Rosacea is a  skin condition in which sufferers experience facial redness, small dilated blood vessels, red papules (bumps), pustules (pimples), and/or swelling.

It normally begins with redness on the central area of the face, across the cheeks, nose and forehead, but can also sometimes affect the neck, chest, ears, and scalp. Some more aggravated sufferers experience dilation of superficial blood vessels on the face, red bumps, pimples, red gritty eyes, burning and stinging sensations, and in worst cases, a red lobulated nose may develop.

Rosacea affects all ages and has four subtypes, three affecting the skin and the fourth known as ocular rosacea, which affects the eyes. It is normally seen in paler people and has been nicknamed the “curse of the Celts”. Rosacea is almost three times more common in women than it is in men but can affect all generations.

It can often be mistaken for rosy cheeks, sunburn or even acne. It is often referred to as “adult acne”; however it is different to acne in that there are no blackheads. It can be triggered by alcohol, hot or spicy food, stress and heat and if left untreated, can worsen with time.

Although rosacea cannot be cured there are a number of treatments that can help control the symptoms. As the signs and symptoms of rosacea vary from one patient to another, treatment must be tailored for each individual case. Some patients are more troubled by redness and flushing, whilst others have bumps and pimples, thickening of the skin, or suffer from rosacea in the eye.

Most patients with bumps and pimples are prescribed oral and topical rosacea products, together with a topical therapy to reduce facial redness. The topical applications come in the form of gels or creams, such as brimonidine, ivermectin and isotretinoin, which are normally applied at night time to clean, dry skin.

Brimonidine is an alpha2-adrenoceptor agonist and is used to reduce the redness associated with rosacea by constricting the blood vessels. It works well in reducing the redness but can cause a burning sensation upon application and can sometimes leave the skin blotchy.

If the rosacea has bumps or pimples present these can respond well to azelaic acid, topical ivermectin and/or to topical metronidazole, which are normally applied twice a day.

If topical products are not effective in clearing the rosacea on their own or there are significant bumps or pimples present then oral antibiotics may be prescribed as the next line of treatment. It is unknown exactly why antibiotics work against rosacea, but it is widely believed that it is due to their anti-inflammatory properties, rather than their bacteria-fighting capabilities.

Practitioners normally prescribe oxytetracycline, tetracycline or erythromycin. Courses normally last for 6-12 weeks and can be repeated intermittently.

Doxycline can be used if oxytetracycline or tetracycline is inappropriate, for example in cases of renal impairment. There is also a modified release preparation of doxycycline which can be used in low daily doses for the treatment of facial rosacea.

Isotretinoin is occasionally given in refractory cases.

Ocular rosacea can be treated using warm compresses, artificial tears and washing the area around the eye with warm water but again doxycycline may be prescribed for more aggressive breakouts.

When appropriate, laser treatment or other surgical procedures may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose.

In addition, rosacea patients are advised to identify and avoid lifestyle and environmental factors that may aggravate their individual conditions. It is always advisable to recommend that sufferers cut down on alcohol, spicy foods and caffeine. Patients may also benefit from gentle and appropriate skincare, and cosmetics may be used to reduce the effect of rosacea on appearance.

Oonagh O Hagan

About Oonagh O Hagan

Oonagh O’Hagan is the owner and managing director of the Meagher’s Pharmacy Group in Dublin, which she has grown from one pharmacy to a chain of eight progressive pharmacies plus a thriving online store The group now employs over 100 people. Oonagh is highly regarded within the wider pharmacy marketplace. She is the acting Chair of the Preliminary Proceedings Committee in the Pharmaceutical Society of Ireland, which is the pharmacy regulator in Ireland. She also sits on the Wholesale Advisory Board of United Drug Group, the largest pharmaceutical wholesaler here in Ireland. Oonagh also contributes to the advancement of Ireland’s top third level colleges. She is a member of the Finance Committee at the Royal College of Surgeons in Ireland and she also sits on Strategic Advisory Board for the School of Pharmacy and Pharmaceutical Sciences in Trinity College Dublin, where she helps to shape the schools future plans and strategic direction. Oonagh is keen to promote other female business owners and as such has taken up a lead role for the past two years in the Going For Growth programme, supporting a group of selected female entrepreneurs to achieve their goals and grow their businesses. In November last year, Oonagh was honoured when she was named Image Magazine’s Entrepreneur of the Year for 2016.


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