All about Rosacea

Rosacea is a red, acne-like benign skin condition which is more common among fair skin types and Caucasians. Typical symptoms of rosacea include red or pink patches and visible tiny broken blood vessels. In more severe conditions, symptoms such as small red bumps containing pus, red cysts, and pink or irritated eyes also occur.
Rosacea commonly affects the central third of the face, especially the nose and cheeks. People suffering from rosacea experience facial flushing, blushing and burning. These symptoms tend to have periodic ups and downs (flares and remissions). When rosacea first develops, it may appear, then disappear, and reappear again. The skin may clear for weeks, months, or years and then erupt again. However, the skin may fail to return to its normal colour and the enlarged blood vessels are rarely reverse itself.
Although rosacea is a chronic (long-term) condition, it is not considered contagious or infectious. There is no evidence that rosacea can be spread by contact with the skin, sharing towels, or through inhalation.

The Causes and Risk Factors of Rosacea

The exact cause of rosacea is still unknown and remains a mystery. The basic process seems to involve dilation of the small blood vessels of the face. Suspected causes of rosacea include but are not limited to genetic factors, genetics plus sun exposure, gastrointestinal disease, and medications that cause blood vessels to widen. Rosacea tends to affect the “blush” areas of the face and is more common in people who flush easily.

Additionally, a variety of triggers are known to cause rosacea to flare:

Emotional Factors
such as stress, fear, anxiety, and embarrassment may trigger blushing and aggravate rosacea.

Weather
A flare-up can be caused by changes in the weather such as extreme cold or heat. According to Dr Litt, rosacea sufferers need to manage their activities carefully to avoid flare-ups, especially during the winter season as there are both high indoor heat and outdoor cold temperature (1).
Sun exposure: sun-damaged skin is generally associated with rosacea as sun exposure cause redness and blood vessel dilation as well as heat up the skin and body overall. Thus, it increases rosacea symptoms in the skin.

Lifestyle
This includes exercise, alcohol consumption, and diet. Research shows that spicy food may aggravate rosacea. Many patients may also notice flares around the holidays, particularly Christmas and New Year’s holidays as they drink more alcohol around that time.

Rosacea risk factors include fair skin, English, Irish or Scottish heredity, easy blushing, and having other family members with rosacea (called “positive family history”). Additional risk factors include female gender, menopause, and being 30-50 years of age.

Treatment for Rosacea

Rosacea is currently considered an incurable auto-inflammatory skin condition. While it cannot be cured, it can usually be controlled with proper, regular treatments. Treatment for rosacea focuses on controlling signs and symptoms. Most often this requires a combination of skin care and prescription treatments. The duration of treatment depends on the type and severity of the symptoms and recurrence is common.

These are some forms of rosacea treatment that may be significantly improved the condition for long periods of time using laser, intense pulse light (IPL), photodynamic therapy, or isotretinoin (accutane). Although these are still not considered a “cure,” some patients experience long-lasting results.

Topical Antibiotics
Topical antibiotics, such as metronidazole or azelaic acid, are effective for improving many cases of rosacea. After washing the face, medication is applied once or twice daily as directed by the doctor. Topical antibiotics can take several weeks to show marked improvement. Possible side effects will be discussed by the doctor or the pharmacist.

Oral Antibiotics for Moderate Rosacea
For patients with moderate rosacea or those who do not respond well to topical antibiotics alone, an oral antibiotic may be prescribed which may be an amoxicillin or tetracycline. Oral antibiotics mainly fight inflammation when used for rosacea.

Gentle Face Cleansers
Cleansers for rosacea can include a gentle, non-medicated cleanser or one that contains benzoyl peroxide or coffee cherry. Gentle cleansers will clear rosacea skin of dirt and oil without causing irritation or drying.

Laser/ IPL
Laser and intense pulse light treatments are effective treatments to reduce the continual redness and noticeable blood vessels on the face, neck, and chest. It also induces more collagen production which strengthens the vessels. Often considered a safe alternative, laser/IPL may help to visibly improve the skin and complexion. Multiple treatments are necessary to maintain the result. Treatments are recommended in three- to six-week intervals; during this time, sun avoidance is a must.

Glycolic peels
Glycolic-acid peels may additionally help improve and control rosacea in some people. The chemical peels can professionally be applied for approximately two to five minutes every two to four weeks. Mild stinging, itching or burning may occur and some patients experience peeling for several days after the peel. Any peel can irritate very sensitive skin and cause flares for some people. Peels should be used with caution in rosacea, as not everyone is able to tolerate these treatments.

Sun protection
Sun exposure is a well-known flare for many rosacea sufferers. Sunscreen protects the skin from UV rays which damage the skin over time. The use of an appropriate daily sunscreen lotion and overall sun avoidance is recommended. Zinc-based sunscreens provide superior sun protection compare to other types of sunscreens.

Change of lifestyle
Smoking, spicy foods, hot drinks, and alcohol may cause flushing and should be minimised. Exposure to sunlight and to extreme hot and cold temperatures should be limited as much as possible. Red wine and chocolate are two well-known rosacea triggers. Individual reaction patterns vary greatly in rosacea. Therefore, a food diary may help to elucidate your special triggers

References
https://www.rosacea.org/rr/2001/winter/article_2.php

Elham
Clinic manager
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