What is rosacea?

What is rosacea?
Rosacea is a very common skin condition, especially amongst female patients aged 35-60 that have fair skin. It’s probably best described as an inflammatory skin condition, although in addition to the immune system, nerves endings, blood vessels, genetics and UV radiation all play a role. There are several subtypes of rosacea, but most patients complain of sensitive skin of the face, redness, flushing and pimple-like spots on the cheeks and nose.

What causes rosacea?
There seems to be a very complex and abnormal interplay between the immune system, nerve endings and blood vessels of the face in patients with rosacea. There is no doubt that genetics also plays a role as rosacea is often seen to run in families. Ultraviolet radiation from the sun is a key trigger for rosacea, as are some foods including spicy foods, alcohol, caffeine and hot drinks. Changes in temperature and emotional stress can also trigger rosacea. There also seems to be the role of a mite called Demodex which we all have living on our skin. For some reason, patients with rosacea tend to have higher numbers of this common mite.

Is rosacea contagious?
Rosacea is not contagious nor a skin infection. Little critters called Demodex mites play a role in some forms of rosacea but these mites are found in normal skin and do not spread from one person to another. In addition to this, the pus-filled spots that some patients develop on the face with papulopustular rosacea are completely sterile. This means that there are no bugs growing to cause the pus to form. The pus is simply due to over-activity of one part of the immune system in the skin, causing inflammation. So, no rosacea is not contagious.

What are the symptoms of rosacea?
The symptoms of rosacea vary depending on the subtype the patient has. There is a crossover of symptoms that can occur in rosacea. Most commonly, we see patients complain of flushing, pimple-like spots on the nose and cheeks and dilated visible blood vessels. Most patients also have a fixed red appearance to their face. In one subtype of rosacea, the eyes can also be affected and patients complain of a gritty sensation like they have sand stuck in their eyes. Another type of rosacea is what we call phymatous rosacea. This is where the skin, usually of the nose, can take a thickened orange peel like texture and appear enlarged. This seems to occur much more commonly in men.

How can you prevent rosacea?
Rosacea can’t really be prevented but the symptoms and signs can be managed effectively. As a rule, when it comes to caring for skin affected by rosacea, the KISS principle needs to be adopted. That is, keeping skin care regimes simple and being gentle with the day-to-day care of the skin. Using soap-free cleansers that are pH balanced is important. Hot water should be avoided and only lukewarm water should be used when washing the face. A soft towel should be used to dry the face and only done by dabbing rather than vigorously rubbing. Toners, fragrances, abrasive exfoliators, peels and such treatments should be avoided. Mineral based powder makeup should be used instead of thick concealers. Avoid creams which have botanical ingredients, as while they sound very ‘natural’ and harmless, these ingredients can often irritate the skin. Finding a broad-spectrum sunscreen which is well tolerated is essential. This needs to be applied regularly during the day if out and about.

How can I treat rosacea?
Antibiotic tablets and medicated creams can be very useful for the pimple-like spots of rosacea. There are several prescription creams on the market that help with this. Sometimes we use isotretinoin for severe cases of rosacea. The dilated blood vessels and fixed redness of rosacea may be improved by specific vascular laser treatments. These treatments need to be performed cautiously by experienced practitioners and tailored to suit the individual patient. If performed incorrectly, lasers can flare rosacea and even cause burning, blistering and scarring of the face. Laser settings must be adjusted according to the skin type, severity and type of rosacea as well as the response to previous treatments. Laser treatments can be ineffective and costly if performed incorrectly.

Flushing can be a more difficult problem to treat, but cream and tablet treatments may suit some individuals, whilst specific laser treatments may also provide some benefit for this as well. If rosacea continues to be difficult to manage despite trying general measures and seeking advice from your GP, it may be time to see a dermatologist.