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.