Rosacea, sometimes called acne rosacea is a common rash, usually occurring on the face, which predominantly affects middle-aged and fair-skinned patients. It is more common in women but tends to be more severe in men, especially men who work outdoors. It is a chronic condition and the severity waxes and wanes over time. Rosacea affect the cheeks,forehead,chin and nose and is characterised by redness, facial flushing, visible telangiectasia( broken veins), small red spots and sometimes pustules. Some men can also develop rhinophyma (hypertrophy of the sebaceous glands of the nose and/or chin) and some patients will complain of discomfort of the eyes and eyelids.
The cause of rosacea is unknown but it does tend to run in families. Patients report worsening of symptoms with extremes of temperature, hot spicy foods, alcohol, stress and exercise. Rosacea will also be worsened by natural sunlight/light.
How is rosacea treated?
The most important part is the correct diagnosis. Some patients with rosacea already suspect they have it, because they have extremely sensitive skin and there will usually also be a family history of the condition. There is a very typical pattern visible on Dermoscopy (which your Dermatology Doctor will have access to) which will confirm rosacea along with the patients’s history. Rosacea is not curable but will eventually subside with age. However it can be very well controlled. The treatment is multi-factorial and involves the use of proper skin care, oral antibiotics and vascular lasers or IPL (intense pulsed light).
Skin are: A broad spectrum sunscreen SPF 30 or above needs to be applied every day and re-applied throughout the day as necessary.
Topical vitamin C 20% serum is a powerful anti-oxidant and should be applied underneath a sunscreen daily. This is very useful to prevent redness.
Topical vitamin B5 gel is an anti-inflammatory which will reduce the inflammatory component of acne rosacea and is applied after the vitamin C serum. It can be applied again in the evening underneath a moisturiser.
Cleansers: We usually recommend glycolic acid cleansers for long-term use in rosacea. However these sometimes can irritate the very sensitive skin of the patient with rosacea ,so your Doctor will advise appropriately and they may need to be introduced very slowly to the daily regime.
Antibiotics. Topical metronidazole will sometimes be prescribed by your Doctor. Antibiotic resistance to topical products seems to be quite common so they will not remain effective long-term. Azeleic acid can also be prescribed topically, this is not an antibiotic and can be effective but can irritate the skin initially. Sometimes an oral antibiotic will be required and in patients with pustules they are needed for a longer time. The duration of the course depends on the patients response to treatment but it is very likely that further course of antibiotics will be necessary to control the rosacea.
IP: Intense pulsed light is used in a lot of clinics for the very mild rosacea.
Lasers: A vascular laser is a much more effective treatment for redness and broken veins and would be recommended for moderate to severe rosacea. We use a pulsed dye laser. Usually a patient starts with a course of 6 sessions 2 weeks apart. This will not make the skin perfect and antibiotics plus ongoing skin protection is required, but it greatly reduces the appearance of dilated veins. Bruising can be a problem but this will be discussed beforehand and a patch test will be performed to check the response of the skin. It is not a painful procedure but paracetomol can be taken beforehand. The bruising can take a few weeks to completely settle in the larger veins and sometimes a camouflage make-up will be required.