Rosacea
Rosacea is a chronic skin condition that primarily affects the face, causing redness, visible blood vessels, and sometimes small, red, pus filled bumps.
Discover Rosacea
Rosacea is a common long term skin condition that predominantly affects the face and typically occurs in cycles of flare ups and remissions. Although there is no cure, rosacea can be effectively managed through clinical treatments and proper skincare. We encourage those who are experiencing rosacea or suspect they have the condition to visit one of our specialist dermatologists for a consultation to discuss your unique skin concerns and develop a personalised treatment plan.
What is rosacea?
Rosacea is a common long term skin condition that predominantly affects the face, causing redness, noticeable blood vessels and at times, pimple like blemishes. The condition can appear in both men and women, with symptoms typically beginning after the age of 30. Often, rosacea begins with episodes of flushing or blushing, evolving to more persistent redness that may spread across the cheeks, nose, forehead and chin.
What causes rosacea?
The precise causes of rosacea remain unknown. Heredity appears to play a role, as rosacea often
runs in families. The complex relationship between the immune system, nerve endings and blood vessels of the face also seems to influence an individual’s vulnerability to rosacea. Rosacea is most likely to affect women, people with fair skin (often with blonde hair and blue eyes), and people between the ages of 30 and 60.
What are common signs of rosacea?
- Extreme skin sensitivity
- Tendency to blush or flush easily
- Fixed redness on the face (typically across the nose, chin, cheeks and central forehead)
- Enlarged capillaries and visible blood vessels
- Pimples and pustules on the forehead, cheeks and chin
- Non-tender lumps under the skin
- Thickening of the skin on the nose
- Rosacea can also affect the eyes, causing irritation, dryness, and redness (ocular rosacea).
FAQs
Rosacea encompasses a wide range of signs and symptoms that often combine in recognisable ways. These combinations are used to classify rosacea into four main subtypes:
- Erythematotelangiectatic: Individuals with erythematotelangiectatic rosacea often develop visible blood vessels on the face. Intermittent flushing and fixed redness are characteristics of this subtype.
- Papulopustular: Papulopustular rosacea is characterised by pimple-like lesions. These lesions may be small bumps or filled with pus, and are often mistaken for acne.
- Phymatous: Phymatous rosacea affects men more often than women. It is associated with thickened skin and prominent pores that typically develop on the nose.
- Ocular: Ocular rosacea affects the eye area. Symptoms may include a gritty, dry sensation in the eyes. This subtype is best managed by an eye specialist.
Many patients experience characteristics of more than one type of rosacea at the same time.
- Use soap-free cleansers to wash your face and micellar water to remove makeup.
- Wear sunscreen regularly. Choose a broad-spectrum sunscreen that protects against both UVA and UVB light, ideally one
formulated with “physical blockers” (titanium dioxide and zinc oxide). - Use a light foundation that can be applied without excessive pressure or pulling on the skin.
- Choose products that contain protective silicones (dimethicone or cyclomethicone) and niacinamide, azleic acid, and hyaluronic acid (anti-inflammatory ingredients that improves skin barrier function).
- Avoid any irritants and look for product ranges that cater for sensitive, rosacea prone skin. Baby skin care formulas are generally good but baby wipes are highly irritating and should be avoided.
- Beware that during a flare up episode, a lot of products (even the most sensitive formulations) can cause a stinging, burning sensation.
- Do not exfoliate, this includes physical brushes or chemical acids.
- Conceal red areas with green-tinted makeup or sunscreen.
- Always test patch vitamin C as this can cause irritation. Never use vitamin C during a flare up.
- If desired, carefully introduce low dose retinol once the inflammatory rosacea settles, to help build up skin barrier function. Introduce this with caution and slowly, as it may cause irritation.
- When it comes to makeup, we recommend mineral makeup, essentially paraben free and talc free.
A simple, gentle skincare routine is essential for managing rosacea.
There are many potential triggers for rosacea and it may take time to identify what causes your skin to flare up. Some of the more common triggers include:
- Stress, anxiety and other strong emotions
- Sun exposure
- Alcohol, caffeine, spicy food
- Exercise
- Heat (showers, saunas, hot tubs, hot beverages etc.)
- Extreme weather conditions (wind, change in temperature)
- Active skincare products (e.g. AHA, BHA, vitamin A, vitamin C, foaming products, facial oil)
- Prescription steroid creams
- Excessive cleansing
- Face wipes
Inflammatory rosacea commonly presents as red bumps on the skin, swelling and sensitivity. Recommended treatments for this type of rosacea are:
- Topical treatments including metronidazole cream or gel, azelaic acid cream or lotion, and ivermectin or permethrin cream
- Oral antibiotics with an anti-inflammatory effect
- Low dose isotretinoin taken orally (dermatologist prescribed only)
- LED light therapy
- Laser Genesis (anti-inflammatory laser treatment)
- Microbotox (also known as neurovasculator modulators)
Usually a combination of above is required.
Erythrotelangiectatic rosacea commonly presents as a red flushed face. Before starting treatment your dermatologist will make sure there are no other causes for your red face.
Recommended treatments for this type of rosacea are:
- Vascular laser treatments
- Some prescription creams can be helpful although the effect is usually short lasting. Examples of creams include: topical brimonidine gel and oxymetazoline hydrochloride cream.
Phymatous rosacea presents as an enlarged nose due to thickened skin and prominent pores.
Recommended treatments for this type of rosacea are:
- CO2 laser resurfacing
- Antibiotics to help with early inflammation
- Isotretinoin to target early to moderate enlargement of the nose. This medication can only be prescribed by your dermatologist.
Facial flushing can be due to other underlying medical problems. Any underlying issues need to be excluded or addressed before treatment for flushing can begin.
Recommended treatments are:
- Anti-flushing medications such as clonidine and propranolol
- Vascular laser treatments
- Micro neurovascular-modulator injections
Often, multiple features of rosacea coexist. We need to treat the different components of rosacea through different modalities.
Vascular lasers are a great alternative to anti-aging skincare. Vascular lasers treat redness and stimulate dermal (skin) collagen production. Research has shown that vascular lasers have a far greater effect than topical anti-aging ingredients.
Biostimulator injections are also a great option. They stimulate collagen production without generating heat and prevent any treatment related rosacea flare ups.
In the event your rosacea does not respond to the recommendations of your doctor, your treatment plan needs to be reassessed.
Some factors to consider:
- Is there an unidentified trigger that is causing your rosacea to flare up?
- Has the appropriate treatment been chosen based on your subtype of rosacea? Different types of rosacea require different treatments and approaches.
- Is the diagnosis correct? Many other skin conditions can mimic or coexist with rosacea. These can include: eczema, seborrheic dermatitis, periorificial dermatitis, allergic contact dermatitis, keratosis rubra faceii and photosensitive conditions such as lupus. A skin biopsy may be required to identify or confirm the condition and ensure the correct treatment is being implemented. You may also be referred to a dermatologist.