Rosacea is a chronic (long term) skin condition characterised by a red facial rash that forms a butterfly pattern on the cheeks of the face. It most commonly affects the nose, cheeks, forehead and chin. Antibiotics are the primary treatment, while changes to your skin care regimen may help prevent recurrences.
Rosacea can have a similar appearance to acne but the two conditions are unrelated. Most young adult sufferers can think they have acne and using acne skincare products can strongly irritate the skin causing Rosacea to become even worse. Rosacea does not produce the blackheads, deep cysts or lumps that are symptomatic of acne. However the swollen lumps (swollen hair follicles and sebaceous glands) can resemble pimples thus the confusion. It mostly affects fair-skinned Caucasians (especially those of Celtic origin) aged 20–60+ years. But recently more people of other races are succumbing to Rosacea.
Signs and symptoms
Identifying the disease is the first step to controlling it. Because it it often confused with Acne, older adults with "strange spots" can often be self diagnosing ACNE - then begin using over-the-counter ACNE skin care may make the problem worse.
Rosacea often begins with episodes of flushing of the skin. As the condition progresses the skin becomes persistently red and spider-like veins (telangiectasia) become visible on the skin.
Other symptoms characteristic of Rosacea include:
- Pimples that may be hard (papules) or pus filled (pustules).
- Infection of Follicle may have occurred. Folliculitis
- Dry and flaky facial skin.
- Burning and stinging of the skin.
- Red, sore eyelids and a tendency to develop sty’s and conjunctivitis.
- Swelling of the face and eyelids.
- In advanced cases, the pores of the skin may become prominent and the nose may become enlarged and un-shapely (rhinophyma) due to skin thickening.
The exact cause of Rosacea is not known but may be due to a combination of hereditary (genetic) and environmental factors.
There are 2 main causes
- A tiny skin mite that lives in hair follicles may be responsible. It is thought that the bacteria that lives on the mite contaminates the skin and causes the inflamation
- Rosacea may also caused by a Vitamin A deficiency may be the cause.
It is known, however, that a variety of factors can trigger an overreaction of facial blood vessels and increased blood flow to the skin surface, causing skin flushing and inflammation.
Factors are known to trigger or aggravate the condition, include:
- Excess alcohol
- Hot drinks and spicy foods
- Application of topical steroids
- Excessive exposure to sunlight or extreme hot or cold temperatures
- Strong winds
- Some facial creams and cosmetics.
The mainstay of treatment for Rosacea is oral antibiotics. Most commonly, tetracycline based antibiotics, such as doxycycline and minocycline are used. Other antibiotics that may be used include metronidazole and cotrimoxazole. Rosex cream or gel both contain metronidazole and is prescribed for Rosacea. Antibiotic treatment usually lasts for between 6 and 12 weeks. It is not uncommon for repeat courses of antibiotics to be required.
It is believed that the antibiotics work by reducing the bacteria that accompanies skin mites but also reduces inflammation in the small blood vessels and structures of the skin. Severe cases are treated with higher doses of antibiotics. Once the symptoms are under control, an antibiotic ointment may be prescribed on a long-term basis.
Other treatments that may be used include:
- Isotretinoin – a Vitamin A derivative that may be recommended in cases of Rosacea that have not responded to antibiotics, or where antibiotic treatment is not well tolerated. Taken orally, Isotretinoin (Roacutane) can help to reduce the papules and pustules that occur with Rosacea. This medication must not be used by pregnant women however as it can cause birth defects.
- Topical Vitamin A Medicine – Retin A Ointment – Prescription Medication
- Stronger Vitamin A Skin Care Products - Retinol
- More mild Vitamin A – Retinyl Palmitate – Vitamin A Capsules
- Ungvita Baby Nappy Cream/Ointment (a gentle Vitamin A ointment)
- Rosehip Oil contains small amounts of both Retinyl Palmitate and Retinol – hence its popular use.
- Azelaic acid – a topical cream or lotion, often used to treat acne, which has proven effective in treating Rosacea
- Brimonidine, a relatively new medication, also helps to reduce the facial redness caused by Rosacea. Applied to the face once a day as a gel, Brimonidine works by restricting the widening (dilation) of the blood vessels in the skin
- Vascular laser treatment – (IPL) this can be effective in treating persistent telangiectasia
- Advanced Electrolysis - Red Vein treatment is also used to treat Spider Veins found on the cheeks, around nostrils and also throat and on chest.
- Other medications – Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, can help to reduce redness and discomfort of the skin. Clonidine and carvedilol, which are used to treat high blood pressure can help to reduce flushing of the skin
- Surgery – this can help to treat rhinophyma by reshaping the nose.
Usually an improvement in the condition should be noticed within three to four weeks of antibiotic treatment. A referral to a dermatologist (skin specialist) may be recommended if the disease does not respond to the antibiotic treatment.
When treatment is followed correctly, there is gradual improvement. In some cases Rosacea can recur and in others it can clear up completely. If left untreated, Rosacea will worsen and become more difficult to treat. The success of treatment depends upon how early Rosacea was diagnosed and if the full course of treatment is followed correctly.
Skin Care For mild Rosacea or recovering Rosacea to help prevent further irritation and promote healthy skin, these general steps can be taken:
- Use simple, basic skin care to cleanse, tone and moisturise skin to avoid irritation
- Gently clean your skin twice daily using a gentle, soap-free, non-abrasive cleanser
- Use pure ingredient homemade skin care to replace commercial skin care.
- Mild diluted toners (or make your own with diluted Apple Cider Vinegar)
- Use alcohol-free facial products – be careful of toners that contain alcohol.
- Witch Hazel solution is a vaso constrictor - shrinks blood vessels
- Use basic simple Moisturisers such as aqueous cream or vegetable oils Rosehip
- Avoid makeup as it may irritate and requires removal that can irritate skin
- Protect against exposure to extreme hot and cold temperatures e.g. hot baths or hot showers or cold winds or over heated rooms
- Use a non-irritating sunscreen with a sun protection factor (SPF) of 30+ to protect your skin from the sun
- Avoid smoking, alcohol, hot beverages and hot spicy food
- Reduce stress levels.
- To reduce skin redness use calming cool masks
- Try aloe vera gel, cucumber slices
- Damp flannel, cotton wool or tissue paper as a cooling mask (apply a moisturiser underneath)
- Calamine lotion or calamine mixed with aqueous cream as a mask
- Baby Nappy Rash creams could also be used – Zinc & Castor Oil
- Minimal touch and skin care can help to keep skin calm and non irritated.