Rosacea

What is Rosacea?

Rosacea is a chronic skin condition that typically affects the face which causes redness, sensitivity and flushing. Primarily rosacea is most evident on the cheeks, nose, chin and forehead. Although it can display symptoms similar to acne such as redness, swelling, and small, red, pus-filled bumps, it is a separate condition. It can also affect anyone, but it most commonly presents in middle-aged women with fair skin. The exact cause of Rosacea is currently unknown, but it’s believed to stem from a combination of genetic and environmental factors. In this guide to rosacea acne we explore the different types, symptoms, causes and triggers and management options for rosacea.

Types of Rosacea

Rosacea is usually divided into four subtypes. Each of these has its own distinct set of symptoms:

• Erythematotelangiectatic Rosacea (ETR): ETR is characterised by persistent redness (erythema) and visible blood vessels or telangiectasia on the face. People with ETR rosacea might experience episodes of flushing and blushing. Their skin might also be sensitive, dry and stinging.
• Papulopustular (or Acne) Rosacea: As its name suggests, this subtype resembles acne. Typically sufferers experience redness, swelling and breakouts in the form of papules and pustules. This subtype mostly affects middle-aged women.
• Phymatous Rosacea: The phymatous form of rosacea causes the skin to thicken and develop a bumpy texture. This often results in an enlargement of the nose, a condition known as rhinophyma. This subtype is more common in men.
• Ocular Rosacea: Generally, Ocular rosacea causes a range of symptoms associated with the eye area. These include dry eye, tearing, redness, burning and the sensation of having something in the eye. Ocular rosacea can be severe in some cases, potentially leading to rosacea keratitis. This is a condition that can damage the cornea and affect vision if left untreated.

Symptoms of Rosacea

The symptoms of rosacea depend on the subtype but they can also vary significantly from person to person. Typically, they include one or more of the following:

• Facial redness: this persistent erythema is a common sign. Small blood vessels on the nose and cheeks often swell and become visible.
• Swollen red bumps: many people with rosacea also develop pimples on their face that resemble acne. These bumps sometimes contain pus and they may make the skin feel hot and tender.
• Eye problems: some people with rosacea experience experience conjunctivitis which manifests as dry, irritated, swollen eyes and red, swollen eyelids. Ocular rosacea can even impair vision if it progresses.
• Enlarged nose: in severe cases, especially in men, rosacea can cause the nose to grow swollen and bumpy from excess tissue.

Causes and Triggers

The exact cause of rosacea remains unknown. It is likely due to a combination of hereditary and environmental factors. Various things can trigger or exacerbate it by increasing blood flow to your skin’s surface. These include:

• Hot drinks and spicy foods
• Alcohol
• Temperature extremes
• Sunlight or wind
• Stress, anger or embarrassment
• Intense exercise
• Certain medications, like blood pressure drugs. These dilated blood vessels hence trigger rosacea.

Who Gets Rosacea?

Rosacea is a common condition that affects millions of people worldwide. While it can occur in anyone, it most frequently affects middle-aged women who have fair skin. There’s also a genetic component to it, and those with a family history of the condition are more likely to develop it themselves. Despite the common demographic, this disease can also affect men and people of all age groups and skin tones. In men, it often appears more severe because they delay medical treatment until the condition reaches an advanced stage. Young people, even children, can develop rosacea. This is often diagnosed due to persistent redness and acne-like symptoms.

Rosacea in Skin of Colour

This condition affects people of all skin tones. However, people of colour typically have a harder time getting diagnosed due to general ignorance in the medical field regarding how rosacea and other common dermatology conditions present in skin of colour. People with darker skin types may exhibit symptoms differently. Rather than redness, it may present as dark brown or purple spots, primarily on the forehead, cheeks and chin.

Another common symptom of rosacea in skin of colour is an increased skin sensitivity. Those with the condition often report that their skin stings or burns when applying certain skincare products. This sensitivity may be a clue to diagnosis in people with skin of colour, even in the absence of visible redness. Inflammatory papules and pustules, similar to those seen in acne, are often more noticeable than erythema in darker skin types. These can lead to post-inflammatory hyperpigmentation, causing further changes in skin colour and potential scarring, making it even more crucial to manage and treat rosacea appropriately in skin of colour.

Rosacea Treatments

Unfortunately, there is currently no definitive cure for rosacea. However, there are treatments that can help manage the symptoms and prevent flare-ups.

• Topical Treatments: Topical treatments are first-line therapy for rosacea. They include simple over-the-counter agents like azelaic acid and gentle skincare containing soothing ingredients like centella. For severe or recurrent cases, prescription rosacea treatments such as metronidazole, high strength azelaic acid and ivermectin can help. These can help reduce inflammation and redness. You typically apply these to the skin once or twice a day.
• Oral Antibiotics: Doxycycline and other oral antibiotics provide anti-inflammatory actions. They can be particularly effective for moderate to severe cases or for times when it has not responded to topical treatments.
• Prescription Retinoids: Vitamin A derivatives like topical Tretinoin and oral Isotretinoin are sometimes useful in acne rosacea but they need extreme care as they can irritate the skin and make it even more sensitive. This is always done on a case by case basis to balance the risks and benefits to the patient. For moderate cases, low dose Tretinoin can help combat acne rosacea symptoms and hyperpigmentation. For severe cases that don’t respond to other therapies, doctors may suggest Isotretinoin. This powerful drug is typically used to treat severe acne, but it can also help by reducing the production of sebum.
• Ablative Treatments & Surgery: These are often reserved for severe cases of rosacea where other treatments may have not worked and for rhinophyma. Intense pulsed light or lasers to can minimise the redness and visible blood vessels and rhinophyma. Electrosurgery uses a thin needle to apply a weak electrical current to the skin, which destroys the blood vessels that cause redness. Radiofrequency ablation uses radio waves to destroy the blood vessels that cause redness. Dermabrasion can be used to improve the appearance of skin that is thickened or scarred. Lastly, surgical resection maybe required in severe cases of rhinophyma. This involves cutting excess tissues with a scalpel under local or general anaesthetic.

Living with Rosacea

This is a condition that affects millions of people throughout the world. Anyone can have rosacea regardless of age, gender or skin colour. However, although it can be challenging, it is manageable. The key is understanding what triggers flares and how to avoid these triggers. Using gentle skincare products, protecting your face from the sun and managing stress. Seek medical help if you suspect you have rosacea especially if over-the-counter products aren’t helping, symptoms are getting worse or affecting the eyes. Your doctor can provide a more accurate diagnosis and if appropriate medical roscaea treatments.