Rosacea affects around one in ten people. There is no cure, there are things that can help. Helen Garston reports.
Most skin conditions tend to hit teenagers but rosacea most commonly strikes in your 30’s, just when you’re least expecting it. Twice as many women than men are affected but symptoms are generally more severe in the latter.
And according to the National Dermatology Society, it’s far more common than you’d expect affecting as many ten per cent of the UK population, making it far more common than most people think.
And it can cause considerable distress for some people. It often affects the middle third of the face- the cheeks and nose and may be mistaken in some cases for sunburn. It can cause flushing and red cheeks, broken blood vessels, pimples, and – more often in men than women, rhinophyma – an enlarged or bulbous nose. It can even affect the eyes, making them look red and swollen. (see subtypes below)
Because it sometimes causes pimples, it’s often mistaken for acne, but they aren’t related and it doesn’t cause scarring. It usually starts with a tendency to blush easily. Later, symptoms such as burning and stinging, redness, spots and broken small blood vessels in the skin can develop.
There is no cure but there are various different causes.
What exactly causes rosacea?
1. A little skin mite
Skin mites called demodex folliculorum are found on everyone’s skin and bizarrely, they emerge from our pores and crawl over our faces while we sleep. When the bug dies, it releases a bacteria called bacillus bacterium which triggers inflammation in rosacea sufferers who, it’s discovered, have particularly large numbers of these mites.
However, scientists don’t know if the mites are attracted to someone’s skin because of rosacea, or whether their presence in such numbers is the cause of rosacea.
Can anything be done?
Dr Emma Wedgeworth, consultant dermatologist, says: “It’s hard to say whether the mite contributes to the condition but they are found in larger numbers on the skin of rosacea sufferers.
“A new cream called topical ivermectin, which is thought to have activity against the demodex mite, is starting to look very promising.”
2. Abnormal blood vessels
Abnormal facial blood vessels may be a contributing factor in rosacea. One theory is that the blood vessels are more easily irritated than in most people which may explain the blushing and redness.
Sun damage may also be responsible for these abnormalities because it causes degeneration of the elastic tissue of the skin and the dilation of blood vessels.
Can anything be done?
Dr Wedgeworth says: “All sufferers should cover up in the sun or use a high factor sun screen. They should also avoid using harsh, irritating skincare products.”
Peptides are protein molecules that are found within the skin and recent research has shown certain triggers such as sunlight (UV light), alcohol (especially red wine), spicy food, heat, exercise, stress and cold weather can activate their production. It’s thought that increased levels of them may affect the immune system or nerves and blood vessels (neurovascular system) of the skin leading to dilation of blood vessels which makes the skin look red and inflamed.
Can anything be done?
Dr Wedgeworth says: “In rosacea skin there are higher than normal concentrations of inflammatory peptides called cathelicidins and matrix metalloproteases.
“This leads to opening up of the blood vessels which causes the redness and swelling, and the bumps which results in spots. For more severe cases, I prescribe oral antibiotics or even low dose isotretinoin (roaccutane).”
What other treatments are there?
According to the British Association of Dermatologists, it’s important to tease out which aspect of rosacea you are treating.
1.Spots: There are a number of creams such as topical antibiotics and azelaic acid.
2. Redness: This can also be successfully improved with laser treatment such as intense pulsed light (IPL) treatment.
Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers causes the blood vessels to shrink so they’re no longer visible, with minimal scarring or damage to the surrounding area.
3. Inflammation: In mild to moderate cases can be controlled with cream like metronidazole (an antibiotic and anti-protozoal mediation) and azelaic acid. It takes at least eight weeks for their effect to become evident.
Oral antibiotics can help with inflammation for severe rosacea. The most commonly used antibiotics belong to the tetracycline group and include tetracycline, oxytetracycline, doxycycline, lymecycline and minocycline.
- Do protect your skin every day with a sun block of at least factor 30.
- Do use an unperformed moisturiser regularly if your skin is dry or sensitive.
- Do try to learn what your triggers may be – alcohol, stress, heat, spicy food etc and avoid them. Keeping a written record of flare-ups may help.
And do nots…
- Do not rub or scrub your face as it can make rosacea worse.
- Do not use performed soap, instead use a soap substitute to cleanse your face.
- Do not use topical preparations containing corticosteroids, unless specifically recommended by your doctor, as these may make rosacea worse in the long run.
What are the subtypes?
There are four subtypes.
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 associated with thickening of the skin of your nose. It usually affects men and is often accompanied by other subtypes of rosacea.
Subtype four is ocular rosacea, and its symptoms are in the eye area. This is a potentially serious condition which, if left untreated, can cause damage to vision. People with dry, irritated and bloodshot eyes and inflammation of the eyelids should see their GP immediately.
For more information contact:
- British Association of Dermatologists www.bad.org.uk
- The National Rosacea Society rosacea.org (an American organisation which is recommended by the NHS).