Rosacea

Rosacea is a common, chronic inflammatory skin condition, which mainly affects facial skin and can be characterised by flare-ups and remissions. Get all the information you need below.

What is Rosacea?

Rosacea can occur at any age, but usually occurs in adults older than 30 years.

This common skin condition usually affects the cheeks, forehead, nose and chin. Rosacea can be accompanied by frequent flushing, persistent redness of central areas of the face, and in some people, acne-like spots or pimples and telangiectasia (dilated blood vessels).

Occasionally, some people may experience some swelling of the facial skin. In rare, severe cases, an overgrowth of oil-secreting glands on the nose may cause thickening of the skin. The nose may appear swollen, red, with enlarged pores; the medical term for this is Rhinophyma. Rhinophyma is found more commonly in men than women.

In some people with rosacea, the eyes may also be affected. Signs and symptoms may include: redness of different parts of the eye and eyelid, dryness, itching, burning, tearing, gritty sensation, light sensitivity and blurred vision.

What causes rosacea?

The exact cause of rosacea remains unclear as of yet, however, a number of theories have been proposed, which include the possible role of genetics, immune system factors, environmental triggers and the Demodex mite.

Potential rosacea triggers can include:

In some cases, people with rosacea, can have their symptoms triggered or made worse by exposure to ultraviolet light, high and low temperatures, stress, physical activity, alcohol, smoking, spicy food, and hot drinks.

What are the symptoms?

As already mentioned above, symptoms may include or incorporate a number of combinations of the following which affects the facial skin or central face (nose, cheeks, central forehead and chin): flushing, persistent redness, visible and dilated blood vessels, spots and pimples. Other possible symptoms may include, skin dryness, skin thickening or swelling, raised red patches, itchy, stinging or irritated skin and eye symptoms.

Rosacea is often categorised into one of four subtypes. Some people may experience symptoms of more than one type. Your doctor will advise you on the type of rosacea you have.

When to contact your GP?

There are different types of rosacea, and some people may experience an overlap of one or more signs and symptoms of this skin condition. Each individual sign and symptom may progress from mild to moderate to severe. Therefore, it is important to visit your GP for an assessment, diagnosis, appropriate advice and treatment or onward referral to a dermatologist if required.

Visiting a doctor will provide an impartial opinion about the severity of your symptoms, what kind of skin care/treatment may help you and reassurance about how common rosacea is.

Rosacea can resemble other dermatology skin conditions; therefore, it is important to get a diagnosis from your GP.

Treatments for rosacea

Topical treatments – come in the form of gels, lotions and creams that are applied directly to the skin.
Systemic treatments (tablets) – medications taken by mouth.
Other treatments – light and laser devices to treat redness and dilated blood vessels.

Topical treatments

Topical treatments provide the mainstay of therapy for many individuals with this condition and maybe used alone or in combination with an oral medication. They have various active ingredients to treat the inflammatory component of the rosacea. When using topical treatments, these are usually applied to the areas affected by rosacea and not just to individual spots.

Systemic treatments

May be prescribed in circumstances where the rosacea is more severe or where topical treatments have not worked, or are not recommended. These treatments are oral antibiotics. In some cases, your doctor may recommend a topical treatment and oral treatment together (combination therapy).

For severe rosacea that responds poorly to prescribed treatment, referral to a dermatologist may be considered for assessment and further treatment. In severe cases of rosacea where the symptoms of acne like spots (papules and pustules) do not respond to oral antibiotics, other systemic treatment may be considered but is prescribed under specialised supervision due to the potential for side effects, and strict monitoring required while on this medication.

Other treatments

Individuals with eye involvement symptoms (Ocular rosacea), may be referred to an ophthalmologist for further management.

Laser and light devices are sometimes used in the treatment of rosacea; these treatments usually target the redness and broken veins (telangiectasia) of rosacea and are available in private dermatology clinics. Your doctor can advise you on whether this is an appropriate option for you.

Cosmetic camouflage can be used to cover the skin. This option can be further explored on Irish Red Cross , Ireland, which runs free one-to-one skin camouflage training.

Tips on Self Care

It has been suggested that ultraviolet rays can trigger a flare or exacerbate symptoms. It is advisable to avoid direct sunlight and use a broad spectrum sunscreen offering protection from both UVA/UVB, with a minimum SPF 30.
If possible, identify and avoid any lifestyle or environmental factors which trigger or exacerbate symptoms, common triggers already mentioned include, alcohol, hot beverages, spicy foods, extremes in temperatures and others. Sometimes it may help to keep a written record of flare-ups to identify any trigger.
Individuals with rosacea, often have sensitive, easily irritated skin. Therefore, it is important to select mild, non-irritating, fragrance-free, alcohol-free, skin care products.
Cleansing – Avoid vigorous washing and scrubbing as this can irritate the skin. Wash the skin with a gentle skin cleanser or a soap substitute, use lukewarm water and pat skin dry.
If the skin is dry or sensitive, use a moisturiser which is fragrance free and “non-comedogenic” or “oil free”, on a regular basis to improve skin hydration and skin barrier function.
Shave carefully – electric shavers may be more comfortable for men with rosacea. Avoid any shaving creams or lotions that burn or sting your skin.
If your eyes are affected, consult with your doctor. For mild eye symptoms which may include dryness a gritty feeling in the eyes, eye care may help in managing these symptoms. These would include: washing the eyes twice daily with warm water and using artificial tears.
Use prescribed topical preparations and oral rosacea medications as directed; e.g. take them at the correct time of day, as often as prescribed, at the right dose.
Unfortunately, patience is necessary; rosacea treatment may take time to take effect. Depending on the individual and type of treatment (topical or oral), some studies have suggested it may take 6 – 12 weeks before any particular therapy is abandoned for another.
As rosacea is a visible inflammatory skin condition, even mild cases of rosacea can cause distress and embarrassment. If your rosacea is affecting your mental health and the symptoms are not under good control, speak with your doctor.

Rosacea Video

Talk on rosacea presented by Prof Anne – Marie Tobin, Consultant Dermatologist, Tallaght University Hospital, Naas General Hospital; Professor in Clinical Medicine, Trinity College Dublin; Clinical Lead for the National Clinical Programme in Dermatology, Ireland.