What is rosacea?

Rosacea (from the Latin for “rose-coloured”) is a common, inflammatory skin condition. It is unfortunately under-recognised and often inappropriately treated or dismissed as a cosmetic concern rather than a recognised dermatological issue. It tends to affect women, usually with fair skin or of Celtic descent, between the ages of 30 and 60 years of age. Common features affecting facial skin include redness, flushing or blushing, sensitive skin, spots or pustules which look similar to acne, and thread veins. Occasionally there can be a thickening of the tissue of the nose known as rhinophyma. A number of people with rosacea may also suffer with eye symptoms such as dryness or grittiness.

What are the main causes of rosacea?

We do not understand the exact pathophysiology of rosacea but the process is due to underlying inflammation in the skin and hyper-reactivity of facial blood vessels due to a number of triggers. Personal genetics, factors involving the immune system, and environment are all implicated. Common triggers include sun exposure, stress, alcohol, spicy foods, temperature changes, exercise and certain skincare ingredients such as fragrances, witch hazel, menthol, peppermint and eucalyptus oil.

What are the early signs of rosacea? And what are the general symptoms?

Redness, flushing, sensitive skin, acne-type spots and prominent blood vessels or thread veins can all be associated with rosacea. The key thing to recognise is that not everyone with rosacea will have every single one of the features mentioned above. Equally, not everyone who has a particular symptom or sign will be suffering to the same degree; there is a spectrum. When making a treatment plan, it is important that the treating dermatologist takes this into account and tailors a plan to the individual sitting in front of them. For example, facial redness is managed very differently from acne-type spots.

How do you clear up rosacea?

Rosacea is often managed badly as it seems to fall between the medical and cosmetic world. Managing rosacea is a tricky process as the condition is chronic (i.e. it can be controlled but not cured). Coming up with a treatment plan involves a combination of lifestyle factors including skincare, medical creams and prescription tablets, light and laser therapies, camouflage techniques (if the patient desires), as well as input from a clinical psychologist where possible. The end goal is to put the patient in control of their skin and not let their skin problems control them.

General tips:

  1. Wear a broad-spectrum sunscreen (ideally SPF 50) every day – over 80% of those who suffer with rosacea will find their facial redness is driven by UV light. Opt for a mineral sunscreen over a chemical one as this is less likely to cause sensitivity and irritation.
  2. Use skincare that is fragrance-free and minimalistic. Complex multi-step routines, acids, exfoliators, menthol and witch hazel can all be common triggers so are best avoided. I recommend the La Roche-Posay Toleriane range or Avène antirougeurs cleanser and skin recovery cream (no conflict of interest).
  3. Green tinted primers can be worn under make-up to camouflage or neutralise redness – again, not being paid to say this, but I like the Vichy and Smashbox ones.
  4. Minimise known triggers where possible. Some people find that alcohol or spicy foods can be problematic; they should limit these.
  5. See an appropriately-trained medical professional. A consultant dermatologist will have extensive experience in managing the condition and those of us that do laser treatments will be able to put together the right plan in the right order to be able to advise you how to manage the condition both short and long term.

Personally, I also recommend that nearly all of my rosacea patients receive input from a clinical psychologist if possible. Living with a visible skin condition can be extremely difficult, especially one that has a habit of flaring up at the most inconvenient of times or can be triggered by stress. Managing any long-term skin condition requires a team effort between the patient, doctor, and ideally a mental health expert to realistically get a good outcome. As always, the impact that one’s skin can have on their self-esteem and body image should never be trivialised or ignored.

Are there different types of rosacea?

In the past, rosacea has been divided into subtypes on largely descriptive factors:

  • Erythematotelangiectatic: redness, flushing, and prominent blood vessels
  • Papulopustular: acne type with presence of spots or pustules
  • Rhinophyma: thickening of skin of nose
  • Ocular: rosacea associated with the eyes