What is Rosacea?
Rosacea is a chronic inflammatory skin condition that often presents as red, sensitive, bumpy skin on the face. Changes are usually most active around the centre of the face (cheeks, nose, forehead, and chin). Rosacea is common, affecting about 5% of people globally. It can occur in any skin type but is much more common in lighter skin tones and particularly in Celtic populations.
What causes Rosacea?
Whilst we don’t know the exact cause, rosacea is a result of genetic tendency combined with extrinsic factors. Within the skin, the blood vessels are abnormally reactive, leading to redness and changes in the skin’s immune system shown as bumps and inflammation. Rosacea is made worse by external factors such as UV exposure.
Types of Rosacea
There are a number of different types of rosacea, which can be classified in different ways:
Type 1 - Erythematotelangectatic Rosacea – which appears as facial redness.
Type 2 - Papulopustular – characterised by bumps and spots.
Type 3 – Phymatous type - involves skin thickening (often around the nose).
Type 4 – Ocular Rosacea - rosacea that affects the eyes.
It is common for individuals to have a combination of these symptoms, so there is a significant overlap between the different types.
Management of Rosacea
Whilst there is no cure for rosacea, it can be very effectively managed with a combination of lifestyle factors and medical interventions where necessary.
Sunlight can exacerbate rosacea both in the short and the long term. It is a common cause of rosacea flares and so it’s important to protect the skin. Wearing hats and seeking shade is useful, alongside the daily use of a carefully chosen SPF.Alcohol
Alcohol is not the cause of rosacea but for many, it can increase facial redness and has been linked to an increased risk of skin thickening (phymatous subtype). Keep alcohol consumption minimal and well within the recommended guidelines. For some people, certain drinks may flare more than others (red wine, for example).Diet
Dietary triggers will vary between people. Spicy food is commonly cited, as well as histamine-rich foods – including processed or pickled food. Keeping a food diary may help to identify your own triggers for rosacea. Hot drinks may also exacerbate redness.Temperature
Heat can often make facial redness and flushing worse. Turn down the heating, keep rooms cool and avoid unnecessary extremes of temperature, for example very hot showers, saunas or hot yoga
Skin with rosacea is frequently dry, sensitive, and prone to burning and stinging. Choosing the right skincare is important to restore and protect both the skin barrier and the microbiome. During flares, keep skincare very gentle – avoid fragrances and essential oils. Use a cream or balm cleanser and a rich moisturiser with a good balance of occlusives such as shea butter, ceramides, niacinamide and emollients.
Sunscreen is an essential daily step - choose an SPF50 with a hydrating formula.
Azelaic acid can also be an excellent addition to your routine. Once the rosacea is calmer, you can think about adding in antioxidants like vitamin C and even a gentle retinoid, but this should be done very slowly, one ingredient at a time and stopped if the skin gets irritated.Medical Treatment
Rosacea is ultimately a medical condition and if skincare and lifestyle alone aren’t helping, it’s important to seek medical attention. Treatment will depend on the pattern of symptoms, which is why it is helpful to try and understand what type of rosacea you have.Spots
The spots of rosacea can be treated by medical creams such as azelaic acid, topical metronidazole or topical ivermectin. These creams need to be used for at least 2-3 months before any benefit is seen. More severe cases may benefit from antibiotic tablet treatment or even low dose Roaccutane (isotretinoin).Facial flushing/redness
Some redness will improve with changes in skincare or treatment of the spots. However, for underlying flushing or redness, laser is often the best treatment. Whilst there are some creams available (topical brimonidine), we often find that once the effect of the creams wears off, there is a significant rebound effect. If anxiety or stress makes flushing worse, certain tablets such as beta-blockers may be helpful.Ocular Rosacea
This can be helped with a combination of lid hygiene, warm compresses, eye drops and sometimes tablet antibiotics. If eyes are an ongoing problem, it’s important to seek medical attention.
Phymatous Rosacea (thickening)
Thickening of the skin may need surgical or laser intervention.
Rosacea is a common skin condition that presents with variable signs of redness, spots and skin sensitivity. Whilst there is no cure as yet, there are a number of ways we can effectively manage the skin with a combination of lifestyle and medical interventions.
Dr Emma Wedgeworth, Consultant Dermatologist