What is Rosacea? 

Rosacea is a rash that most often affects the centre of the face. It is a long-term condition that can fluctuate in severity over time. Unfortunately, it cannot be cured but treatment can improve the symptoms. In the past it was sometimes called acne rosacea.

Anyone can be affected by the condition but it more commonly affects people with fair skin and most often begins between the ages of 30 and 60. It is more common in women but if men are affected their symptoms are often more severe. 

Causes of Rosacea

The exact cause is not known but below we have listed several factors scientists think may contribute to the condition.

Changes in blood vessels

When blood vessels near the surface of the skin are dilated redness and flushing occur. The redness and flushing that occurs in rosacea may be caused by changes that lead to increased blood flow and dilation of the blood vessels and an increased number of these blood vessels in the surface of the skin.  

Many triggers for rosacea temporarily dilate the blood vessels and cause flushing for example, alcohol, spicy foods and hot drinks.

Microbes

Demodex folliculorum are mites that naturally live on the face. Research shows that there is an increase of these mites in rosacea sufferers. There is conflicting evidence currently but some evidence points to this excess of mites triggering an immune response from the body, leading to inflammation linked to rosacea.

Another microbe that has been researched in rosacea is H.Pylori. This is normally seen in the digestive system and can lead to stomach ulcers. The presence of H.Pylori in patients has been proposed as a possible cause of rosacea but the evidence remains inconclusive.

Skin peptides

Our skin contains antimicrobial peptides that form part of the immune response of the body against viruses, bacteria and fungi. One of these peptides is cathelicidin. 

This peptide has been found to be present in abnormally high levels in rosacea patients. Cathelicidins increase dilation of blood vessels, increase inflammation and may cause bumps and pimples in the skin. These effects are commonly seen in rosacea which has led some researchers to think that an excess of cathelicidins in the disease may play a significant role.

Treatment

The flushing or redness that patients often suffer from is due to increased blood flow in the skin as a result of dilated blood vessels. The treatment that we offer is Mirvaso (brimonidine) gel. This is an important medication in managing rosacea because it narrows the blood vessels in the surface of the skin, reducing blood flow and improving redness and flushing.

Other topical treatments used include metronidazole gel and azelaic acid gel. Azelaic acid gel is useful for treating patients with bumps and spots on affected areas of their skin. 

Oral antibiotics such as oxytetracycline or tetracycline can be used for periods of 6-12 weeks at a time.

Laser therapy can also be used to treat rosacea. Other treatments can be used for eye problems if the eyes are affected. 

Please note that steroid creams should not be used for rosacea as they can worsen symptoms.

This website contains some before and after photos of treatments.

Self Care

• Reduce factors that can trigger rosacea (see our FAQ)
• Avoid oil-based products, use water-based makeup
•  Use a sunblock every day to protect your skin from the sun
• Use a soap substitute to wash your face, avoid perfumed products
• Visit the Changing Faces charity website which provides a Skin Camouflage Service
• Aim to reduce your stress levels 

Symptoms of Rosacea

Facial redness or flushing commonly of the forehead, nose, cheeks and chin

• Skin that is dry and flaky
• Burning or stinging sensations, especially after applying make-up and creams
• Small bumps and pus-filled spots
• People with the condition may feel embarrassed, have low self-esteem, anxiety and/or depression
•  Swelling, redness or changes in the shape of the nose (rhinophyma)
• Visible blood vessels (telangiectasia)

Ocular rosacea is when the disease affects the eyes or eyelids. Eye symptoms of ocular rosacea include: itching, burning, soreness, red or dry eyes, blepharitis and swelling around the eyes.

This website contains some images of people with rosacea. You may find it useful to compare your symptoms with these images but be mindful of the fact that symptoms and appearance can be different for different people.

What can trigger rosacea? 

Everyone will be different but listed below are some common triggers. Many of them are environmental factors. Keeping a diary of your symptoms will help to track any flare-ups and may be a useful way to discover personal triggers.  

• Alcohol
• Caffeine
• Sun exposure
• Hot and spicy foods
• Hot drinks
• Cheese
• Certain medications
• Emotional stress
• Strenuous exercise

Are there conditions that are similar to rosacea?

There are a number of conditions that have similar symptoms and patterns to rosacea such as acne, some types of dermatitis, lupus and keratosis pilaris.

This is why it is important to complete the online assessment with as much detail as possible to enable our doctors to properly assess your symptoms. 

Will my nose swell or change shape (rhinophyma)?

Rosacea can affect the nose and cause rhinophyma, but this is uncommon. It usually only develops in rosacea which has been active and left untreated for many years and because of this it may be more common when patients are middle-aged. This is why it is important that you are assessed and treated promptly if you suspect you have rosacea. 

Is Rosacea a sign of poor hygiene?

Rosacea is not related to poor hygiene. 

How should I wash my face if I have rosacea?

Patients should use a mild soap or non-soap cleansers. Use your fingertips to apply the cleanser, avoid using rough cloths or sponges. Wash the cleanser away with lukewarm water (hot or cold water may cause flushing) and pat your face dry with a towel. Avoid rubbing the skin with a towel because this may cause irritation.

Should I moisturise my face?

Many rosacea sufferers will also have dry skin. Moisturising affected areas can help with any dryness, stinging and irritation. Patients may find creams designed for sensitive skin are gentler and cause less irritation. These can be used together with topical medication but make sure to leave at least 30 minutes between different creams or ointments.

References:

https://www.dermnetnz.org/topics/rosacea/

https://www.nhs.uk/conditions/rosacea/

https://www.bad.org.uk/pils/rosacea/

https://www.rosacea.org