ROSACEA

Rosacea is a common skin condition affecting around 5% of adults. It is a type of inflammatory skin disorder characterized by sensitivity of the skin and a red face that flushes, itches, and burns. It typically emerges between the ages of 30 and 60 and is a common cause of persistent facial redness. In its initial stages, rosacea tends to be intermittent, with symptoms like flushing, redness, and pustules resembling pimples. It is more common in patients with fair skin, and detecting rosacea in darker skin tones can sometimes be challenging.

The Science

Rosacea is a chronic inflammatory skin condition that primarily affects the central areas of the face. It is believed to be caused by a combination of genetic, environmental, vascular, and immune factors. Here are some key aspects of its development:

Genetics: There is a genetic predisposition to rosacea, with certain genetic markers often found in people with the condition
Vascular Factors: Rosacea involves a sudden dilation of arterioles, increasing blood volume in the capillaries. This rapid expansion causes a sensation of heat, burning, and itching, resulting in a ‘ruddy complexion’
Immune Response: An overactive immune system, particularly involving the protein cathelicidin, can lead to inflammation and the red, swollen skin typical of rosacea
Microbiome: The skin microbiome, including bacteria like Staphylococcus epidermidis and mites like Demodex folliculorum, plays a role in rosacea. An overpopulation of these mites can trigger immune responses, leading to inflammation. Disturbances in the gut microbiome, such as SIBO (small intestinal bacterial overgrowth), can also trigger flare-ups, suggesting an interaction between the gut and skin in rosacea
Environmental Triggers: Sun exposure, heat, spicy foods, alcohol, and other factors can exacerbate rosacea by affecting blood vessels and skin responses
Hormones: Hormonal changes, such as fluctuations in estrogen and testosterone, can influence rosacea symptoms. Women may experience more flare-ups due to estrogen levels, while testosterone may affect men differently

Clinical Features

Signs and Symptoms

Rosacea often starts with mild symptoms that gradually worsen. Here are the key signs and symptoms:

Early Signs:

Redness that comes and goes.

Redness in photos.

Flushing with emotions or exercise.

Hot, itchy, and red face during certain activities or after consuming alcohol or spicy foods.

Progressive Symptoms

Persistent redness in the central face, including the cheeks, nose, chin, and forehead.

Visible blood vessels (telangiectasia) and broken capillaries.

Bumps and pimples (papules and pustules).

Burning, stinging, and itching sensations.

Skin that feels dry, rough, or swollen.

Severe Symptoms:

Thickening of the skin, particularly around the nose (rhinophyma).

Ocular rosacea, affecting the eyes with dryness, irritation, and swollen, red eyelids.

Triggers

Various factors can trigger or worsen rosacea symptoms. Understanding and avoiding these triggers can help manage the condition. Common triggers include:

Environmental Factors: Sun exposure, wind, hot weather, and extreme temperatures.
Lifestyle Factors: Stress, alcohol consumption, spicy foods, hot drinks, and intense exercise.
Skincare Products: Certain ingredients can irritate sensitive skin, including alcohol, fragrances, menthol, and chemical sunscreens.
Medications: Some medications, such as corticosteroids, can exacerbate rosacea symptoms.
Hormonal Changes: Fluctuations in hormones due to menstrual cycles, pregnancy, or menopause.

Dr May's Opinion

Managing rosacea requires a comprehensive approach, including avoiding triggers, using appropriate skincare products, and seeking professional treatments when necessary. By understanding the causes and symptoms of rosacea, you can make informed decisions to manage this condition effectively and maintain healthy, radiant skin.

Solutions

Effective rosacea treatment often involves a combination of lifestyle changes, skincare, and medical treatments. Here are some in-clinic options from the Marr Clinic:

Other Treatments and Strategies

Other strategies include:

Use of Medications:

Topical Treatments: Metronidazole, azelaic acid, and ivermectin can reduce inflammation and bumps.

Oral Antibiotics: Doxycycline or minocycline can help with moderate to severe rosacea.

Beta Blockers: These can help reduce flushing.

Use of Advanced Treatments:

Brimonidine: A topical gel that can reduce persistent redness by constricting blood vessels.
Isotretinoin: An oral retinoid used for severe cases with significant pustules and papules.

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