Rosacea

In this month’s journal I discuss rosacea, a skin condition that impacts how many of my patients see themselves.  Affecting nearly one in ten people in the UK, rosacea is often thought of as a condition that simply involves redness of the face, but symptoms can be more complex and varied.  Whilst not curable, rosacea is manageable.

What is Rosacea?

Rosacea is a common skin condition, usually occurring on the face. It predominantly occurs in people with fair skin but may affect all skin types. Rosacea is more common in women, but when it affects men, it may be more severe. Rosacea is often first seen in middle-age.

Rosacea is classified as a chronic condition, persisting for a long time with fluctuating severity. Rosacea tends to affect the central face and may be characterised by persistent redness and small bumps and pus-filled spots similar to acne. You may also suffer from uncomfortable inflammation over your eyes and eyelids.

Rosacea has four subtypes that may overlap. It’s best to consult with your GP or a dermatologist to understand what type or types of rosacea you have and discuss a treatment plan that will work best for you.

Erythematotelangiectatic rosacea

This form of rosacea is mainly characterised by redness, flushing and broken capillaries.

Papulopustular rosacea

Red papules and pustules will appear on the skin, often over a background of erythema (redness).

Rhinophymatous rosacea

A rarer, more severe form of rosacea, this type causes the skin to thicken, giving it a more bulbous appearance, particularly on the nose.

Ocular rosacea

This rosacea subtype causes redness and irritation within the eyes, as well as swollen eyelids.

Since rosacea tends to develop well into adulthood, it can suddenly crop up after years of blissfully, blemish-free skin. You may feel like your trusted skincare regime has been thrown into disarray. But while rosacea isn’t curable, it is manageable, and there are many ways to decrease the regularity and severity of your flare-ups.

Managing your rosacea takes routine and perseverance, but improvement is possible and consistent treatment can keep your symptoms at bay.

Understanding your rosacea and your triggers

We don’t yet know the exact causes of rosacea, but environmental factors and genetics play a part. It helps to understand what triggers your rosacea. Anything that makes your skin flush is a potential trigger. Your skin may appear flushed when you drink alcohol, hot drinks or eat spicy food. Many patients find stress, heat, sunlight or extreme winter weather such as cold or wind can trigger their rosacea.

Smoking and exposure to pollution can worsen rosacea symptoms by damaging the skin’s natural barrier.

I work with patients to help them understand and avoid potential triggers which is an important part of learning to manage rosacea.

Rosacea Treatments 

There are a range of treatments available, and the options are constantly increasing as skin science develops. Often, it’s about trying different options or a combination of medications to find the treatment regime that works for you and your skin.  This may include targeted skincare, prescription medications and light-based treatments such as LED and IPL.

Positive changes to manage your rosacea 

You can make changes to your skincare regime that can help manage your rosacea and reduce your flare-ups.

Be gentle

Look for washes, cleansers and moisturisers designed specifically for sensitive skin.  Always patch-test your skin before using new products on your face.  Remember retinoids, witch hazel, menthol and eucalyptus oil can aggravate rosacea.

I recommend La Roche Posay Toleriane Dermo-Cleanser and CeraVe Hydrating Cleanser.

• Minimise make-up products

Aim for multi-tasking products to reduce the amount of different ingredients you are applying to your skin, helping to avoid irritation.

• Maximise mineral-based SPF

UV radiation is one of the common rosacea triggers, meaning sunlight can cause flare-ups. Rosacea sufferers also have fragile capillaries which can be easily damaged by UV. Using a good broad-spectrum SPF every day is crucial.  Look for a mineral sunscreen containing physical blockers such as zinc and titanium dioxide which are less likely to exacerbate rosacea-prone skin compared to chemical blockers.

I recommend Kiehl’s Ultra Light Daily UV Defense SPF 50 and Elta MD UV Clear SPF 46.

Prescription medications

For mild to moderate rosacea, topical prescription medications are available to help control redness and spots. Brimonidine helps reduce flushing by constricting blood vessels. Azelaic acid, metronidazole and ivermectin may also be prescribed to help control symptoms.

For moderate-severe, an oral, antibioticmedication may be recommended to help reduce inflammation. Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These medications are usually taken for four to six weeks, but longer courses may be necessary if your symptoms are persistent.  Isotretinoin is also an option for severe rosacea. It’s important to note that there are potential side effects with these medications which your doctor will discuss with you. 

LED and Intense pulsed light (IPL)

The flushing, redness and visible blood vessels associated with rosacea (particularly with the erythematotelangiectatic subtype) can be reduced with both LED treatments and intense pulsed light (IPL). LED may be done in a clinic setting or via at-home devices. Intense pulsed light (IPL) is a customisable treatment that incorporates multiple wavelengths of light to visibly reduce the appearance of redness and thread veins, typically multiple sessions are required.

If you are suffering from rosacea speak to a dermatologist about developing a treatment plan tailored specifically to your skin.