It’s estimated that one in 10 people in the UK have this chronic inflammatory skin condition, which causes redness to spread over the cheeks, nose, chin and forehead.
By Dr Roger Henderson
Rosacea is a long-term (chronic) skin condition characterised by flushed skin on the face that typically targets the nose, cheeks, forehead, and chin. People with light skin are more prone to rosacea, although all types of skin tone can develop the condition.
But what causes rosacea, and how is it treated? Dr Roger Henderson explains everything you need to know:
What is rosacea?
Rosacea is a rash occurring on the face, which usually affects people aged 35 to 55 years old, who are fair-skinned. It’s more common in women, but tends to be more severe in men. It is a chronic condition and, in any individual, the severity tends to come and go.
Rosacea tends to affect the cheeks, forehead, chin and nose, and is characterised by redness, dilated blood vessels, small red bumps and pus-filled spots (sometimes these may only be visible with a magnifying glass), often with a tendency to blush easily. There may also be uncomfortable inflammation of the eyes and eyelid. Rosacea is diagnosed by its appearance. There are no diagnostic laboratory tests for it.
What causes rosacea?
The cause of rosacea is unknown, but underlying trigger factors cause both inflammation and an undue readiness of the blood vessels in the skin of the face to dilate. Rosacea is not contagious.
Rosacea does seem to run in some families, but there is no clear genetic link. There are a variety of trigger factors which may make rosacea worse, but which probably do not cause it in the first place. These include alcohol, exercise, high and low temperatures, hot drinks, spicy foods and stress. Rosacea can be worsened by natural sunlight.
What are the symptoms of rosacea?
The rash and the flushing associated with rosacea can lead to embarrassment, lowered self-esteem and self-confidence, anxiety and even depression. The skin of the face is often sensitive, and the affected area can feel very hot or sting. Some people with rosacea also have eye symptoms (which include red, itchy, sore eyes and eyelids, a gritty feeling and sensitivity to light).
What does rosacea look like?
Rosacea usually starts with a tendency to blush and flush easily. After a while, the central areas of the face become a permanent deeper shade of red, with small dilated blood vessels studded with small red bumps and pus-filled spots, which come and go in crops. Scarring is seldom a problem.
Occasionally, there may be some swelling of the face (lymphoedema), especially around the eyes, and very occasionally, an overgrowth of the oil-secreting glands may cause the nose to become enlarged, bulbous and red (rhinophyma), which is more common in men than women.
How can rosacea be treated?
The inflammation that accompanies rosacea can be treated with preparations applied to the skin or taken by mouth.
✔️ Local applications
The inflammatory element of mild to moderate rosacea may be controlled with just a topical preparation (one that is applied to the skin) and usual preparations include metronidazole and azelaic acid. They take time -at least eight weeks- for their effect to become evident.
✔️ Oral antibiotics
These are helpful in treating the inflammation of moderate or severe rosacea. The most commonly used antibiotics belong to the tetracycline group and include tetracycline, oxytetracycline, doxycycline, lymecycline and minocycline.
Erythromycin is another commonly used antibiotic. The duration of an antibiotic course depends on your response. Your doctor may suggest that you use a topical and oral treatment together.
What can I do to treat rosacea myself?
Protect your skin from the sun by using a sun block (with a sun protection factor of at least 30) on your face every day and do not rub or scrub your face as this can worsen rosacea. Do not use perfumed soap as this can make rosacea worse – instead, use a soap substitute (emollient) to cleanse your face and an un-perfumed moisturiser on a regular basis if your skin is dry or sensitive.
Consider the lifestyle factors that can worsen rosacea. Learn which upset your rosacea and avoid them; a written record of your flare-ups may help.
Cosmetics can often cover up rosacea effectively, and some rosacea patients may benefit from the use of skin camouflage. This may help hide excessive redness. A health care professional will be able to make a referral for you if necessary.
Protect your skin from the sun by using a sun block with a sun protection factor of at least 30.
Unless they are specifically recommended to you by your doctor, it may be best to avoid some treatments for acne, as they can irritate skin that is prone to rosacea. Do not use topical preparations containing corticosteroids, unless specifically recommended by your doctor, as these may make rosacea worse in the long run.
If your eyes are giving problems, do not ignore them – consult your doctor. Some medications can aggravate blushing, and your doctor may make appropriate changes to your medication.