Rosacea

What is rosacea?

Rosacea is a skin condition characterised by redness and visible blood vessels on the face*. Sadly, the condition is chronic, though symptoms are manageable with long-term treatment and lifestyle changes.

Rosacea will typically develop after you turn 30. Interestingly, rosacea is more prevalent in women (more so in their 40s and 50s), yet men suffer more severe symptoms. Individuals with lighter skin tones are also more prone to the condition.

Rosacea is often misdiagnosed as acne or an allergic reaction as it can present with small pus-filled bumps. If you believe you have rosacea, it is important you are first diagnosed by your GP or a dermatologist.

As this condition alters your appearance, it may be necessary to seek mental health advice - especially if you find it affects your self-esteem and general well-being.

*A less common variant known as ocular rosacea can affect the eyes.

What causes rosacea?

Currently, the cause of rosacea is undetermined. However, there are several theories as to what it is.

1. Vascular abnormalities - blood vessels in the face of those with this condition are abnormal or are damaged. For example, overexposure to the sun may cause blood vessels to widen; this explains why individuals with sun-sensitive, fairer skin are disproportionately affected.
2. Mites - believe it or not, you have microscopic mites that live on your skin called Demodex folliculorum. These mites are normally harmless, however, if there are too many, they can cause skin irritation.
3. Immune system abnormalities - your immune system uses antimicrobial molecules called cathelicidinsto aid in fighting infection. Individuals with rosacea show a higher concentration of cathelicidins.
4. Genetics - there is evidence that rosacea has a genetic component; someone with the condition likely has a close relative with it too.
5. Bacteria - Helicobacter pylori is a bacterium that is usually present in the gut. It can raise the amount of gastrin (a digestive hormone) in your system, and this can cause your skin to appear flushed.

Alongside these theorised causes, many environmental and lifestyle factors have been linked to more severe cases of the condition. Triggers differ from causes in that they exacerbate symptoms, in this case, by increasing blood flow to the skin's surface. Potential triggers include:

• sunlight exposure
• stress and emotional turmoil
• certain cosmetics
• extremes in temperature and humidity
• strenuous exercise
• alcohol and caffeine
• spicy food

Only some of the above triggers may apply to you.

What are the symptoms of rosacea?

The symptoms of rosacea are generally progressive. What might start as episodes of flushing can develop into more unpleasant symptoms, including pain and itching.

Most patients will experience a burning or stinging sensation in the face, especially in inflamed areas. As the condition persists, you may experience some of the following symptoms:

• redness
• spots
• telangiectasia (spider veins)
• patches of rough, dry skin
• more visible pores
• lymphoedema (facial swelling)
• rhinophyma (enlarged nose)*

It is important to remember that the symptoms of this condition are episodic and vary in severity.

Ocular rosacea

Rosacea can also affect the eyes. In this case, the condition is referred to as ocular rosacea. Ocular rosacea has specific symptoms that you should report to your doctor immediately. If left untreated, the condition has the potential to damage your sight irreparably.

Ocular rosacea may follow a flare-up of facial rosacea. However, it may also appear first or independently.

Generally, the condition presents with dry, irritated and bloodshot eyes. Your eyelids may also become inflamed. Other than that, symptoms include blurred vision, recurrent eye infections, photophobia and the sensation that you have something stuck in your eye.

A serious complication of ocular rosacea is keratitis; this is where the cornea becomes inflamed and damaged. Keratitis leaves the affected eye vulnerable to ulceration and infection, which in severe cases can cause blindness. The symptoms of keratitis are:

• eye pain
• photophobia - extreme sensitivity to light
• deteriorating vision

Contact your doctor if you experience any ocular symptoms of any kind.

How can I treat rosacea?

*For ocular rosacea, you should seek the advice of an ophthalmologist or other eye specialist.

To date, there is no cure for rosacea. Fortunately, symptoms are manageable with treatment. For most people, treatment is a combination of lifestyle changes and medication.

If your symptoms improve, your doctor may advise that you take a break from treatment. However, generally speaking, it is recommended that a course is long-term.

The following actions will complement a course of medication:

• avoid any known triggers
• protect your skin from the sun
• avoid touching your skin too frequently
• use an unperfumed cleanser and moisturiser regularly
• wear make-up (that does not irritate your skin)
• massage your face daily

Medication

As rosacea is a skin condition, a doctor will normally prescribe a topical cream or gel first. You should apply these to the affected area of skin.

Topical treatments for mild to moderate rosacea may contain the active ingredients brimonidine and oxymetazoline - both of these temporarily constrict blood vessels. You will usually see results within 12 hours of application. However, the effect is temporary, so you must apply the treatment regularly.

Another method of reducing the redness and pimples associated with rosacea is to target any damaging bacteria on the surface of your skin. Topical medications containing the ingredients azelaic acid and metronidazole work in this way. A course will typically last three to six weeks.

Not all treatment for rosacea is topical. A doctor will prescribe oral antibiotics if your condition is more severe. Antibiotics prevent bacteria from multiplying so that your immune system can better clear an infection. The result is fewer spots and less inflammation.

If your condition does not improve with other treatments, your doctor might prescribe isotretinoin. Isotretinoin is a potent acne drug. However, do not use this drug during pregnancy - it can cause serious birth defects.

Other treatments

If medications, both topical and oral, do not work, your doctor may recommend intense pulsed light (IPL) treatment. IPL is similar to laser therapy and has various applications, from cosmetic procedures, like hair removal, to reconstructive surgery. IPL treatment for rosacea falls into the latter category, however, this does not mean it will always be covered by the NHS. Always consult with your doctor before arranging any medical procedure.

With IPL treatment, beams of light, in varying wavelengths, are directed at visible blood vessels, causing them to constrict and shrink. Dilated blood vessels create the redness associated with the condition - by limiting dilation, redness is reduced.

For more severe cases of rosacea, a dermatologist may recommend electrosurgery. In principle, electrosurgery is similar to IPL in that it targets blood vessels. Your doctor will use a needle to transfer an electric current to the blood vessels that sit below the surface of your skin. The charge causes them to constrict and clot. At first, they will scab, but with time they will heal and redness will lessen.

Dermabrasion is a surgical procedure that is recommended if less invasive treatments are unsuccessful. Usually performed by a plastic surgeon or a dermatologist, this procedure involves removing the upper layers of the epidermis (the outer section of the skin).

After administering a local anaesthetic, the surgeon will use a rotating instrument that “sands” skin imperfections. There is recovery time with this procedure, and you may experience some level of pain, comparable to a moderate case of sunburn. A less aggressive version of dermabrasion is microdermabrasion. Beauticians and other professionals may offer microdermabrasion, however, you should always seek the advice and service of a healthcare professional.