What is rosacea?

Rosacea is a common skin condition, usually occurring on the face, which predominantly affects fair-skinned but may affect all skin types in people aged 40 to 60 years old. It is more common in women but when affecting men, it may be more severe. It is a chronic condition, and can persist for a long time and, in any individual, the severity tends to fluctuate. Rosacea tends to affect the cheeks, forehead, chin and nose, and is characterised by persistent redness caused by dilated blood vessels, small bumps and pus-filled spots similar to acne. There may also be uncomfortable inflammation of the surface of the eyes and eyelids. Rosacea is classified into four subtypes that may overlap. Your doctor will advise you of the type you have.

What causes rosacea?

The cause of rosacea is not fully understood. Your genetics, immune system factors, and environmental factors may all play a part. Factors that trigger rosacea cause the blood vessels in the skin of the face to enlarge (dilate). The theory that rosacea is due to bacteria on the skin or in the gut has not been proven. However, antibiotics have proven helpful to treat rosacea. This is because of their anti-inflammatory effect. Rosacea is not contagious.

There are a variety of triggers that may make rosacea worse. These include alcohol, exercise, high and low temperatures, hot drinks, spicy foods and stress. Rosacea can be sun sensitive.

What are the symptoms of rosacea?

The rash and the blushing associated with rosacea can lead to embarrassment, lowered self-esteem and self-confidence, anxiety and even depression. Furthermore, the skin of the face is often sensitive, and the affected area can feel very hot or sting.

Some people with rosacea have eye symptoms. A few patients with rosacea may develop more serious eye problems, such as painful inflammation involving the front part of the eye (rosacea keratitis) and this may cause blurred vision. It is important that you consult a dermatologist or an optician if you develop symptoms affecting the eyes.

What does rosacea look like?

Rosacea usually starts with a tendency to blush easily. After a while, the central areas of the face become a permanent deeper shade of red, with small dilated blood vessels, bumps and pus-filled spots.

Occasionally, there may be some swelling of the facial skin (lymphoedema), especially around the eyes. Occasionally, an overgrowth of the oil-secreting glands on the nose may cause the nose to become enlarged, bulbous and red (called rhinophyma). Rhinophyma 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; however, not all these will help the redness or blushing that may be associated with rosacea.

Local applications:

The inflammatory element of rosacea may be controlled with a medication applied to the affected areas It takes at least eight weeks for their effect to become evident and some applications work specifically to reduce the redness associated with rosacea.

Oral antibiotics:

These are helpful for the inflammatory element 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 cream and oral treatment together.

Other treatments:

  • An eye specialist should manage the severe types of eye involvement.
  • A bulbous nose affected by rhinophyma can be reduced by a dermatologist or a plastic surgeon
  • Redness and dilated blood vessels can be treated with laser therapy by a dermatologist.
  • A beta-blocker tablet or clonidine may be prescribed by the dermatologist – it may help if blushing is a significant problem.
  • Isotretinoin tablets are sometimes prescribed by a dermatologist for severe rosacea.

This information is courtesy of the British Association of Dermatologists Rosacea leaflet.