Read on to find out answers to some commonly asked questions such as:
- What is rosacea?
- What are the symptoms?
- What treatments are available for it?
What is Rosacea?
Rosacea is a fairly common skin condition that affects the face, particularly the nose, cheeks and forehead. Around 10% of people in the UK will experience rosacea, occasionally referred to as acne rosacea, with most cases appearing between the ages of 40-60. Although the condition closely resembles acne in some patients, it is not a form of acne and has different and more wide-ranging effects.
There are no treatments available to cure rosacea, however, there is a range of ways in which it can be controlled and the symptoms reduced.
What are the Main Symptoms of Rosacea?
Rosacea can present itself in various ways and in different forms of severity in different patients, however, in the vast majority, it will begin with flushing and redness in the cheeks and slowly develop into other symptoms. These include the following:
- Dry skin which is rough and scaly around the affected area.
- Red bumps which usually resemble acne, however, they will usually burn or sting or be accompanied by swelling.
- Visible blood vessels that appear around the cheeks and nose.
- Irritated eyes usually referred to as ocular rosacea. They usually appear bloodshot or watery and may have visible blood vessels around the lid area. An ophthalmologist referral may be necessary if this has developed.
How Do I Know if it’s Rosacea?
Rosacea can sometimes resemble other conditions, so If you find yourself developing symptoms which are associated with rosacea, it may help to find out if you’re in a commonly affected group. Rosacea is most commonly found in the following groups:
- Women, although men are usually more severely affected when they do get it.
- Fair-skinned ethnic groups, however olive and dark-skinned people can also develop it.
- Middle-aged people, usually between ages 40 – 60. Although, symptoms can appear at any time, even in your 20’s.
- Those with a family history, as rosacea is known to be passed on genetically in families.
- Smokers have a higher incidence of rosacea.
Nobody knows for certain what causes rosacea, however, some studies have indicated the following as possible reasons:
Consistent exposure to the sun without adequate protection can break down the elastic tissue in the skin and also lead to blood vessel dilation. This can be responsible for the red flushes and visible capillaries and blood vessels associated with rosacea.
Helicobacter Pylori are bacteria found in the digestive tract. In some people, the bacteria can produce a more copious amount of a digestive hormone known as gastrin which can lead to flushed skin. Another theory is that these bacteria can stimulate the production of a protein, bradykinin, which can dilate and expand the blood vessels.
Microscopic bugs called demodex folliculorum normally live undetected on human skin. People with rosacea may have a higher number of these present on the face, which may play a role in increasing the risk of rosacea. Some research has indicated that the symptoms may be caused by the skin reacting to these mites’ faeces.
New studies have started to explore a link between certain variants of the human genome and increased incidence of rosacea.
What Treatment Options are Available for Rosacea?
Whilst there’s no treatment to cure rosacea, the treatments focus on reducing symptoms and making their everyday impact more manageable. Although rosacea sufferers will experience phases of improvement, a long term treatment plan is necessary to keep it under control.
As rosacea presents as a range of different symptoms, different patients will be offered treatment plans depending on which symptom bothers them the most. Your GP will normally recommend a treatment plan which focuses on self-help measures supplemented by the necessary medical help.
There are a number of things you can do yourself to help keep the symptoms of rosacea under control, including:
Using suitable skin care products
Make sure you’re using skincare products targeted for use with sensitive skin or rosacea. Other types may aggravate the skin more with harsh ingredients.
Avoiding sun exposure
Ensure you’re always using SPF when going outside, even in winter, and covering up with a wide-brimmed hat in direct sunlight.
Treating your skin right
Many rosacea sufferers turn to makeup to help cover the redness, however many makeup products contain irritating ingredients such as fragrance/parfum or alcohol. Makeup which contains these ingredients, as well as harsh exfoliators, can lead to skin irritation.
Although it’s easy to become self-conscious or uncomfortable, make sure you’re not rubbing, itching or touching your skin too much as this can make the rosacea worse
Treating facial redness
Along with the above-mentioned self-help measures, other medical ways to help control redness are:
- Brimonidine tartrate. Brimonidine tartrate is reported to be an effective prescription treatment for facial redness caused by rosacea. It comes in the form of a gel that’s applied to the face once a day. The gel works by restricting the dilation of the blood vessels in your face and can begin to work almost instantly. However, some users have reported burning sensations when it’s applied and occasionally, a rebound effect, where flushing becomes worse, has also been reported.
- Clonidine. This has been used to try and control redness associated with rosacea and works similarly to the brimonidine. However, oral alpha agonists have been known to cause adverse effects.
- Beta blockers. Low doses of beta blockers such as propranolol may also be used to restrict dilation and thus the appearance of flushing and redness. However, you will be closely supervised if taking these.
Treating Bumps (Papules/Pustules)
If your rosacea has caused you to have round red bumps (papules) or pus-filled ones resembling cysts (pustules) you may be prescribed one of a range of medical treatment options by your GP.
These are usually the first-line treatment recommended for rosacea, and if they don’t work, then oral medication will be explored as a treatment. The most commonly used topical options are, Metronidazole cream or gel, Azelaic Acid Cream or Gel or Ivermectin Cream. These are usually applied once or twice a day and may take a few weeks to start significantly reducing the appearance/irritation of bumps. However, side effects include itchiness, burning and dry skin, so some patients may not get along with a certain type.
If the papules and pustules are more severe or the topical treatments haven’t worked effectively, an oral antibiotic or low-dose isotretinoin medication may be recommended. These can help reduce inflammation of the skin. Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These will usually be taken for a few weeks to help reduce symptoms.
These can be effective in reducing the inflammation of the bumps, as well as the appearance, however these results may not be seen until after 4-6 weeks of use.
You should always let your GP know if you may be pregnant, as isotretinoin has been known to cause birth defects.
Laser/IPL (Intense Pulse Light) Treatment
Laser or IPL treatments are usually done privately in aesthetic clinics and can be quite costly. However, they have been shown to reduce the intensity of facial redness and possibly also the appearance of visible blood vessels associated with rosacea. It can be a good option for those who wish to try a more gentle approach than taking strong medications. However, it’s important to always check the credentials of whoever is carrying out your treatment.
Treating Ocular Rosacea
Ocular rosacea can develop into other conditions such as blepharitis, which may need to be treated with a lotion, wipes or antibiotics. If you develop any further problems with your eyes, you’ll need to be referred to an eye specialist for further assessment and treatment.
- Bupa- Articles- How to combat rosacea. Available: https://www.bupa.co.uk/newsroom/ourviews/combat-rosacea Last accessed February 2019
- NHS- Conditions-Treatments- Rosacea. Available: https://www.nhs.uk/conditions/rosacea/treatment/. Last accessed February 2019
- PCDS UK- Rosacea. Available: https://www.pcds.org.uk/clinical-guidance/rosacea. Last accessed February 2019.
The information contained in this article is not a substitute for personalised medical advice. Should you have any concerns about your health please speak to your pharmacist or doctor.