Rosacea is a common inflammatory skin condition, often recognised by the flushed or reddened ‘butterfly’ pattern it creates across the middle of the face.
Other common symptoms include broken capillaries and inflamed acne like lesions
It generally affects people with a lighter skin tone, but can appear in any skin type. Most sufferers are women aged 30-50, although young adults who have previously had acne (A.Vulgaris) are also susceptible. Men, although less likely to be affected, often experience the condition more severely.
Rosacea is a chronic condition that tends to fluctuate in severity from mild to severe, and mostly affects the cheeks, forehead, chin, and nose. Very occasionally it may also affect the neck and chest.
What are the signs and symptoms of rosacea?
The main characteristic symptom is patches of redness on the skin, often in the central zone of the face.
Initially it can appear to be periods of blushing, but over time these patches of redness can become more persistent or even permanent.
Other symptoms include:
- visible capillaries
- small red bumps (papules)
- pus-filled spots (pustules) similar to acne.
- itching and burning of the skin
- dry skin
- redness and irritation of the surface of the eyes and eyelids
- swelling of the facial skin – often around the eyes
- thickening of the facial skin, principally on the nose, but also the forehead, chin, ears and eyelids can be affected.
What causes Rosacea?
The characteristic redness of rosacea is caused by dilated blood vessels. However the root cause is not fully understood, and like other chronic skin conditions it is likely the result of a number of interacting factors.
Potential causal factors:
Genetics
Rosacea does seem to be a familial condition, but a clear genetic path has not yet been identified.
Neurovascular factors
The body’s nerve and blood circulation system are linked and research has discovered that sensory nerves around blood vessels linked to sensations of stinging increase during the development of rosacea. Also the communication between nerve cells which is thought to control inflammation and flushing is disrupted in rosacea skin.
Blood vessel changes
Exposure to sunlight causes the production of a growth factor that has been linked to the development of visible blood vessels. As rosacea is more evident in lighter skin tones whose pigmentation offers less protection against UV radiation penetration, it is suggested that this may be a factor in the development of this characteristic of the condition.
Immune system factors
One of the first reactions caused by the activation of the immune system is inflammation and recent research has revealed significant differences in certain components of the immune systems of rosacea sufferers, specifically :
- a higher than average numbers of mast cells (these are responsible for histamine production).
- irregularities in important protective microbiological components known as cathelicidins which are known to switch on the immune system. There is also evidence that the release of these biochemicals is prompted by factors also known to trigger rosacea.
Factors known to trigger Rosacea.
Whilst the exact cause of rosacea is still unclear, a wide variety of factors have repeatedly been shown to trigger a flare-up
- Sun or UV Exposure
- Hot and/or Cold Weather
- Hot and/or Cold Water
- Wind
- Stress
- Histamine-Rich foods e.g. cheese, processed meat and some fermented foods
- Tomatoes and citrus fruits
- Chocolate
- Spicy food
- Alcohol
- Aerobic Exercise (cardio)
- Medication
Triggers can and do vary greatly between individual people and so need to be identified in each case in order that they can be avoided.
Types of Rosacea
Despite the common name of ‘rosacea’ and the characteristic diffuse redness on the skin of people with the condition, rosacea is actually a group of four different sub-types which may overlap.
Type 1 – ERYTHEMATOTELANGIECTATIC ROSACEA
Characterised by flushing in the central portion of the face, often with a burning, stinging or itching sensation. The skin texture can also feel rough and dry, despite the overall tendency towards oiliness.
Type 2 – PAPULOPUSTULAR ROSACEA
Characterised by flushing in the central portion of the face, but with the addition of acne-like papules and pustules. There may also be burning and stinging sensations.
The presence of these acne-like blemishes meant that previously the condition was often incorrectly diagnosed as a type of acne, and led to it being labelled as ‘Acne Rosacea’.
Type 3 – PHYMATOUS ROSACEA
Characterised by a thickening of the skin so that the skin surface appears bumpy and irregular. The commonest manifestation of this subtype occurs in males, where the nose becomes red and bulbous. It generally takes many years to develop and so it is often dismissed as being the result of long-term alcohol consumption.
Type 4 – OCULAR ROSACEA
Characterised by redness and irritation of the eyes and eyelids. Unlike the other subtypes, the diffused redness of the centre of the face may not appear until problems with the eyes are already established.
Treating Rosacea
The first step:
An initial in-depth consultation and skin health assessment is important to determine potential triggers and design a treatment and management plan suitable for your unique circumstances.
In clinic treatments
The actual treatment options will depend and may vary according to the type of rosacea you have.
Peels – often metabolic rather than generic chemical peels as these contain supportive antioxidant ingredients (primarily Vitamins A&C) that support the skin whilst initiating the skin’s natural healing response.
LED therapy – either blue or red light, or possibly a combination depending on your unique skin requirements. Blue light provides an antibacterial effect, whilst red light has a healing and cellular renewal effect.
Microneedling – can be extremely effective at strengthening the skin by increasing collagen production. It also helps by strengthening the blood vessels, reducing the excessive dilation that produces the flushing effect.
Please note it can often be beneficial to combine treatment therapies and bespoke packages attract significant discounts and savings.
Homecare – a suitable homecare regime will be devised for you to follow in between treatments to support the in-clinic therapies. This will be discussed during your initial investigative consultation.
Can antibiotics help?
The use of antibiotics stems from theories that bacteria in the gut or on the skin can cause rosacea. They can prove useful as they have an anti-inflammatory effect. However, given that a universally accepted cause for the condition has yet to be found, their effects are likely to be limited and transient. Moreover, the increased widespread use of antibiotics is fuelling resistance and so is not generally recommended.
It is important to point out that rosacea is not contagious.
Rosacea also falls under the category of sensitive skin and so treatment and management of the condition is similar to that of highly reactive skin (see here)
