Rosacea

Rosacea

What is Rosacea?

Rosacea types

Rosacea symptoms

Rosacea causes

Rosacea dos and don’ts

Rosacea diagnosis

Rosacea treatment

 

What is Rosacea?

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

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Rosacea types

The four types of rosacea are:

  • Subtype one, known as erythematotelangiectatic rosacea (ETR), is associated with facial redness, flushing, and visible blood vessels.
  • Subtype two, papulopustular (or acne) rosacea, is associated with acne-like breakouts, and often affects middle-aged women.
  • Subtype three, known as rhinophyma, is a rare form associated with thickening of the skin on your nose. It usually affects men and is often accompanied by another subtype of rosacea.
  • Subtype fouris known as ocular rosacea, and its symptoms are centered on the eye area.

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Rosacea symptoms

Rosacea symptoms are different between each subtype.

Signs of rosacea ETR:

  • flushing and redness in the center of your face
  • visible broken blood vessels
  • swollen skin
  • sensitive skin
  • stinging and burning skin
  • dry, rough, and scaly skin

Signs of acne rosacea:

  • acne-like breakouts and very red skin
  • oily skin
  • sensitive skin
  • broken blood vessels that are visible
  • raised patches of skin

Signs of thickening skin:

  • bumpy skin texture
  • thick skin on nose
  • thick skin on chin, forehead, cheeks, and ears
  • large pores
  • visible broken blood vessels

Signs of ocular rosacea:

  • bloodshot and watery eyes
  • eyes that feel gritty
  • burning or stinging sensation in the eyes
  • dry, itchy eyes
  • eyes that are sensitive to light
  • cysts on eyes
  • diminished vision
  • broken blood vessels on eyelids

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Rosacea causes

Doctors don't know exactly what causes rosacea. A few things that may play a role are:

  • Your genes. Rosacea often runs in families.
  • Blood vessel trouble. The redness on your skin might be due to problems with blood vessels in your face. Sun damage could cause them to get wider, which makes it easier for other people to see them.
  • They're tiny insects. A type called Demodex folliculorum normally lives on your skin and usually isn't harmful. Some people, though, have a heightened sensitivity to the mites, or more of these bugs than usual. Too many mites could irritate your skin.
  • A type called H. pylori normally lives in your gut. Some studies suggest this germ can raise the amount of a digestive hormone called gastrin, which might cause your skin to look flushed.

Some things about you may make you more likely to get rosacea. For instance, your chances of getting the skin condition go up if you:

  • Have light skin, blonde hair, and blue eyes
  • Are between ages 30 and 50
  • Are a woman
  • Have family members with rosacea
  • Had severe acne
  • Smoke

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Rosacea dos and don’ts

Rosacea is not caused by poor hygiene and it's not contagious. But there are things you can try to help with symptoms.

If you know that a trigger, for example alcohol or spicy food, makes symptoms worse, try to avoid it as much as possible.

Do

  • wear a high SPF sunscreen of at least SPF 30 every day
  • try to avoid heat, sunlight or humid conditions if possible
  • try to cover your face in cold weather
  • use gentle skincare products for sensitive skin
  • clean your eyelids at least once a day if you have blepharitis
  • take steps to manage stress

Don’t

  • do not drink alcohol
  • do not have hot drinks
  • do not have too much caffeine (found in tea, coffee and chocolate)
  • do not eat cheese
  • do not eat spicy food
  • do not do too much aerobic exercise, like running

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Rosacea diagnosis

No specific test is used to diagnosis rosacea. Instead, your doctor relies on the history of your symptoms and an examination of your skin. You may have tests to rule out other conditions, such as psoriasis, eczema or lupus. These conditions can sometimes cause signs and symptoms similar to those of rosacea.

If your symptoms involve your eyes, your doctor may refer you to an eye specialist (ophthalmologist) for evaluation.

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 Rosacea treatment

  • General measures
  • Where possible, reduce factors causing facial flushing.
  • Avoid oil-based facial creams. Use water-based make-up.
  • Never apply a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased production of nitric oxide).
  • Protect yourself from the sun. Use light oil-free facial sunscreens.
  • Keep your face cool to reduce flushing: minimize your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms.
  • Some people find they can reduce facial redness for short periods by holding an ice block in their mouth, between the gum and cheek
  • Oral antibiotics for rosacea

Tetracycline antibiotics including doxycycline and minocycline are commonly used to treat rosacea

  • They reduce the redness, papules, pustules and eye symptoms.
  • The antibiotics are usually prescribed for 6–12 weeks, with the duration and dose depending on the severity of the rosacea.
  • Further courses are often needed from time to time, as antibiotics don't cure the disorder.

Sometimes other oral antibiotics such as cotrimoxazole or metronidazole are prescribed for resistant cases.

Anti-inflammatory effects of antibiotics are under investigation.

  • They have been shown to inhibit MMP function and in turn reduce cathelicidins and inflammation.
  • The effective dose of tetracyclines in rosacea is lower than that required to kill bacteria, so they are not working through their antimicrobial function.

Disadvantages of long-term antibiotics include development of bacterial resistance, so low doses that do not have antimicrobial effects are preferable (e.g., 40–50 mg doxycycline daily).

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Topical treatment of rosacea

  • Metronidazole cream or gel can be used intermittently or long-term on its own for mild inflammatory rosacea and in combination with oral antibiotics for more severe cases.
  • Azelaic acid cream or lotion is also effective for mild inflammatory rosacea, applied twice daily to affected areas.
  • Brimonidine gel, an alpha-2 adrenergic agonist, and oxymetazoline hydrochloride cream, an alpha1A adrenoceptor agonist, reduce facial redness temporarily.
  • Ivermectin cream can be used in the treatment of papulopustular rosacea. It controls demodex mites and is anti-inflammatory.
  • Isotretinoin

When antibiotics are ineffective or poorly tolerated, oral isotretinoin may be very effective. Although isotretinoin is often curative for acne, it may be needed in low dose long-term for rosacea, sometimes for years. It has important side effects and is not suitable for everyone.

  • Medications to reduce flushing

Nutraceuticals targeting flushing, facial redness and inflammation may be beneficial.

Certain medications such as clonidine (an alpha2-receptor agonist) and carvedilol (a non-selective beta-blockers with some alpha-blocking activity) may reduce the vascular dilatation (widening of blood vessels) that results in flushing. They are generally well tolerated. Side effects may include low blood pressure, gastrointestinal symptoms, dry eyes, blurred vision and low heart rate.

  • Anti-inflammatory agents used for rosacea

Oral non-steroidal anti-inflammatory agents such as diclofenac may reduce the discomfort and redness of affected skin. Although these are uncommon, serious potential adverse effects to these agents include peptic ulceration, renal toxicity and hypersensitivity reactions.

Calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream are reported to help some patients with rosacea.

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  • Vascular laser

Persistent telangiectasia can be successfully improved with vascular laser or intense pulsed light treatment. Where these are unavailable, cautery, diathermy (electrosurgery) or sclerotherapy (strong saline injections) may be helpful. Papulopustular rosacea may also improve with laser treatment or radiofrequency.

  • Surgery for rhinophyma

Rhinophyma can be treated successfully by a dermatologic or plastic surgeon by reshaping the nose surgically or with carbon dioxide laser.

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