Rosacea

What is rosacea?

Rosacea is a long-term or chronic skin condition. It can also affect the eyes and causes red patches of skin and small spots to develop. Rosacea commonly concerns the face but it can affect other areas of the body, and in severe cases it can cause the skin to become thicker.

Who can develop rosacea?

Rosacea is most common in people aged between 30 and 60 years old. It tends to affect women more often than men and is most common among fair-skinned individuals. Rosacea is particularly common in women who are going through the menopause.

How does rosacea appear?

Rosacea can cause a range of symptoms, with the condition being characterised by red patches that develop on the skin. There are also various conditions connected to rosacea, including vascular rosacea, inflammatory rosacea and other conditions affecting the eyes, nose and skin.

During the first stages of rosacea symptoms include flushing around the centre of the face, which causes the forehead, chin, nose and cheeks to become red in colour. Some people also experience a burning sensation when their skin is flushed, which tends to get worse when cream or lotion is applied to the face. In some cases the face may also become swollen.

Vascular rosacea causes enduring spells of redness and flushing of the skin. It can also cause the blood vessels underneath the skin to become dilated, which appears through the skin as fine red lines (known as telangiectasia). The skin may also become swollen and warm.

Inflammatory rosacea can lead to continual flushing, as well as the formation of pustules (spots filled with pus) and papules (small red bumps on the skin). Inflammatory rosacea can cause the eyes to become swollen and more sensitive than usual and some people also experience telangiectasia.

In the advanced stages of rosacea the skin develops into a very dark red shade and the eyes become noticeably swollen. In most cases there are numerous telangiectasia (fine red lines that show through the skin), and the nodules that have developed on the skin can cause considerable discomfort. In some cases a condition known as rhinophyma can develop in men (it is very unusual in women). This condition causes the nose to become swollen, red and bulbous, and is caused by the sebaceous glands underneath the skin that cover the nose becoming inflamed. In severe cases advanced rosacea can also result in the skin becoming very thick.

How are the eyes affected?

Around 50% of people with rosacea also experience eye problems. Common symptoms include itchy eyes, redness and dryness, irritation, heightened sensitivity and feeling like you have sand in your eye. It is also possible for the eyelids to become swollen and many people become more sensitive to bright lights.

What are the causes of rosacea?

The reasons for rosacea are not fully understood. However, scientists and doctors think that a number of people inherit a propensity to develop the condition. People who are prone to blushing are more prone to developing rosacea and some people think that rosacea is caused by the blood vessels dilating too easily, which causes increased blood flow and subsequent redness and flushing.

Factors which have been associated with rosacea and may trigger symptoms include:

• Hot water (for example, having a bath).
• Exposure to sunlight.
• Cold temperatures.
• Exposure to wind.
• Exercise.
• Drinking alcohol.
• Eating spicy food.
• The menopause.
• Using topical steroids on the face.
• Emotional stress or anxiety.

In many cases factors that affect one individual will have no effect on another individual. Some people may assume that pustules are associated with bacteria in the skin. However, researchers haven't found a connection between bacteria and rosacea.

Is there a cure for rosacea?

There is currently no cure for rosacea, but there are treatments that can help to control and reduce symptoms. If you have rosacea it is likely that you will be referred to a skin specialist, known as a dermatologist. The aims of treatment are to reduce pain and discomfort and improve the look of the skin, which also helps to boost confidence and reduce the risk of anxiety and depression. It can take a number of weeks, even months, for the skin to show signs of improvement once a course of treatment has begun.

Some doctors recommend topical antibiotics for rosacea, which involves applying antibiotic cream directly onto the skin. In severe cases oral antibiotics may be prescribed. Examples of topical antibiotics include metronidazole, while oral antibiotics include doxycycline, minocycline, tetracycline and erythromycin. Antibiotic treatment usually clears up pustules and papules quickly but it can take much longer to ease other symptoms, including flushing and reddened skin.

A number of people who develop rosacea suffer from low levels of confidence and depression as a result of the alteration in their skin's appearance. This may also cause low self-esteem, anxiety and stress. Some people worry about going out in public and socialising, which can have very negative implications for their quality of life. If you suffer from confidence issues or you are worried about your condition, do not hesitate to see your doctor. They will be able to help you and may refer you for treatment, such as counselling. They can also provide contact details and information about relevant charities and support groups. Many people find it comforting to talk to people who also have rosacea so that they understand what they are going through, and online forums have made it easier to meet and communicate with people in the same situation.

Doctors normally treat eye problems with oral antibiotics, most commonly tetracycline and doxycycline. It is advisable for people who are prone to eye infections to keep their eyes clean in order to reduce the risk of infection. You may be advised to wipe your eyes using a warm cloth several times a day. In severe cases steroid eye drops may be prescribed.

If a patient has red lines on their skin, laser treatment may be beneficial to reduce the visibility of lines without a risk of scarring. Laser treatment can also be beneficial for patients suffering with rhinophyma (swelling and redness of the nose) and surgery may be recommended to remove the surplus tissue in the nose, which will decrease the size and improve the overall shape of the nose.