Rosacea is a common skin condition which affects approximately 10% of the population. It is more common in people with fair skin and also more common in females. Symptoms present in various combinations and severity, and there are often periods of remission.
Diagnosing the condition is sometimes challenging due to the overlap in appearance with chronically sun-damaged skin, also more common in fair skinned individuals.
Rosacea can be categorized into four main subtypes:
- Mild (Erythematotelangiectatic) –Main symptoms are facial flushing and redness, which may come and go. There might also be some swelling, burning, stinging, roughness, and visible red blood vessels
- Moderate (Papulopustular) –This more problematic rosacea has persistent redness and bumps (often mistaken for acne), also causing burning and stinging
- Severe (Phymatous) –Advanced rosacea may affect the nose and this is called rhinophyma. In this situation, tissue on and around the nose thickens, giving a bumpy or enlarged appearance
- Ocular rosacea –Rosacea may affect the eyes and eyelids. As well as redness in skin tissue surrounding the eyes, there is also burning or stinging, dryness, light sensitivity, blurred vision, or watery, bloodshot eyes.
FACTS ABOUT ROSACEA
A recent study showed that patients with rosacea were more likely to be affected by other conditions including:
- Respiratory diseases
- Gastrointestinal (GI) diseases
- Metabolic diseases
- Urogenital diseases
- Female hormone imbalance
- Type 1 diabetes mellitus
- Coeliac disease
- Multiple sclerosis
- Rheumatoid arthritis
- Depression and anxiety disorders
Although it’s not known what the exact causes are, there are certain triggers that are known to worsen the condition. These triggers can vary from person to person and can include:
- Exposure to sunlight
- Changes in temperature and cold weather
- Emotional stress
- Intense physical exercise
- Spicy food
- Skin products
How to manage this condition:
- It is important for the patient to understand the chronic and relapsing nature of the disorder
- Where possible, triggers should be avoided
- A gentle skin care regimen helps maintain hydration and the barrier function of the skin
- Sun protection, including avoidance and a daily sun-cream with SPF 30 or greater
- Cover-up powders can help alongside more active treatment
- Creams and gels containing metronidazole, azelaic acid, ivermectin, and brimonidine have a strong evidence base and are approved for rosacea by the US Food and Drug Administration (FDA). They tend to be used in mild to moderate rosacea.
- Antibiotic tablets including oxytetracycline, doxycycline and erythromycin may be recommended for their anti-inflammatory effect
- In severe or persistent cases of papulopustular and early phymatous rosacea, oral isotretinoin therapy may be required
- Where eye symptoms are due to ocular rosacea, this can be treated with gentle lid-hygiene and lubricating eye drops
Visible red blood vessels can be treated using vascular lasers. Light energy is absorbed by hemoglobin and water in these vessels, this leading to vessel heating and coagulation. The most frequently used types of laser are the PDL (pulsed dye laser) and Nd:YAG
A recent study has shown excellent outcomes following a course of Nd:YAG laser for visible vessles associated with rosacea. Severe phymatous disease with deformity responds best to surgery or CO2 laser resurfacing.