Rosacea treatment

What is roasacea?

This is a facial skin condition that presents in various ways. Most commonly patients complain of persistent facial flushing, skin dryness and sensitivity, prominent thread veins, often papules and less commonly pustules. The skin flushing may be triggered by a change in temperature, emotional stimuli and sometimes it is noticed after drinking alcohol or eating certain (often spicy) foods. There is a commonly held myth that rosacea is related to excessive alcohol intake. That is not true. As rosacea seems to affect patients most commonly with fair skin it is likely that rosacea is a response to sun damage. Increasingly we are aware that sun exposure , pollution, stress, intrinsic ageing amongst other issues damage our skin barrier. As a consequence the skin is often more sensitive , dry and inflamed. I believe that one of the key components of managing rosacea is to aim to calm the skin and attempt to repair the skin barrier

What should I avoid?

Unless you feel there is a definite trigger between a food eaten, or an activity, I wouldn’t suggest making any changes of that nature. Wearing a sun block and using a gentle cleanser that has a pH close to normal skin is a good idea as it is very tolerable on vulnerable inflamed skin. A gentle moisturiser is also important if the skin is red and scaly. This will help to repair and protect the damaged skin barrier and reduce further irritation. There is a lot of interest now in what is referred to as the gut-skin axis. Changes in gut flora and inflammation seem to have an effect on the skin.

Are there different types of rosacea?

Yes. 80% of patients have erythemato-telangiectatic rosacea. This is manifest with prolonged facial flushing often resulting in persistant facial erythema( redness) dryness and increased sensitivity. Choosing a gentle cleanser and moisturiser is important as a mainstay here. Sometimes light treatments such as intense pulsed light (IPL) may reduce the redness and help symptomatically. These patients also often have ocular rosacea that presents with red, dry gritty eyes. This can be helped with lubricant eye-drops, I recommend Hylo-Tears Forte. Antibiotics may also help. Some patients have papules and pustules as well as a background skin redness. This can be very distressing for patients. A topical antibiotic treatment can be useful for this.I recommend anti-biotic creams rather than gels in general as they are better tolerated by sensitive skin. Newer treatments include topical azelaic acid which can help. Recently there have been studies supporting the use of topical Ivermectin in this condition which effectively reduces demodex mites in the skin which have been implicated in rosacea.Oral antibiotics eg a tetracycline may be prescribed again for 3-6 months often with significant improvement.

Finally the biggest fear in most rosacea patients is that they are going to develop a large red, sometimes warty nose, known as a rhinophyma. This is a rare and quite separate manifestation of rosacea. It is very uncommon in women and treatable. Sometimes a low dose vitamin A medication (Isotretinoin) can be given in the early stages to reduce down the sebaceous (oil producing) glands in the nose. An established rhinophyma can be treated surgically, often with very good results.