Rosacea: Symptoms and Treatment

Is your skin redness caused by rosacea? While rosacea can affect everyone, those with lighter skin may be more prone to it.

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If you suffer from rosacea, try to avoid exposure to sunlight, alcoholic drinks and spicy foods as these could worsen your condition.

Symptoms of Rosacea 

Rosacea is a chronic disorder that primarily affects facial skin. It typically begins after the age of 30, with initial symptoms such as redness on the cheeks, nose, chin or forehead that may come and go. Occasionally, rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness tends to become more persistent, accompanied by swelling, tiny blood vessels becoming visible, and small bumps. In some patients, the eyes are also affected and may be watery or bloodshot.

Rosacea is characterised by flare-ups and remissions. In long-standing and severe cases, the nose may grow swollen and lumpy from excessive tissue (rhinophyma).

Although rosacea can affect everyone, lighter-skinned individuals who flush or blush easily are believed to be more susceptible. The disease is more frequently diagnosed in women, but more severe symptoms tend to be seen in men.

The exact cause of rosacea is unclear. There is no permanent cure for rosacea, but medical therapy is available to control or reverse its signs and symptoms.

Signs of rosacea include:
• Facial flushing
• Persistent facial redness
• Bumps and pimples
• Visible blood vessels
• Eye irritation
• Burning or stinging
• Raised red patches (plaques)
• Skin thickening
• Facial swelling

There are four types of rosacea, and patients may experience characteristics of more than one type at the same time:
• Erythematotelangiectatic rosacea, characterised by flushing and persistent redness, with multiple visible tiny blood vessels
• Papulopustular rosacea, characterised by persistent redness with transient bumps and pimples
• Phymatous rosacea, characterised by skin thickening, often resulting in an enlargement of the nose from excessive tissue
• Ocular rosacea, characterised by dry eyes, tearing and burning, swollen eyelids, and potential vision loss from corneal damage. Referral to the ophthalmologist may be required for severe cases

What can Trigger or Worsen Rosacea?

Exposure to sunlight, alcoholic drinks, spicy foods and hot drinks such as coffee and tea can cause flushing and trigger rosacea. Other triggers include exercise, vasodilators (drugs that dilate blood vessels), stress, anxiety and extreme temperatures. The use of topical steroids on the face can worsen the condition. 

Demodex mites, tiny mites that live on the face, are thought by some experts to be a contributory factor. Strong facial washes, fragrances, acetone or alcohol-containing hair sprays and cosmetics can also irritate the skin.

How is Rosacea Treated?

Various oral and topical medications may be prescribed to treat the bumps and redness often associated with the disorder.

1. Avoidance of Rosacea Triggers
Sun exposure is one of the most common triggers of a rosacea flare-up. People with rosacea are advised to avoid direct sun exposure, wear broad-brimmed hats and use umbrellas, as well as to apply sunscreen. Sunscreen should have a high SPF (sun protective factor) of 30 and above. Alcoholic beverages and application of topical steroid creams should also be avoided.

2. Topical Therapies
Topical antibiotics (for example, metronidazole gel 0.75%, clindamycin gel 1% and erythromycin 2% or 4% gel or lotion) may be useful in controlling symptoms and maintaining remission.

3. Oral Antibiotics
In more severe cases, a course of oral antibiotics (usually doxycycline or erythromycin) may be prescribed to control symptoms. These oral antibiotics may exert an anti-inflammatory effect and are usually taken for several months. However, repeated courses may be necessary for patients with frequent recurrences.

4. Isotretinoin
For patients who are unresponsive to oral antibiotics, oral isotretinoin may be prescribed with good result. Adverse effects of isotretinoin include dry lips and skin, muscle aches, hair loss, abnormal liver function tests and raised lipids, muscle inflammation and depression. Female patients should not become pregnant while on therapy as it can affect the developing foetus.

5. Laser and Light Therapies
The pulsed dye laser and the intense pulse light (IPL) machine can be useful in reducing persistent redness and treating the prominent blood vessels of rosacea. For patients with an enlarged swollen nose (rhinophyma), the carbon dioxide laser can be used to reduce the thickness of the skin.

How Can I Take Care of My Skin?

A gentle skincare routine can be useful. Patients are advised to clean their face with a mild and non-abrasive cleanser, then rinse with lukewarm water and blot the face dry with a cotton towel. Never pull, tug or use a rough washcloth.

Certain cosmetics can help conceal the effects of rosacea, such as green make-up or green-tinted foundations which can counter redness. This can be followed by a skin-tone foundation with natural yellow tones, instead of those with pink or orange hues.

Read these next:
Isotretinoin
Inflammatory Skin Conditions


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