Living with Rosacea

What is Rosacea?

Rosacea is a skin condition characterised by redness and flushing of the skin of the face, affecting mainly the cheeks and nose.
People who have Rosacea complain of a red complexion with dilated, broken blood vessels (telangiectasias), but sometimes have papules and pustules that can be mistaken for acne.

One less common form leads to an enlarged, red nose with thickened skin, large sebaceous glands and large pores. This form is called Phymatous Rosacea and occurs mainly in men, who are often wrongly thought to be alcoholics.

Ocular Rosacea presents with redness and irritation of the eyes.

Rosacea is common in fair skinned individuals but can occur in skin of any colour. Patients with Roscaea also complain that their skin is dry and ‘sensitive’, and ‘stings’ on application of skincare products.
For this reason there are numerous ranges of skincare that cater for those with Rosacea.

What causes Rosacea?

The cause of Rosacea is mainly unknown, there are however genetic and environmental influences and people with Rosacea have a 20% chance of having a family history of the condition.

Rosacea may start from an early age with frequent flushing and redness of the face. This is due to abnormal reactivity of blood vessels caused by dysregulation of the nervous system. This vascular hyper-reactivity worsens into adulthood. At first it is reversible, but in time there is persistent dilatation of the blood vessels and leaking of fluid into the tissue. The face may become tense with fluid (oedematous), leading to the formation of papules and pustules similar to acne.
In addition the skin is dry and sensitive due to a damaged skin barrier and there is a defective immune response further contributing to the inflammation seen in Rosacea.

Rosacea may also be caused by sun damage to the skin with damage to the dermal connective tissue and blood vessels and resultant leakage of fluid from blood vessels into the surrounding tissue.

Demodex mites, which seem to contribute to the development of Rosacea, are part of the normal skin flora and are found in large numbers in the skin of Rosacea sufferers

A secondary form of Rosacea can be caused by using steroids on the skin, often seen with inappropriate use of steroid creams on the face when treating conditions like eczema.

What triggers Rosacea?

A trigger is anything that causes Rosacea to flare up.
These may be anything from food and drinks, medication, medical conditions, physical activity, emotional factors, to weather and temperature changes and personal care products.

Identifying and avoiding trigger factors is an important part of the management of Rosacea but may not always be possible.
Most patients have multiple triggers and the list of reported triggers is exhaustive.
The most common trigger for Rosacea is heat and temperature changes, while other common triggers are alcohol, hot or spicy foods, emotional stress, wind and cold exposure, smoking and menopause.

Can Rosacea be cured?

Rosacea cannot be cured.
It is important for patients to understand what their possible triggers are and to try to avoid them.
Medical treatments are aimed at controlling signs and symptoms and the condition may then go into remission for some time.

What are my treatment options?

Treatment options are medical and surgical and an individual will probably go through a variety of different treatment options in their lifetime.
Rosacea requires continuous management and the foundation for this is a good skincare regimen including a gentle cleanser, moisturiser and suitable sun protection. There are also various ingredients in skincare that successfully reduce redness and calm inflammation.
In addition, this is combined with a prescription treatment depending on the type of Rosacea.

Erythematotelangiectatic Rosacea is characteristised by redness and broken veins.
This type is best treated with topical metronidazole or topical azeleic acid. Laser may be helpful to improve redness.
Topical oxymetazoline is used in the United States, but is not available in South Africa

Papulopustular Rosacea is treated with a combination of topical antibiotics eg metronidazole, erythromycin, or clindamycin and oral antibiotics eg tetracyclines and erythromycin.
Other treatments including benzoyl peroxide, tretinoin, pimecrolimus and permethrin are also sometimes prescribed.

Isotretinoin may be prescribed for Rosacea that is severe and unresponsive to other treatment.
It is also used for a type of Rosacea called solid facial oedema in which the skin is tense with inflammation.

Are there any procedures to treat Rosacea?

Laser or light treatment can reduce redness, shrink blood vessels and remove thickening of the skin.
Laser is particularly useful for Erythematotelangiectatic Rosacea or Phymatous Rosacea.

Some chemical peels may also be suitable to calm skin and reduce redness and inflammation. An example of this is SkinTech Easy Phytic peel.
This chemical peel is specifically designed for sensitive skin like Rosacea. It is useful for those that have an acute flare-up of their Rosacea.

General measures

Identify and avoid your triggers.
Sun protection is essential, as sun damage may precipitate or worsen Rosacea.
Use a sunscreen for sensitive skin. These are usually mineral sunscreens contains zinc oxide or titanium dioxide.
Wash the face twice daily with a gentle soap-free cleanser suitable for sensitive skin.
Avoid products with alcohol, menthols, camphor, witch hazel and fragrances.
Avoid toners and facial scrubs.
Use your prescription topical treatment after washing the face.
Use a moisturiser with ingredients that reduce redness and calm the skin.
Avoid heavy occlusive makeup or greasy cosmetics as these are difficult to remove without scrubbing the skin.
Patients with Rosacea often complain that products ‘sting’ their skin. This is because of a damaged skin barrier.
It is sometimes necessary to try a few skincare products before finding a suitable one.

Rosacea is a condition that develops over time and patients are initially unaware of their symptoms. If you are experiencing some of these symptoms and believe you may have Rosacea, visit your dermatologist to confirm your diagnosis and receive prescription treatment suitable for your skin.

To book an appointment with our skin specialist email info@skinsmart.co.za