcoholic Drinks
Excessive Heat
Strenuous Exercise
Stress and Anxiety
Hot Drinks
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Light or laser therapy can prove beneficial in the treatment of redness. This can also destroy the tiny, visible blood vessels under the surface of the skin without causing damage to surrounding tissue. This treatment is commonly combined with other treatments for spots/cysts and inflammation.
Certain skin peels contain ingredients that are particularly beneficial in calming down and treating rosacea. They can help reduce redness and inflammation.
The inflammation and redness that accompanies rosacea can be treated with prescription medication, such as metronidazole gel, applied topically to the affected areas. This can take up to 8 weeks to work.
Rosacea is commonly treated with antibiotics. The most commonly used are tetracyclines, although erythromycin is an alternative. Treatment is usually for several weeks or months and may be combined with a prescription cream or gel. When an antibiotic course is finished, spots and cysts commonly reoccur and repeated courses of treatment may be required.
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