Rosacea

Rosacea, pronounced roh-zay-sha, is a skin condition which causes redness, flushing and spots (amongst other symptoms) on certain areas of the face including the forehead, chin and nose. The condition, which is thought to be caused by a variety of factors including blood vessel abnormalities, genetics and bacteria found in the digestive system, is often mistaken for acne and is sometimes referred to as acne rosacea despite the two having no links in terms of cause, effect or treatment.

It is thought that up to one in ten individuals suffer from rosacea, though for some it is so mild that the sufferer remains unaware. Rosacea can occur at any age, though onset is most common between the ages of 30 and 55 and it affects a higher percentage of females than it does males.

Rosacea symptoms

Generally rosacea is not painful or itchy but it can cause a slight burning sensation in the affected areas. The severity of the symptoms will vary from person to person and may include one or more of the following:

  • Eye symptoms – Eye symptoms actually occur in about half of rosacea cases though are often very mild and do not cause much discomfort. Those who are affected may experience sensitivity to light, dryness, burning, stinging, itching, inflammation of the eyelid or the sensation of having something inside the eye. If your vision becomes significantly impaired then you should visit your GP as soon as possible.
  • Facial flushing This is one of the most common of all the rosacea symptoms and for some sufferers is the only one they develop.
  • Redness – Red face and/or red cheeks with a similar appearance to that of sunburn are very common.
  • Spots – In some of the more severe cases sufferers may develop small spots known as papules and small cysts known as pustules on the face. It is these spots which often result in rosacea and acne being referred to as one of the same due to similarities in the appearance of both. However, both require different treatment.
  • Telangiectasia – These are very small blood vessels under the skin which are quite noticeable and prominent when they occur on the face.
  • Thickening of the skin – Rhinophyma, otherwise known as thickening of the skin, most commonly occurs around the nose area and results in the bulbous appearance of the affected area.

Whilst many people don't experience too much discomfort with rosacea, it's appearance can cause distress and embarrassment for suffers.

Rosacea causes

Experts have been unable to pinpoint the exact cause of rosacea but believe that it may be caused by a combination of factors including the following:

  • Blood vessel abnormalities – Abnormalities in the blood vessels are thought to be a contributing factor which could explain flushing, redness and viable blood vessels.
  • Demodex Follicularum – This is a tiny mite which usually lives harmlessly on human skin. Experts have found that higher numbers of the mites are found on people with rosacea though it is not known whether this is a cause or effect of the condition.
  • Genetics – Rosacea does often run in families though it is not know what genes are involved.
  • Helicobacter pylori bacteria- This bacteria can be found in the digestive system and it is thought that it could stimulate the production of a protein known as bradykinin, which can trigger the expansion of blood vessels.

Though experts are yet to find a way of identifying and eliminating the cause or causes of rosacea, sufferers may notice that certain triggers make their symptoms worse, and identifying and limiting exposure to these triggers may help to keep symptoms to a minimum. Different people will have different triggers but some of the most commonly reported include the following:

  • acute medical conditions such as a fever or cold
  • alcohol
  • caffeine
  • chronic medical conditions such as high blood pressure
  • cold weather
  • dairy products
  • exposure to wind
  • hot baths
  • hot weather
  • humidity
  • overuse of steroid cream
  • spicy foods
  • strenuous exercise
  • stress
  • sun damage/ exposure.

Rosacea diagnosis

Usually a rosacea diagnosis will be based solely on your symptoms and the appearance of your face. In some rare cases your GP may require a blood test so that they can rule out any other issues which may cause redness of the skin.

Treatment

Experts are yet to discover a way to cure rosacea but there are a series of treatments which can be used to keep symptoms under control and to a minimum. There are a various options available to sufferers and the treatment chosen will really be dependent on what the key symptoms the individual is experiencing. Some people may find that they have to alter their treatment plan from time to time as a result of worsening symptoms, or because they are no longer responding to the treatment. Some of the most common remedies can be found below:

Acne medication

Though rosacea is not a form of acne in some cases GPs may prescribe acne treatments such as Tretinoin or Adapalene. In cases of severe rosacea which has shown a resistance to other treatments, doctors may prescribe a very strong medication known as Isotretinoin (Accutane), which is usually used to treat a severe but common form of acne called acne vulgaris. It is taken in the form of daily capsules for four to sixth months and close monitoring and blood testing may be necessary for some patients. For women, birth control is a must when taking this medication as it has been linked to a higher risk of miscarriage and congenital malformations such as facial and nervous system defects.

Cleansers

In addition to topical creams, cleansers which can be bought from chemists and supermarkets can provide a great deal of symptom control for some individuals. Experts warn against any harsh products and instead recommend simple and pure, gentle cleansers which will not cause irritation. Some dermatologists also recommend sulfa-based washes and benzoyl peroxide based washes.

Glycolic peels

Glycolic acid peels may help to improve and control symptoms in some individuals. The peels should be applied professionally for between two and five minutes every two to four weeks.

Laser/light therapy

Laser and light therapies tend to be used to treat the facial redness and visible blood vessels associated with rosacea as opposed to the pimples and bumps which are also a common symptom. Though there is very little evidence which proves the efficacy of these types of therapy, many sufferers have found that the treatment has had extremely positive and side effect free results.

Oral antibiotics

This option is usually prescribed to patients who are suffering from moderate rosacea. Most forms are to be taken once a day and are aimed at reducing inflammation and pimples.

Photodynamic therapy

This therapy is commonly used to treat pre-cancers and acne vulgaris but is now often used to treat rosacea. Treatment involves the use of a photosensitizing agent (often a gel which is spread on the skin) and a particular type of light. When the photosensitizing agent is exposed to a specific wavelength of light, they produce a form of oxygen which kills nearby cells.

Sun protection

Sun exposure is one of the most common triggers of rosacea so it is really important that sufferers make every effort to protect their skin. Rosacea occurs more commonly among fair skinned adults so use of an overall daily sunscreen which contains Zinc and is no lower than SPF 30 is recommended.

Topical creams

Topical cream or gel will usually be recommended as the first treatment option for those suffering from mild rosacea. They can help to unblock pores and reduce inflammation but some of the stronger forms can cause skin irritation.

Though the treatments detailed above can be extremely beneficial for rosacea sufferers, most of them are aimed at reducing the severity of the symptoms and not at preventing or limiting them in the first place. As the actual cause is unknown it is difficult to prevent rosacea, though many individuals do choose to make changes to their diet so that food triggers can be limited.

Though there is little scientific research to support the idea that certain foods can cause rosacea symptoms to worsen or flare-up, many sufferers have found that eliminating certain foods from their diet or changing their nutritional intake helps to keep their rosacea under control.

Whilst there are many dietary triggers for sufferers and they will vary from person to person, alcohol and spicy foods are among the two most commonly reported, and individuals who have cut these out of their diet often find that flare ups are significantly reduced. Other common food triggers include the following:

  • chocolate
  • citrus fruits, including tomatoes, bananas, red plums, raisins, or figs
  • dairy such as yogurt and cheese
  • aubergines, avocados, spinach
  • some beans and pods, including lima, navy or peas
  • soy sauce
  • yeast extract.

Individuals who do decide to make changes to their diet and lifestyle often find that they struggle to maintain a good nutritional balance. Removing certain food groups such as dairy or citrus fruits may result in withdrawal symptoms and in some cases could lead to nutritional deficiencies if the changes are not executed correctly.

Those who do not feel confident about implementing changes independently may benefit from the expertise of a qualified nutritionist, who will ensure that whilst some foods are removed they will be substituted with another. As well as providing you with a personalised nutrition program, a nutritionist will also be there to monitor your progress and provide motivation and support.

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