Rosacea

How can our skin specialists help to treat rosacea?

Rosacea is very common and can be successfully managed. Our dermatologists have years of experience treating all types of rosacea. Our strength lies in being able to treat all aspects of rosacea – from skin care advice to prescription medications for control of the red bumps (papules and pustules), and lasers to manage the redness, capillaries and flushing.

Having rosacea can be embarrassing and erode confidence and self esteem. Take heart, though, because it is manageable and treatable!

Importantly, rosacea can often co-exist with other conditions such as acne, seborrhoeic dermatitis and sun damage. Our expertise and experience allows us to recognise and treat these problems too getting you the best possible results.

What is rosacea?

Rosacea is marked by redness and flushing of the face with or without red bumps and pimple like lesions. Visible blood vessels (capillaries) can develop over time causing persistent redness. The skin is often sensitive and easily irritated.

The exact cause of rosacea is still not fully understood.

The most likely people to develop rosacea have an English or Irish background, although it’s possible to get it even if your family genes are not Celtic or Northern European. Many rosacea sufferers are fair skinned, particularly women between the ages of 30 and 50, although rosacea also affects men and occasionally even teens. Researchers do not know why women get rosacea more often than men, and some cases have been associated with menopause.

The key to successful management of rosacea is early diagnosis and treatment.

What are the signs and symptoms of rosacea?

Common signs and symptoms include:

  • Redness across the cheeks and nose which can spread to the chin and forehead
  • A tendency to flush or blush
  • Acne-like breakouts with red bumps and pustules. Unlike acne, there are no blackheads
  • Swelling across the bridge of the nose and into the cheeks, forehead, and chin
  • Skin with is sensitive and easily irritated
  • Thin red/purple veins which become visible on the skin (capillaries/telangiectasia)
  • About 50% of patients with rosacea have eye symptoms. Many experience some burning and grittiness of the eye (conjunctivitis) or inflammation and swelling of the eyelid areas

For some people, rosacea can become worse over time. Initially the redness can come and go and many people don’t realise they have it. After a while the skin can become more permanently hot tender and red. Skin sensitivity burning and stinging are very common.

In more advanced cases of rosacea, a condition called rhinophyma may develop. The oil glands and the blood vessels on the nose enlarge so much that the nose becomes very bulbous in appearance. Thick bumps can develop on the nose and may require laser or surgery to treat. This tends to develop more often in men. Rosacea suffers can often be unfairly labeled as alcoholics because of these skin changes Unfortunately these skin changes are often incorrectly associated with alcoholism.

What are the different types of rosacea?

Rosacea has four subtypes:

  • Erythematotelangiectatic rosacea Redness, flushing, visible blood vessels
  • Papulopustular rosacea: Redness, swelling, and acne-like breakouts
  • Phymatous rosacea: Skin thickens and has a bumpy texture
  • Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty

I flush and blush easily, does that mean I have rosacea?

Just because you flush, it doesn’t mean you have rosacea or will get it but almost everyone who goes on to get rosacea has a history of flushing and blushing. Many of us flush and blush, especially with exercise, heat, and stressful situations. People with or prone to rosacea start to flush more and more frequently and with more triggers. The redness doesn’t seem to go away as easily and is a more permanent flush. If you’re not sure, you can make an appointment to see one of our therapists or dermatologists who can help.

What triggers Rosacea?

There are a number of rosacea triggers. These differ between people, so you might need to do some detective work to figure out what causes your skin to flare up. Triggers can be unique to each individual, but some of the more common reasons include:

  • Alcohol – especially red wine, beer, bourbon, gin, vodka, or champagne. You may need to experiment with different types. Occasionally it is the sulfites in the wine that are the problem. Try a sulfite free wine
  • Heat from saunas or hot tubs, sun and strong winds
  • Exercise
  • Coffee or other hot drinks
  • Foods such as dairy products, chocolate, soy products, vegetables especially eggplants, tomatoes and beans, fruits including avocados, bananas and citrus fruits, hot and spicy foods. You may need to keep a food diary to work out which (if any) foods cause you problems
  • Skin care products (particularly sprays containing alcohol, fragrances or witch hazel) also stronger “anti-ageing” ingredients such as tretinoin (Vitamin A) and AHA’s (alpha hydroxyl acids) can be irritating
  • Prescription topical steroid creams. Initially these can help reduce redness but will make rosacea much worse if used continuously
  • Sun and weather. Extremes of hot and cold weather can aggravate rosacea. Make sure you are very careful with sun protection
  • Emotional influences. Stress and anxiety can certainly be an aggravating factor for some people

The little things that you do every day really do make a difference to help control your rosacea over the long term.

How can rosacea be treated?

We’re all individuals, so there may be variations in rosacea treatment depending on your particular needs. In general, there are three key areas to consider when treating rosacea.

Repairing the skin barrier function to improve the sensitivity
Using the correct skincare, and being careful everyday with your sun protection, is vital to protecting your skin and controlling the flares. We can help guide you with straightforward skincare advise if you need help. Lifestyle factors are important here too.

Controlling the inflammation (acne like red bumps and papules)

  • Non-Prescription Creams
    • Azeleic acid (Finacea)
  • Prescription Creams
    • Metronizazole gel or cream (Rozex)
    • Brimonidine (Mirvaso)
    • Permethrin (Soolantra)
  • Oral Antibiotics (Doxycycline/Minocycline/Metronidazole/Azithromycin and others)
  • Isotretinoin
    • Accutane/Oratane/Roaccutane

Clearing the redness and capillaries
In our experience vascular laser (Candela V beam pulsed dye laser) is a very important tool for managing rosacea long term. Once your rosacea is treated and under control, you may want to consider having treatment with our V beam laser to reduce the remaining redness and/or dilated blood vessels. Many people find maintenance laser treatment everyone to two years is an excellent way to keep their redness and capillaries under control and to keep their skin in great shape.

When is it worth considering laser treatment for rosacea?

  • If your flushing is bad enough that it is interfering with your work or social life
  • If people constantly ask you if you are sunburnt or worse, you’ve had people assume that you’re a heavy drinker because your nose and cheeks are red
  • If you notice your face always looks red in photographs
  • If you feel you need to pile on the make-up in the morning just to feel presentable for work or play
  • If you have a strong family history of rosacea, and you know you’re probably going to get worse over the next several years

What are the rosacea dos and don'ts?

What to do

  • Use soap-free cleansers and remove with a wet cotton pad
  • Apply beauty products gently with your fingers
  • Choose sunscreens that protect against ultraviolet A and ultraviolet B light
  • “Physical blockers” (titanium dioxide and zinc oxide) are best tolerated
  • Cosmetics and sunscreens should contain protective silicones (dimethicone or cyclomethicone)
  • Choose a light foundation that is easy to spread and can be set with powder (foundations containing ultraviolet A–ultraviolet B sunscreen are encouraged)
  • Use green-tinted makeup or sunscreen to provide extra coverage for red areas
  • Avoid waterproof cosmetics and heavy foundations that are harder to apply and remove without irritating solvents

Consider laser to treat the flushing and redness

What NOT to do

  • Wash your face in the shower under the hot water stream
  • Rub your face with face cloths or towels
  • Use harsh products such as toners, exfoliants, masks, chemical peels, scrubs
  • Use products containing – acetone, alcohol or benzoyl peroxide
  • Use heavy cream moisturisers if your skin is oily, look for serums or lotions
  • Get regular facials or undergo facial steaming or microdermabrasion
  • Experiment with anti-ageing products
  • Deviate from your skin care regime

Maintenance

  • Stick to a simple routine
  • Keep away from the irritants
  • Use prescribed topical products to control flares
  • Consider introducing topical retinoids when settled to rebuild the dermis
  • Consider products containing niacinamide