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Rosacea

What is Rosacea?

ROSACEA refers to a chronic inflammatory skin condition that primarily affects the face of adults and is a very common cause of facial redness. The word Rosacea is derived from the Latin Rosaceus meaning rose coloured and the condition is characterised by facial redness and flushing. Whilst the cause of Rosacea is unclear it tends to be genetic and it is particularly common in fair skinned descendants of Celtic and Northern Europe.

Onset is typically around 35-50 years of age however recent studies suggest it is much more common in under 30 year olds than originally thought. It is slightly more common in women than men and whilst it is estimated that around 10% of adults from a Western background are affected it is probably under diagnosed and the true incidence is likely much higher.

How do I know if I have Rosacea?

The diagnosis of Rosacea is clinical and if you have persistent redness on the centre of your face for over 3 months you probably have Rosacea. By centre of the face it refers to cheeks, nose, chin and forehead. Main features are flushing, persistent redness, bumps and pimples and visible blood vessels. Other features include burning or stinging, with dry and thickened skin and sensitivity to cosmetics. Itchiness is not a typical symptom. Rosacea is a chronic condition that typically flares up intermittently. In Rosacea inflammatory lumps are typically red dome shaped lumps with or without pustules but not comedones (ie no blackheads or whiteheads) which are found in Acne.

Typical complaints by patients with Rosacea are such things as:

  • Red nose and cheeks – “I look like a drinker but I don’t drink”
  • Flushing – “I always look as if I’m embarrassed”
  • Sensitive Skin – “All creams make my face sting or burn”
  • Pimples and Pustules – “But I’m too old to have pimples”
  • Facial Swelling – “My nose feels thicker or bigger”

What things aggravate Rosacea?

Whilst trigger factors can vary between individuals, clinical studies report that the most common triggers for Rosacea in descending order are: Sun exposure, Emotional Stress, Hot weather, Wind, Heavy exercise, Alcohol, Hot Baths, Cold weather, Spicy foods, Humidity, Skincare products, Indoor heat, Hot Drinks and Cosmetics.

Things that trigger flushing are known to worsen Rosacea. Certain food additives (eg MSG in Chinese food and Sodium Nitrate in cured meats), a variety of medications (eg Calcium channel blockers, Vasodilators, Tamoxifen, Cholinergic drugs), and some supplements (eg Nicotinic Acid). It is also important to remember that some rare tumours can cause flushing and facial redness such as Carcinoid Tumour and Phaechromocytoma.

Types of Rosacea

There are 4 main types of Rosacea and patients can have more than one type at the same time but having one type does not necessarily mean that you will develop any of the other types.

  1. Facial Redness (Erythemato-Telangiectatic Rosacea) – flushing and persistent central facial redness with or without visible blood vessels.
  2. Bumps and Pimples (Papulopustular Rosacea) – Also called Acne Rosacea. It is characterised by pimples, lumps and pustules and is usually seen on a background of facial redness.
  3. Skin Thickening (Phymatous Rosacea) – Thickening skin, irregular surface nodules and enlargement. May occur on nose, chin, forehead and checks. The most common presentation is as Rhinophyma where there is thickening of nasal skin resulting in an enlarged bulbous nose.
  4. Eye Irritation (Ocular Rosacea) – Redness or irritability of the eyes. Eyelids may show redness and scaling

How is Rosacea treated?

Realistic expectations are important as Rosacea is a medical condition and it is being managed not cured. The aim of treatment is to try and prevent the Rosacea worsening and reducing the frequency and severity of flare ups.
Whilst specific treatment must be tailored to each individual the general advice is:

  1. Identify and avoid trigger factors.Avoid irritating skincare products.
  2. Avoid irritating skincare products. Gentle skincare with no scrubs, astringents, alcohol; eucalyptus, witch-hazel.
  3. Sun protection with hats/shades and use of sunscreen. Zinc Oxide or Titanium Dioxide in simethicone/dimethicone base seem better in Rosacea eg EGO Sun Sense oil free sunblock.
  4. Use a hypoallergenic moisturiser eg CETAPHIL.
  5. Makeup can be used but should not clog pores and a green tint is usually the most effective for camouflage of the redness. Eg LYCOGEL
  6. Consider topical Niacinamide which improves skin barrier function and also reduces inflammation and oil production eg PROPAIRA Rozaway
  7. Treat any acne. This can involve use of a topical cream eg ROZEX (Metronidazole), FINACEA (Azelaic Acid), SOOLANTRA (Ivermectin). It may involve oral antibiotics such as Doxycycline or Minocyline or even ROACCUTANE in severe cases. Sometimes the use of blue light lasers and the use of photodynamic therapy (PDT) can be very effective for more severe acne.
  8. Treat the Redness. A daily topical cream can be tried (MIRVASO) but the best results to reduce the redness component of Rosacea is through the use of a vascular laser or broadband light source. The light from these devices can result in a significant reduction in facial redness by shutting down and removing unwanted blood vessels. The choice of vascular laser will depend on individual requirements but at the Cosmetic & Laser Medical Centre we have a range of vascular devices to select from including the Pulse Dye Laser, the EXCEL V laser, the VARILITE and the Sciton BBL.
  9. A combination approach of therapies usually achieves the most effective results in the treatment of Rosacea. Maintenance topical creams, avoiding trigger factors plus occasional laser treatments is often the optimal approach. Recent studies suggest that even better results can be obtained when 2 laser/light sources are used in the same treatment session.