Rosacea Treatment
Rosacea treatment success hinges upon proper skin care, avoiding trigger factors and utilising clinically proven medical therapies. Rosacea is a chronic condition where symptoms start with flushing and redness. Rosacea can lead to anxiety, low self-esteem and can negatively affect your quality of life. Rosacea is a condition that can be treated and controlled with early diagnosis.
What Is Rosacea?
Rosacea is a chronic inflammatory disease that affects mainly the forehead, nose, cheeks and chin. You may experience inflammed red bumps, visible small blood vessels and episodic flushing. It may lead to a thickening of the nasal skin and commonly involves ocular symptoms.
Who Gets Rosacea?
Rosacea usually begins from the ages of 30-50 years and is typified by episodes of flares and remissions. Women are characteristically affected more than men. Although it is common in fair skin individuals of Celtic origin, it is not an uncommon occurence in fair skin Asian individuals as well.
What Does Rosacea Look Like?
The National Rosacea Society Expert Committee has classified rosacea into 4 subtypes:
- Erythematotelangiectatic Rosacea: Flushing with persistent central facial redness
- Papulopustular Rosacea: Central facial redness with papules, pustules with or without burning sensation
- Phymatous Rosacea: Thickened, irregular skin nodularities
- Ocular Rosacea: Watery, blood-shot eyes, burning sensation, light sensitivity and blurred vision
Affecting mainly the central region of the face, rosacea can appear as inflammed papules, pustules, telangiectasia (small visible blood vessels) and skin redness that may be persistent or transient (flushing). You may also notice the skin to be dry, sensitive and stinging as the skin barrier is disrupted. Eye-related symptoms include irritation, redness, dryness, tearing and light sensitivity. Indeed, rosacea may progress from one subtype to another with periods of exacerbations and remissions in between.
What Causes Rosacea?
The exact cause of rosacea remains unknown. It is possible that multiple factors are at play. These include genetic factors, dysregulation of the immune system, vascular and neuronal dysfunction as well as the involvement of the Demodex folliculorum (tiny mites that reside in your hair follicles).
Diagnosing Rosacea
Most cases of rosacea can be diagnosed based the clinical history and examination findings. While it can be confused with acne vulgaris, the latter is associated with the presence of comedomes. It may overlap with eczema as the skin barrier is disrupted leading to dry and itchy skin.
What can Trigger Rosacea?
- Sun exposure
- Stress
- Spicy Foods
- Hot drinks
- Heavy Exercise
- Caffeine
- Alcohol
- Hot showers or Hot Baths
- Hot or Cold weather
- Humidity
- Skin care products and cosmetics
Most people with rosacea feel that their symptoms are not well-controlled. As rosacea is a chronic condition with the potential for skin scarring, early treatment and maintenance therapy is essential. The best rosacea treatment plan is one that is designed for sensitive rosacea skin in mind.
Rosacea Treatment
Rosacea treatment options would depend upon the severity of your condition, the rosacea subgroup and your skin type.
Generally, use of cosmetics (e.g. exfoliants, sodium lauryl sulphate, glycolic acid) that can irritate the skin are to be avoided. A gentle moisturizer to repair the skin barrier is encouraged.
As sun exposure is a major trigger factor, physical sunscreens containing zinc oxide and titanium dioxide are advised due to lesser risks of side effects. We advise a sunscreen of SPF 30-50 and PA +++ to protect against both UVA and UVB light.
Rosacea Treament For Facial Redness And Flushing
Facial redness is usually due to underlying inflammation and abnormal vasculature.
- Mirvaso gel, containing 0.5% Brimonidine is FDA-approved and clinically proven in studies to effectively reduce facial redness. The onset of effect is about 30 minutes, and results may last for up to 12 hours. Common side effects include redness, itchiness, burning sensation and rebound erythema.
- 1% Oxymetazoline hydrochloride cream
- Pulsed Dye Laser to improve appearance of erythema by targeting oxyhemoglobin in the skin.
Rosacea Treatment For Inflammatory Lesions
Recalcitrant Rosacea
- Low dose Oral Isotretinoin has shown to be effective.
- Side effects include dry lips, skin and eyes.
- Contraindicated in pregnant and breastfeeding women
Exposure to the sun, heat, high humidity, cold and wind may trigger rosacea.
As part of caring for rosacea skin type, use a sunscreen regularly with sensible sun protection measures using UV umbrellas, wearing long-sleeved clothing and staying away from intense sunlight. If the weather is cold and windy, protect your face with a scarf or balaclava. It’s important to use sunscreen in snowy conditions, because snow is reflective of UV light.
Certain medications can increase the blood vessel diameter and blood flow to your skin. Prolonged use to topical steroid creams not only causes skin thinning, but worsens your rosacea. A discussion with your doctor on the best treatment for your unique condition is advised.
Stress is inevitable in life. Some stress relieving methods include deep-breating exercises, meditation and stretching exercises. A well balanced diet, moderate exercise activity with periods of relaxation will go a long way.
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Related Information:
References:
- Two AM, Wu W, Gallo RL, Hata TR. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015 May. 72 (5):749-58; quiz 759-60.
- Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. 2005 May. 19(3):273-85.
- Lonne-Rahm S, Nordlind K, Edstrom DW, Ros AM, Berg M. Laser treatment of rosacea: a pathoetiological study. Arch Dermatol. 2004 Nov. 140(11):1345-9.
- Fowler J Jr, Jackson JM, Moore A, et al; Brimonidine Phase III Study Group. Efficacy and safety of once-daily brimonidine tartrate gel 0.5% for the treatment of moderate to severe facial erythema of rosacea: results of two randomized, double-blind, and vehicle-controlled pivotal studies. J Drugs Dermatol. 2013;12(6):650-656.
- van Zuuren EJ. Rosacea. New England Journal of Medicine. 2017 Nov 2;377(18):1754-64.
