What is Rosacea?
Rosacea is a chronic rash involving the central face that most often affects those aged 30 to 60. It is more common in women than in men, and in those with a fair skin who flush easily. those with fairer skin, blue eyes and Celtic origins. It may be transient, recurrent or persistent and is characterised by its colour, red.
A tendency to flush easily is followed by persistent redness on the cheeks, chin, forehead and nose, and by crops of small inflamed red bumps and pus spots.
What are the different types/stages of Rosacea?
- Mild papules and erythema
- Moderate papules and early pustules
- Severe erythema, papules and pustules
- Inflammatory papules
- Advanced rhinophyma
What are the possible causes of Rosacea?
The cause of rosacea is not fully understood, but many think that the defect lies in the blood vessels in the skin of the face, which dilate too easily in response to an inflammatory stimulus. This stimulus maybe different for different people.
Many things seem to make rosacea worse, but probably do not cause it in the first place. They include alcohol, too much exercise, both high and low temperatures, hot spicy foods, stress, and sunlight. Things that stir up one person’s rosacea may well have no effect at all on the rosacea of someone else. The idea that rosacea is due to germs in the skin, or in the bowel, has not been proved.
Rosacea is not contagious.
There are several theories regarding the cause of rosacea, including genetic, environmental, vascular and inflammatory factors. Skin damage due to chronic exposure to ultraviolet radiation plays a part.
The skin’s innate immune response appears to be important, as high concentrations of antimicrobial peptides such as cathelicidins have been observed in rosacea. Cathelicidins are part of the skin’s normal defence against microbes. Cathelicidins promote infiltration of neutrophils in the dermis and dilation of blood vessels. Neutrophils release nitric acid also promoting vasodilation. Fluid leaks out of these dilated blood vessels causing swelling (oedema); and proinflammatory cytokines leak into the dermis, increasing the inflammation.
What does rosacea look like?
Mild Rosacea starts with a tendency to blush and flush easily.
After a while, the central areas of the face become a deeper shade of red and end up staying this colour all the time. The area becomes studded with small red bumps (papules) and pus spots, which come and go in crops. Small dilated blood vessels (telangiectasia) appear, looking like thin red streaks. Scarring is seldom a problem. Other problems with rosacea include the following
- Rosacea can lead to embarrassment, anxiety, or depression, and a disrupted social life
- The face may swell (lymphoedema), especially around the eyes.
- Some people with rosacea have eye symptoms (red, itchy, sore eyes and eyelids; a gritty feeling; sensitivity to light). A few patients with rosacea have more serious eye problems, such as rosacea keratitis, that can interfere with vision.
- The nose may grow big, red and bulbous (rhinophyma) due to the overgrowth of the sebaceous glands. This is more common in men than women
How will rosacea be diagnosed?
Your doctor will recognise rosacea just by looking at your skin. There are no diagnostic laboratory tests. Rosacea differs from acne in that the skin is not extra-greasy; blackheads and scarring are not features; flushing is common; and there is a background of red skin.
What are the treatment options availabe for rosacea?
- Reduce factors that can causing facial flushing
- Check for food sensitivities. At 23MD, we provide Alcat blood testing services for this. Alcat tests can be used to check up to 300 types of food that you may be silently inflaming your skin and manifesting as rosacea.
- Check and maintain your hormone balance with bio-udentical hormones. At 23MD, Dr Galy can measure and rebalance hormone disturbances.
- Avoid oil-based facial creams. Use water-based make-up.
- Never apply a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased production of nitric oxide).
- Protect yourself from the sun. Use light oil-free facial sunscreens.
- Keep your face cool to reduce flushing: minimise your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms if necessary.
- Topical treatment of rosacea
- Azelaic acid cream or lotion is also effective for mild inflammatory rosacea, applied twice daily to affected areas.
- Antibiotics like Metronidazole cream or gel can be used intermittently or long-term on its own for mild inflammatory rosacea and in combination with oral antibiotics for more severe cases. It is uncertain if the positive effects of this result from the antibiotics component to the anti-inflammatory component of these medicines
- Vascular laser or IPL
- Persistent telangiectasia can be successfully improved with vascular laser or intense pulsed light treatment.
Please contact us here to make an appointment for your assessment.