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What is rosacea?

While many people may find their skin gets sensitive and red at times, for people with rosacea these symptoms are more serious and permanent. We spoke to the consultant dermatologist Dr Anjali Mahto from the Cadogan Clinic to find out more about the condition and how to get the treatment you need.

What is rosacea?

“Rosacea is a skin condition that most commonly affects individuals aged 30 to 60. It is generally commoner in females and individuals with fair skin, blue eyes or Celtic origin. It often presents as facial redness, which is usually intermittent at first, but over time can become fixed.”

What are the main symptoms?

“Symptoms of rosacea include facial skin sensitivity, redness, flushing, a sensation of heat and small red bumps known as papules. Some people may develop prominent small dilated blood vessels known as telangiectasia. Other potential problems include facial swelling, gritty eyes, and enlargement and redness of the nose (rhinophyma).”

How common is rosacea?

“Rosacea is quite a common condition, with the NHS estimating approximately one in every 600 people are diagnosed with rosacea each year in the UK.”

What causes it?

“One of the main difficulties when facing rosacea is that the exact cause of it is unknown. It seems to develop due to a complex interplay between genetic, environmental, inflammatory and vascular factors.

“Triggers that make it worse are well documented. These include alcohol, too much exercise, change in temperature, hot drinks, spicy foods, stress and sunlight. Prolonged and repetitive exposure to pollution can also be an aggressor. Air pollutants, volatile organic compounds (VOC), oxides, ozone and cigarette smoke harm the skin’s natural barrier and expose it to irritants.”

Do mental factors have a role to play?

“The exact way in which emotional stress exacerbates rosacea is not understood, however we do know that it can worsen symptoms. Emotional stress can lead to an increase in inflammatory mediators and greater circulation to the face, causing redness and flushing. Prolonged emotional stress can worsen many common skin conditions such as acne, eczema and psoriasis too.”

What tend to be the first signs of the condition?

“The progression of rosacea can vary from one individual to another, however it often begins with episodes of flushing (where the skin turns red for a short period). This is usually intermittent at first, but over time it can become fixed. The other symptoms then can develop as the condition progresses.”

How can someone tell the difference between normal flushing and the condition?

“Although many people without rosacea experience evanescent flushing in response to embarrassment, exercise, hot environments, a glass of wine or other triggers, this type of blushing is often short and transient whereas flushing in the case of rosacea is persistent. A rosacea sufferer may also experience burning and stinging sensations.”

Can it be cured?

“There is no cure for rosacea but the condition can be managed with creams, oral antibiotics, anti-flushing medications and laser therapy.”

What sort of products should I use?

“A dermatologist will be able to prescribe anti-inflammatory creams that will calm redness, but in terms of products available on the market, look for washes, cleansers and moisturisers designed specifically for sensitive skin, as we know that individuals with rosacea tend to have extremely sensitive skin.

“The products you use should ideally by fragrance-free. Avoid harsh exfoliators, toners and astringents, and other known triggers. Certain ingredients in skincare, like alcohol, retinoids, witch hazel, menthol, fragrance and eucalyptus oil, can aggravate rosacea, as can acne treatments and retinoid products, so always test a patch on your skin before applying products to your face.

“Bioderma Sensibio and La Roche-Posay Rosaliac are both excellent options for covering up redness. Vichy’s Dermablend range provides good cosmetic camouflage to the areas and is suitable for sensitive skin types.”

Can I wear make-up?

“Before camouflaging rosacea with make-up, make sure you have cleansed and moisturised. You could also apply a redness-reducing treatment to help the skin cool off. You should also look for multi-tasking products to reduce the amount of different ingredients you’re applying, helping to avoid irritation. A fragrance-free, green-hued primer with mineral SPF will balance redness as well as protecting from the sun. Avoid too much rubbing when you apply your base and try not to use rich, heavy formulas, as these can aggravate the dry patches so often associated with rosacea. Layer on light, mineral coverage and very lightly brush on or press in foundation to create both a flattering finish and reduce the risk of further irritation.”

Are there any activities you should avoid?

“Steam-rooms and saunas should be avoided, as they heat up the skin, resulting in a flare up. Rosacea sufferers often have sensitive skin, so chemical peels may cause irritation as they exfoliate the skin.”

What about sun protection?

“It’s extremely important to use sunscreen daily to help manage your rosacea as UV radiation is one of the common triggers, meaning sunlight can cause flare-ups. Ideally an SPF of 50 should be worn that provides broad-spectrum, UVA and UVB protection. Special attention should be paid to the type of sunscreen you use too. Sunscreens containing physical blockers such as zinc and titanium dioxide are less likely to exacerbate rosacea-prone skin than chemical blockers such as avobenzones and benzophenones.”

What are the benefits/drawbacks of…

…treatment creams?

“To deal with associated spots, topical creams such as metronidazole cream, azelaic acid cream and ivermectin cream may be useful. You’ll usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth.

“It may be several weeks before you notice any significant improvement in your symptoms. Side effects of these treatments can include a burning or stinging sensation, itchiness and dry skin.”

…oral antibiotics?

“If your symptoms are more severe, an oral, antibiotic medication may be recommended to help reduce inflammation of the skin. Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These medications are usually taken for four to six weeks, but longer courses may be necessary if the spots are persistent. For example, a low-dose doxycycline capsule is available if oral antibiotics need to be taken long term.

“Common side effects of these medications include: vomiting, diarrhoea, bloating and indigestionabdominal pain and loss of appetite. These medications can also make your skin sensitive to artificial light and UV rays. As with the topical treatments, these medications usually need to be taken once or twice a day and you may not notice a significant improvement in your symptoms for several weeks.”

…laser therapy?

“Flushing, redness and visible blood vessels can also sometimes be improved with vascular laser or intense pulsed light (IPL) treatment. Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated veins and causes them to shrink so they’re no longer visible, with minimal scarring or damage to the surrounding area.

“Around two to four treatments may be needed, so the overall cost may be significant. Laser treatment can cause some pain, but most people don’t need an anaesthetic. Side effects of laser treatment are usually mild and can include bruising, crusting of the skin, swelling and redness, and in very rare cases, blisters and infection. These side effects usually only last a few days and are rarely permanent.”

When should you book in to see a dermatologist?

“If you suspect you may have rosacea, you should see a dermatologist as soon as possible for diagnosis and appropriate medical care before their condition grows increasingly severe.”