How do I know if I have rosacea?

Rosacea should be diagnosed by a GP or dermatologist. It is a condition which leads to reddening and sensitivity of skin, with increased flushing and sometimes visible thready blood vessels in the areas of the cheeks, forehead, nose and chin. There are also often red pimples/papules which can develop into inflamed pustules in severe cases.

What causes rosacea?

That is not an easy question to answer, as the exact cause of rosacea still remains unknown. Various genetic, immune system, and environmental causes, are all thought to play a part.

There is some genetic susceptibility with an association with fair complexion and blue eyes. There are links to certain skin microbes (demodex mites and staphylococcus epidermidis) and with the Helicobacter pylori bacteria being present in the gut.

Neurocutaneous mechanisms (brain/skin links) triggered by skin reactions to UV light, temperature change, exercise, spicy foods, alcohol, psychological stress, air pollution, and tobacco smoking are also thought to play a role.

There are changes in the skin barrier function and recent research suggests that an altered immune response within the skin is also involved. Disturbances of blood flow to the skin and chronic inflammation may also be factors. In rosacea, white blood cells release vasodilators which cause the visible blood vessels and the redness.

It may be that all these different factors feed into one, as yet, unknown process, but it seems that UV light radiation from the sun or sunbeds is the most significant trigger.

How common is rosacea?

Rosacea is thought to affect around 5% of the worldwide population. It is more common in less pigmented skin, but can be found across all skin types. Rosacea may be present in up to 1 in 10 Caucasians, but most of these cases will be mild. About 14% of Caucasian women have rosacea and about 5% of men. The more severe cases of rosacea, including rhinophyma, tend to be in men.

I had bad acne in my teens - will I develop rosacea in later life?

No. Although rosacea is sometimes called acne rosacea, this is a misleading name. Rosacea is not a type of acne and is not linked to acne. In rosacea there are no black heads, or the infected nodules found in severe acne. Instead there are inflammatory papules and pustules, associated with redness, flushing and dilated blood vessels (telangiectasia).

At what age does rosacea develop?

Rosacea is most likely to develop between the ages of 30 and 60. But cases have been seen in children and younger adults.

Are there different types of rosacea?

Doctors sometimes divide rosacea into four subtypes, but most people overlap the groups. They are:

• Erythematotelangiectatic – skin redness and thread veins.
• Papulopustular – pimples, papules and pustules.
• Phymatous - thickening and swelling especially of the nose (rhinophyma).
• Ocular – eye symptoms.

Is rosacea hereditary?

As mentioned above, people of fair skin seem to be more likely to be affected, and skin type tends to run in families, as can rosacea. It is not directly inherited though, and it is not possible to predict who in a family may be affected.

Is rosacea hormone related?

There is no research supporting a link between rosacea and hormones. However menopausal flushes can contribute to symptoms. And some women feel that it is worse at different times of their menstrual cycle.

Does rosacea go away with age?

Unfortunately no, rosacea is mainly a condition of middle and older life, and is a long-term condition, although it tends to fluctuate, with alternating periods of being more settled and flare-ups.

Does rosacea get better on its own?

With no treatment it is likely that the rosacea will worsen over time, with more permanent redness, spider veins, and papules and pimples.

Is rosacea infectious?

No, theories regarding the cause of rosacea include reaction to microbes, but the rash does not spread via touch. Antibiotic treatment is thought to be effective due to its anti-inflammatory properties rather than because of its antibacterial properties.

Can diet help with rosacea?

A lot of people find that things that cause facial flushing, including alcohol and spicy foods, worsen the redness. Avoiding these can help. Some people do find certain diets to be of benefit. There is no evidence that this is true for most rosacea sufferers, but if this interests you, you may like to read Brady Barrow's Rosacea Diet.

What are common triggers?

Alcohol, spices, sun, heat, stress, hot or cold weather, wind, exertion, hot baths, hot drinks, and applying steroid creams or ointments.

What can I do to help my rosacea?

You can avoid triggers, which are usually things that cause flushing. These may vary from person to person. Keeping a symptom diary may help to work out what your triggers are. Triggers may include skin care products - particularly if oily. Rosacea sufferers have a degree of inflamed skin, so skin is likely to be sensitive. Be careful what you apply and stop using any products that irritate your skin. Wearing a water based sunscreen is advised, especially if sun exposure noticeably worsens your symptoms. The UK's National Institute for Health and Care Excellence recommends Uvistat and Sunsense.

Does drinking water help rosacea?

Drinking water helps to keep skin hydrated but it is unlikely to make a significant difference to the main symptoms of rosacea.

How should I wash my face if I have rosacea?

It is important not to further irritate your skin with soap, strong cleansers, and rubbing or scrubbing. Use a mild, unperfumed soap substitute (emollient), and apply gently with finger tips. Rinse with lukewarm (not hot) water.

What skin products/make-up can I use with rosacea?

Avoid greasy products and perfumed products. Choose those for sensitive skin and use as sparingly as possible. If a product stings or causes dryness or irritation then do not continue to use. Some foundation is formulated with a greenish tinge which tends to disguise redness. Eucerin and Clinique both have a range of anti-redness facial skin products.

Which sun screen should I use?

One that does not aggravate your skin, as sunscreen itself may cause irritation. These tend to be chemical sunscreens (that soak in nicely but work by chemicals absorbing the light) rather than physical ones. Look for the ingredients Zinc oxide or titanium dioxide, as these reflect away the harmful rays without being absorbed into the skin, and are therefore less likely to cause irritation.

The UK's National Institute for Health and Care Excellence recommends Uvistat and Sunsense.

Do steroid creams help rosacea?

No. Steroids are used to treat many skin conditions but they actually make rosacea worse, despite initially appearing to help. They should NOT be used.

Can steroid tablets cause rosacea?

Yes. Steroid tablets and some other medications are linked with triggering rosacea.

Is rosacea curable?

Rosacea is treatable rather than curable. Symptoms can usually be controlled with topical or oral medications such as Mirvaso, Soolantra, Rozex, and Efracea.

How do I choose which treatment to use?

There are many different treatments for rosacea and it can be confusing to decide which is best for you.

Dr Fox prescribes 4 different treatments to use depending on the main symptoms and severity.

• Flushing/redness – Mirvaso (brimonidine) applied once daily lasts 12 hours.
• Mild-to-moderate papules and/or pustules - Soolantra (ivermectin) applied once daily, or Rozex (metronidazole antibiotic) applied twice daily.
• Moderate to severe papules and/or pustules - in addition to topical treatments, add-in Efracea (doxycycline 40mg) capsules daily for 8-16 weeks.

Efracea capsules should only be used in moderate to severe rosacea, after a trial of a topical treatment (applied to skin). The capsules contain an anti-inflammatory dose of doxycycline and can improve rosacea in more than 80% of patients.

How long will I need treatment?

Rosacea is generally a long-term recurring condition. In some people treatment settles the symptoms quickly and for a long period, but others may need repeated treatments, or may need to try different treatments. Some people may need to treat almost continuously.

Will the cream/gel become less effective over time?

Rosacea is a condition which comes and goes. The creams and gels should not become any less effective but the rosacea flare-ups may sometimes be worse.

I take other medications - can I use rosacea treatments?

There are a few interactions between some rosacea treatments and other medications. During the online consultation Dr Fox will check if the treatment is suitable for you.

Why prescribe antibiotics for rosacea?

Some antibiotics have been shown to help rosacea, but it is unclear why as bacteria do not cause rosacea. Efracea is used in a low dose which is anti-inflammatory rather than antibacterial. Rozex gel also helps but it is not clear exactly how. The doses of antibiotic prescribed by Dr Fox to treat rosacea are very low so there is a low risk of developing antibiotic resistance.

Are there any non medical treatment options?

Is rosacea linked to migraine?

People with rosacea are twice as likely to suffer with migraines as people without. A Swedish study found that in a rosacea group, 27% also had migraine, compared with 13% in the control group. Regulation of blood flow is likely to be a factor in both these conditions.

Can rosacea affect the eyes?

Ocular symptoms occur in 20-50% of rosacea cases. In most cases, it is mild but it can be more severe and in very severe cases can lead to keratitis (corneal inflammation and ulceration) which needs urgent specialist assessment.

What are the symptoms of ocular rosacea?

Eye dryness is an early sign. Later blockage of oil glands causes inflammation and crusting around the eyelashes. More severe symptoms include bloodshot/red eyes, eye irritation such as stinging, itchy, or gritty sensation. Light sensitivity can occur as can blurring of vision. Consult your GP or an optician if you develop severe eye symptoms.

How to treat ocular rosacea?

Mild cases can be managed yourself.

Eye care - keeping the eyelid margin (meibomian) glands unblocked and thus eyelids clean from crust - is important. This can be done by applying a warm water compress twice daily or by gently wiping with a cotton bud soaked in cooled boiled water. It may also be helpful to wear UV protection sun glasses. Your GP may prescribe artificial tears for dry eye and antibiotic tablets, as for facial rosacea, to ease the inflammation. More severe or persistent cases may be treated by an ophthalmologist.

Further information from Eyecare Trust.

Will stopping smoking help with rosacea?

No, probably not. Smoking is associated with a reduced risk of developing rosacea. Of course smoking is not generally beneficial to health.

Can rosacea cause disfigurement of the nose?

Yes in one rare type of rosacea called rhinophyma. This is more common in men. If the rhinophyma is very bulky and distressing, various surgical treatments can be used, including: cryotherapy, dermabrasion, dermaplaning, electrosurgery and laser resurfacing, (using CO2, Argon, Nd:YAG, or Er:YAG lasers). The treatments aim to remove the thickened bulky tissue and healthy skin slowly regrows over the treated area.

Is perioral dermatitis a form of rosacea?

There is debate amongst dermatologists about this. However there is a definite overlap of features and perioral dermatitis responds to the same treatments as rosacea. perioral dermatitis is most often triggered by use of steroid based medication or creams, and similarly rosacea can be triggered by steroid use. Sometimes people with perioral dermatitis go on to develop full rosacea.

Further information from the British Association of Dermatologists - Peri-oral dermatitis

Rosacea treatment