Rosacea

What is rosacea?
A common skin condition, presenting as redness, sensitivity, flushing, prominent blood vessels, pimples and red bumps.

What makes it worse
Sun exposure, heat, spicy food, stress and alcohol

How to treat it?
Avoid triggers
Gentle skin care

Topical agents: niacinamide, azelaic acid, metronidazole cream or gel, ivermectin cream, brimonidine
Oral medication: oral antibiotics, low dose isotretinoin
Physical measures: intense pulsed light, vascular laser, ablative laser for rhinophyma

Example starting skincare regime
A gentle soap-free wash, avoid hot water directly on the skin and physical exfoliants.
AM: 5-10% niacinamide serum or cream, follow with a light moisturiser and SPF 50+ sunscreen.
PM: 15-20% azelaic acid, follow with a light moisturiser.

Rosacea is a very common condition, and can present on the skin in a variety of ways. Sun protection, avoiding triggers and gentle skin care are the cornerstone of treatment, with the addition of active skincare ingredients, oral medications and lasers for some. Rosacea is a chronic problem, meaning that maintenance treatment is usually required to keep it under control. Be encouraged though, in the right hands it is easily managed. 

What is rosacea? 

Rosacea is a common skin condition affecting the face. It tends to appear between the ages of 30 and 60, and is more common in women and those with fair skin and blue eyes. It can present as redness, flushing, prominent blood vessels, sensitive skin, red bumps and pimples. 

What makes rosacea worse?

Rosacea can be aggravated by sun exposure, heat, spicy food, stress and alcohol. The triggers aren’t the same for everyone, so if you have rosacea, it may be worth keeping a diary to see what flares up your skin.

What types of rosacea are there?

Erythrotelangiectatic rosacea: flushing, skin redness, prominent capillaries.

Papulopustular rosacea: red bumps and pimples.

Rhinophyma: thickening of the skin on the nose, more common in men. 

Ocular rosacea: red eyelid margins and a gritty sensation in the eyes. 

How can I treat my rosacea?

Avoid triggers

The first step in treating rosacea involves avoiding things that are known to make it worse. These include sun exposure, heat, spicy food, alcohol and topical corticosteroids. SPF 50+ sunscreen should be worn daily, even if it’s a cloudy day and you’re inside. Ultraviolet rays can penetrate window glass, which can aggravate rosacea.

Gentle skin care

Use lukewarm (not hot) water to cleanse the skin, and avoid harsh soaps and surfactants. Avoid all physical exfoliants, and take care with chemical exfoliants which can aggravate rosacea in some people.

Topical measures 

Niacinamide and azelaic acid are two over the counter products which can help reduce the inflammation of rosacea, and are generally well tolerated. Metronidazole cream or gel and ivermectin cream are prescription products which can be very helpful. Topical brimonidine may temporarily reduce skin redness, but it can cause ‘rebound’ redness when the effect wears off.

Oral medications 

Oral antibiotics for several weeks to months and low dose isotretinoin may be recommended by your doctor for some cases of rosacea.

Physical treatments

Intense pulsed light and vascular lasers can be very effective in addressing the prominent blood vessels. Ablative lasers can help improve the appearance of rhinophyma.

References
Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018;7:F1000 Faculty Rev-1885. Published 2018 Dec 3.

Oge’ LK, Muncie HL, Phillips-Savoy AR. Rosacea: Diagnosis and Treatment. Am Fam Physician. 2015 Aug 1;92(3):187-96. 

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ABOUT THE AUTHOR

Dr-Julia-Rhodes

Spotlight on Skin was created by award-winning Melbourne-based dermatologist, Dr Julia Rhodes.

Julia knows first-hand how overwhelming the skincare world can be, and that’s with over 10 years of experience practicing dermatology. Given that even she gets overwhelmed, she appreciates how hard it can be for those of you without a scientific background to make sense of all the information available, and choose products that are right for your skin…